"Carlos Santander B." <csantander619@gmail.com> wrote in message news:cu9eh5$26nj$2@digitaldaemon.com...
> John Reimer wrote:
>> Walter wrote:
>>
>>> "John Reimer" <brk_6502@yahoo.com> wrote in message news:cu6h5v$2tl5$1@digitaldaemon.com...
>>>
>>>> I think few people in this field fit the stereotypical geek profile
>>>
>>>
>>> anymore.
>>>
>>> I do.
>>>
>>>
>>
>> He he, well you must be a special, multi-faceted geek then, which makes you even more special than us wannabes.
>>
>> Stereotypical geeks don't jog. I believe you do.
>>
>> Stereotypical geeks don't rebuild novelty cars.  That's something you do, isn't it?
>>
>> Walter, as much as you may aspire to it, I'm afraid I can't give you the official seal of stereotypical geekdom.  As one of your loyal fans, that can't happen. Yeah, you're a geek, but, sorry, you don't qualify for TV.
>>
>> Ah, but who cares?
>>
>> I guess it really doesn't matter anyway, does it?  More than half the people on the list have some sort of geek blood flowing through their veins or they wouldn't be sticking around to see where D goes.
>>
>> Have I dug myself deep enough yet? :-)
>>
>> - John R.
>>
>
> I don't like to think I'm a geek. Not because I think it's a bad thing, but because the world we've created is full so many different things that just sticking to typical geek stuff doesn't make much sense to me (sorry to whoever feels affected by that). However, I must agree with John in that there's a bit of "geek-ness" in most of us, me in particular. The real problem with that is what Matthew said: that we human beings are so stupid to understand and accept each other. So, if we've chosen to be geeks, what's wrong with that?
>
> I went to the beach with my family. I really like the beach: I like the sun, the sand, the sea, the food and the girls. But I don't like it when it's too crowded, like this past weekend (being carnival, there were the usual dose of tourists. Although some people were scared for the possibility of a tsunami). I much prefer to have peace and truly rest (which is different to "rest in peace"). However, against what I already know, I went out at night for the usual "Wild On" stuff. But I didn't enjoy it (it was not that bad, but it wasn't good either). I can't remember a single time when I went out at night and actually had a really good time. Due to that, many times I've chosen not to go, and people find that weird, think I'm crazy, think I'm a bored person. Why? Just because we find fun in different things?. I like sports, I like music, I like movies, I like TV. Most people like those things too: let's have fun with that. But I also like to be at home and I don't like crowds. Is that a bad thing? Am I/are we freaks who should be sent to another planet and leave the "normal" ones here?
>
> That's were the problem is: after I don't know how many thousands of years of being at the top of the world, we still don't know how (or don't want) to accept that, while being the same, we are different and can't just force the rest to be like us. "Diversity of opinions is important: that's what make horse-racing possible".

Very interesting, and well put.

Especially the bit about agreeing with me! LOL! (SHOHWL)

Matthew

FYI: It's a new one: Smacks Himself On Head With Laptop.

For those unfamiliar with EMS techno speak, I'll be spelling out some of the terms here; I know John will probably know them.

John Demme wrote:
> 
> 
> I think we are in agreement.  I'm merely comparing the new style to the old certification.  The old way (according to the guys I've talked) was to teach students how to determine the "norm", then determine what's wrong with the patient, then treat the ailment with various treatments also taught.

Interesting. I'd say our new way translates something to what your old way was.  In the past (>7 years ago) we were told NOT to make a diagnoses on patients: we were to stick to the simple treatment plan (sounds more like what you are talking about with treating the symptoms).  We were to make our observations and assessments as best we could and record them appropriately for the benefit of the hospital. The diagnosis belonged to the doctor.  Patients were either stable or unstable; this meant the process was (skipping scene assessment)

(1) primary survey - quickly assess patient's DABC's (Delicate spine, Airway, Breathing, Circulation)
(2) make a transport decision - is patient stable or unstable
(3) if stable: "stay and play" - further assess on scene
(4) if unstable: initiate transport immediatly -- (the PUFO principle as some people like to put it rather impolitely)

(above almost could be put in a programming language format :-) )

One paramedic I highly respect once told a bunch of us:

"You can never go wrong by treating every patient with spinal precautions, oxygen, and code 3 to the hospital."

He was being facetious, of course, but you get the idea.

When I got in the ambulance service about 6.5 years ago, big changes were just starting in our system in BC.  Our training levels were considered some of the lowest in Canada at the time; new initiatives were being put in place to make us more competitive again.  Along with these initiatives came a new training mentality.  The idea was to bring the ALS (Advanced Life Support -- highest level trained paramedics; aka EMT-P's) methodology of assessment to the lower levels.  The hope was to make BLS level attendents smarter and sharper, keener to do detective work, more intelligent to make appropriate decisions for the good of the patient (all in theory, of course).

We learned to make a quick assessment called a provisional diagnosis on patients (typical a total of 3 good guesses), and then use a functional assessment to recursively update our initial diagnosis (narrow it down as more data was collected on a patient).  This model was designed based on research collected on what the "best" paramedics do as part of their natural process.  The plan was to finally get the BLS paramedics thinking more carefully instead of just treating signs and symptoms. It's an excellent idea in theory, but unfortunately as some shortcomings.  Shortcoming #1 is that in order to get BLS attendants to follow a new process, you have to provide them with a whole lot more knowledge in physiology, pathophysiology, anatomy, and biology, etc. Few of our BLS level's had much training to talk about in those regards because the old system had dragged them through minimal training.  So now they have started to try to update those areas too.  But doing that is a bit of a shocker for EMT's that have been operating for years with the old methods.  They tend to bulk at changes like that.  I personally enjoy it immensely, but I'm a guy that wants to keep moving forward to higher levels anyway.  For others it was an unreasonable step to more responsibility when they were doing just fine as they were thank you very much.  They are enough "keeners" around here though to make that outlook the exception, I think.

Note that the new method does implement the above algorithm still.  It just integrates the above thought process into the flowchart.  Honestly, I found readjusting to the new way somewhat difficult; it's an ongoing learning process but an excellent opportunity to learn the way I'm inclined to learn anyway (instead of being held back by old methods).

My conclusion is that the change is excellent, but it's only effective for those EMTs that are keen to learn and extend their skills.  It completely confuses everyone else and introduces inaccurate and ineffective care.


> With the newer style (which I was taught) feels much more like treating symptoms.  E.G., if the patient has symptoms X,Y,Z, then do A,B,C.  This is what I meant by protocol.... procedure is perhaps a better word? Protocol has a slightly different meaning in this field.

That style still works.  Protocol is an appropriate term, and we still use them with our "new" model (we'll always use them).  I usually think of procedure to mean "a trained mechanical skill often associated with a protocol: cricothyrotomy, needle thorocentesis, tracheal intubation, iv initiation, Bag-valve mask etc).

Our new system encourages a whole lot more thinking about the patient's condition.  The protocol is more a guideline now than it ever used to be, so I guess that was my perspective when I was going on about it in my last post.  The idea is to make sure we learn to identify patients that are having CHF, cardiac-type chest pain, asthma, COPD, etc. and treat them appropriately.  Eg... we don't want to give Sabutamol to a CHF patient, mistaking their condition for asthma, pneumonia, or even possibly COPD (though many COPD patient's typically have CHF as part of the disease -- that's called a "complex case").  The idea is to think more carefully before giving a drug that could possibly cause disastrous results on the patient.  In this case, Sabutomol could worsen the CHF if we gave it to a patient that had that ailment.


> Of course we /never/ step outside what we are allowed to do.  For instance, as an EMT-B, I'm not permitted to start an IV.  I never have, and probably never will.
> 
> John


IV's have been added and removed a couple times in our system.  They are now being approved here for the BLS level (They were available for years until just after I got hired, then no new people were allowed to get the training). It's been a long debated topic here about whether BLS level EMT's should be allowed to have the skill.  I'm just glad we're getting it now because I've had so many situations where the skill would have been practical, useful, and the obvious part of a definitive treatment plan.

Case in point:  we are called Code 3 to a 14 year old Diabetic Type I. I arrive at the house. The kid's unconcious.  BGL if I recall correctly  was < 2.0 mmol/L.  Mom asks if we can do IV.  I, secretly frustrated beyond belief, say "no", knowing D10W IV will bring this kid right out of it; all I can give him is oral glucose which isn't a safe thing to give him in his current level of consciousness (semi-prone and a bit in the bucal mucose doesn't do much).  She wonders out loud, "why did I call you guys then? I might as well have brought him to the hospital myself"; I agree with her how stupid it is, specifically the politics of the service.  Even worse, if one of our senior employees had been along (who got the IV training from way back, with the appropriate protocol), the kid would have got the treatment he needed.  We bring the kid to the hospital (not that short of a trip).  IV in. Kid fixed.  Me more frustrated.  This kid was put in more danger by extending the time his brain was going without glucose.

That's finally getting fixed now.  I guess the committees finally realized we had to start competing with the rest of Canada.  Politics never end on these things.  I know some places in the States where BLS do a whole lot more than I do. It's wierd.

But that's the way it goes, right?

And how does all this tie in to D programming?  Well, I like what both you and Matthew had to say about.  Many systems have protocols, and procedures are implemented for a purpose.  They are in place to solve problems and implement structure within a realm of common patterns. It's really quite fascinating how so many systems approach problems in similar ways.

Whew! Was that long winded... I might give Matthew a run for his money! (he he... but he writes better) ;-)

- John R.

On 2005-02-03 18:31:55 -0600, "Carlos Santander B." <csantander619@gmail.com> said:

> Since there're many new faces around here, I thought maybe we could run the introductions again.

Name: Brian
Age: 29

I'm a looser whose is hopelessly obsessed with game programming. Not playing games so much anymore. Mostly just programming them. Also dig the demoscene big time, but I'm too lame to make my own demos. I'd rather work on game stuff. Anyway, I originally taught myself programming in C with DJGPP in MSDOS. But before that I'd have to say my first real programming was HyperScript for HyperCard on the Mac Plus System 6 old skool! Awwe-yea! Can I get a show of hands? *nobody moves*..hehe. Okay, maybe I did some BASIC in grade school and at my grandparents house when I got bored. But HyperScript was what introduced me to the important concepts. Events, flow control, functions, algorithms, etc...oh yes...that blocky keyboard, that one button mouse, that tiny black and white monitor, down in the basement with my HyperScript programming reference...ah, the memories.

So at some point I went to college for awhile and had to correct the teachers all the time and explain to the graduates what simple things like hash tables were. No kidding. It sucked. Not to mention, their idea of a test was having you vomit man pages and if you forgot one little argument to some useless utility then you didn't get an A. Since I don't care about stupid things like that I didn't get A's. I still have yet to complete my degree.

Anyway, eventually I hope to find a place where I fit in and doesn't suck. D shows a lot of promise for not sucking. So it looks like a good start. Maybe I'll have a game/tech demo or something out soon. Working with SDL, OpenGL, and ODE among other things.

Wanna talk about Legacy data! My favorite coding font is the same one I've always used way back from my Win16 Boraland C++ compiler: "borte.fon". You can still find it on the net if you search for it. Not only do I still use it now under Windows XP, but I've converted it to .bdf and use it under X11 on Linux and Mac OS X. After all this time it still totally ownz. I hate coding with the worlds default font: "courier.ttf". Yeah I think everyone needs to find a good personal coding font! ;-)

Matthew wrote:

<snip>

> I now think that the specifics of a language, and any attendant langauge lawyering, are far less important than a person's desire, intent, dedication, pride in their work and, importantly, perspective on their own skills. Furthermore, I now know that it's just as important to have access to people more knowledgable and/or experienced than oneself. We are fortunate in this group that both criteria are amply satisfied.
> 

Absolutely true!  Your description echos many of my thoughts.  Different professions have more in common than we realize.


>>Well, it won't be the first time this newsgroup has drifted off topic, so I don't think we'll be booted for making it into an EMS discussion forum... at least not just yet. :-)
> 
> 
> No fear! It's interesting to read about the lives of people with different experiences. I hope that this characteristic of the Digital Mars newsgroups never changes.
> 

Wonderful!  The flood comes. :-)


- John R.

pragma wrote:
> In article <cu90sj$1e0s$2@digitaldaemon.com>, John Demme says...
> 
>>As for protocol vs improv, I agree that improv is the way to go, but in my (admittly short) experience, at home in New Jersey, we are being push to the protocol side.  Do we practice that way?  Only to an extent, and most interactions with other units.
>>
>>I don't like the way it's heading, but I was told during my initial EMT training, that all EMTs do (officially) is follow protocol.  Unfortunate.
>>
>>I wonder if there's some way to relate this to software?
>>
> 
> 
> Absolutely there is.
> 
> I feel that every programmer here, from novice to expert, can acknowledge that
> sometimes your bookshelf will fail (if not outright betray) you.  At some point,
> all that study, experience and peparation boils down to how well you can
> improvise a good solution to the problem.  After all, I doubt we'd all be in
> this if there wasn't *some* kind of creative element involved here.  


Agreed. Improvising is hugely important.


> I'd like to think that being an EMT has a certain "MacGuyver" feel to it.  I
> know that engineering certainly does. :)
>

Actually, you are correct when it comes to some things in the EMT field.  Although we don't typically improvise our protocols much without dire consequences as John Demme noted; for example if I must stick to a protocol's strictly stated drug dosages, or I could lose my job.  Some instances demand that I contact a physician to request repeat orders, though.  So there is somewhat of a safety net there.

But improvisation is hugely important in the EMT field when it comes to everyday mechanics.  What do I do if I don't have the required equipment for the job?  What if I can't stop this bleed with what I've got with me?  How do I get this patient out of that vehicle without causing further injury?  Where do I hang this IV bag?  How do I move this 300 lb woman without straining my back?  How do I determine a patient's weight to give the correct drug dose?  There are tons of opportunities to be a "MacGuyver" here.  Thinking smart, thinking efficiently is a huge asset to the job as I'm sure it is for almost any other.  I love working with people that have a natural talent for such things.

> Now perhaps this a bit too mechanistic for some folks, but the human body is
> basically a wonderfully complicated machine. I'll add that its so "perfect" that
> it doesn't run without fault but has built-in fault protection... like D! 
> 
> To add to this relationship, an anesthesiologist friend of mine tends to draw
> parallels between patient treatment and hacking his G5.  
> 
> So like software engineering, medical treatment of most forms involves the same
> basic skills: 
> 
> - Understanding a complex web of interacting parts/systems
> - Identifying where the problem is (and what if possible)
> - Applying a proven or improvised solution
> - Knowing when a problem is unsolvable
> 
> Now in the workplace, the protocol vs intuition bit is a big issue.  Take a look
> at the Capability Maturity Model for example.  It basically says that in order
> to progress as a software engineering team, you must adopt rigid controls in
> order to mitigate risk, error and ultimately achieve reasonable timelines and
> deliveries.  
> 
> http://www.emoxie.com/whitepapers/CMMandISO9001-v2.html
> 
> Now, what does CMM have to do with being an EMT?  The model drives home the
> notion that relying on "Heroes" is fine for a start, but you need to not rely
> upon superstar talent in order to have repeatable success.  I immediately
> thought of this concept when you mentioned your boss' words.  For an EMT, in
> order to mitigate risk of litigation and loss of life, strict protocols and
> procedures are needed to maintain an acceptable standard of service.  
> 
> http://www.ee.ryerson.ca:8080/~elf/hack/heroes.html
> 
> (I'm also a former boy-scout, so I'm familiar with basic first aid.  I remember
> becomming CPR certified a decade ago, and all the rules that come with it; and
> that was just for "patient has no breathing and maybe a pulse".  But I can only
> imagine what being trained for gunshots wounds, auto accidents, massive burns,
> deep knife wounds, severe head trauma, field triage, et al. would entail.
> ::shudder::)


It get's interesting fast, yes.  :-)  It's amazing what the mind gets used to when it comes across enough of those sort of things.


> The good thing is that in both fields one can acknowledge that while *depending*
> on heroics isn't a good idea, such talent is always a boon to business.
> 
> - EricAnderton at yahoo


Thanks for that read.  It was an excellent description and comparison. Very accurate and germane.

- John R.

Matthew wrote:
> 
> Very interesting, and well put.
> 

Thanks. How about me becoming a writer? .... Nah, who would buy a book written by a geek, except other geeks? :D

> Especially the bit about agreeing with me! LOL! (SHOHWL)
> 
> Matthew
> 
> FYI: It's a new one: Smacks Himself On Head With Laptop.
> 
> 

_______________________
Carlos Santander Bernal

> I also started the Apollo library, which is
> supposed to be a GUI library built over the Borland VCL using Delphi
6.
> However, my (never ending) lack of time hasn't allowed me to go any
> further, and I don't think there's much interest on it because the
> Delphi 6 Personal Edition (the one I have) doesn't allow to use it
for
> commercial applications. Besides that, a couple of uni projects, but mainly personal thingies.

Just wondering ... can D actually use Delphi VCL components? Directly or indirectly? I tried to find Apollo, but the link was dead http://earth.prohosting.com/carlos3

A friend of mine writes freeware using Delphi, and has put together an very nice GUI. He said it was straightforward using Delphi's VCL.That got me thinking ... what would be involved for a D program to use VCL for its gui?

Name: Lynn David Allan
Age: 53
Location: Colorado Springs, CO USA

Background:
* Wrote first fortran program in '68 on IBM 7094 ... 'perfect' integer
right triangles. (3-4-5, 5-12-13, etc).

* Last date with '68 Miss Teenage Kansas (runnerup) ... explaining how
above program worked. MEGO (my eyes glaze over :-)

* Resigned from military due to reluctance to conform to authority.

* MSIE/MSPH ... hospital efficiency expert ... paid to tell other people how to do things better

* Fired from assistant hospital administator position ... completely unsuited

* Drifted into computer programming in 1980 as COBOL CICS programmer

* first performance review ... "doing ok ... try to tone down your arrogance"

* On my way to being IBM mainframe systems programmer and discovered Sinclair z80 computer

* Couldn't believe how slow a z80 basic program was ... couldn't believe how fast a z80 asm program was

* "gypsy contract programmer" going around the country chasing $ for 10+ years

* fired two more times, quit before being fired another 3 times

* 44 addresses in 44 years by '94

* Worked long enough in C.Springs to get mortgage approved in '94 and retired ... good riddance

* ski bum for 5 years (xc and downhill)... bike racing as off-season
training ... go Birkie!

* became Christian 9.9.99 ... from flaming skeptic ... not what I expected

* developed several Bible related freeware programs using Java and C++

* volunteer webmaster ordinaire for several organizations and local right wing politician

* married to 2nd wife, 27 year old son from 1st marriage

* best job: 68k asm for medical instrumentation in '85

* 2nd best job: C++ on 128-node 'hypercube' for Star Wars simulator

* 3rd best job: 5 twelve hours days working on payroll, then 9 days off ... back in the "good old days" when prima-donna techies were pampered and indulged

D activities:
* Mostly a lurker with occasional newbie questions ... also have been
VERY impressed with the civility of this newsgroup

* Contributed some tutorials to dsource, some beta testing for gui libraries

* Semi-patiently waiting for 1.0 and reasonably mature gui to port C++ freeware to D (inverse and lcdbible/berbible)

* Current main involvement is with Audacity open source audio editor ... trying to add some features applicable to speech recordings. Hope to help eventually "wrap" libsndfile and audacity's mezzo audio library for D.

Lynn Allan wrote:
> Just wondering ... can D actually use Delphi VCL components? Directly
> or indirectly? I tried to find Apollo, but the link was dead
> http://earth.prohosting.com/carlos3

That site is long dead. Try this: http://dblinux.sis.epn.edu.ec/~csantand/dmdscript.html

> 
> A friend of mine writes freeware using Delphi, and has put together an
> very nice GUI. He said it was straightforward using Delphi's VCL.That
> got me thinking ... what would be involved for a D program to use VCL
> for its gui?
> 
> 


-- 

_______________________
Carlos Santander Bernal

John Reimer wrote:
> Interesting. I'd say our new way translates something to what your old way was.  In the past (>7 years ago) we were told NOT to make a diagnoses on patients: we were to stick to the simple treatment plan (sounds more like what you are talking about with treating the symptoms).  We were to make our observations and assessments as best we could and record them appropriately for the benefit of the hospital. The diagnosis belonged to the doctor.  Patients were either stable or unstable; this meant the process was (skipping scene assessment)
> 

Your old way sounds exactly like our new way.  Much like yourself, I prefer (and usually do better) with your newer way.

> 
> 
> 
> IV's have been added and removed a couple times in our system.  They are now being approved here for the BLS level (They were available for years until just after I got hired, then no new people were allowed to get the training). It's been a long debated topic here about whether BLS level EMT's should be allowed to have the skill.  I'm just glad we're getting it now because I've had so many situations where the skill would have been practical, useful, and the obvious part of a definitive treatment plan.
> 
> Case in point:  we are called Code 3 to a 14 year old Diabetic Type I. I arrive at the house. The kid's unconcious.  BGL if I recall correctly  was < 2.0 mmol/L.  Mom asks if we can do IV.  I, secretly frustrated beyond belief, say "no", knowing D10W IV will bring this kid right out of it; all I can give him is oral glucose which isn't a safe thing to give him in his current level of consciousness (semi-prone and a bit in the bucal mucose doesn't do much).  She wonders out loud, "why did I call you guys then? I might as well have brought him to the hospital myself"; I agree with her how stupid it is, specifically the politics of the service.  Even worse, if one of our senior employees had been along (who got the IV training from way back, with the appropriate protocol), the kid would have got the treatment he needed.  We bring the kid to the hospital (not that short of a trip).  IV in. Kid fixed.  Me more frustrated.  This kid was put in more danger by extending the time his brain was going without glucose.
> 
> That's finally getting fixed now.  I guess the committees finally realized we had to start competing with the rest of Canada.  Politics never end on these things.  I know some places in the States where BLS do a whole lot more than I do. It's wierd.
> 

Don't get me started on restrictions in New Jersey... I guess it's that way since ALS is usually only about 15-20 minutes away.  We can't even have any ALS on our squads.  If one of the paramedics we have on the squad gets on scene, and the patient needs an IV, or to be intubated, our /trained/ EMT-P cannot do it until the other (paid and on the clock) paramedics get there and give permission for our guy to /help/.  It's pathetic.

And on top of all this, NJ EMT-B's (the only type we can have on local squads*) are basically only allowed to do CPR, and apply oxygen. (There's a lot more we can do for trauma.)  We can't intubate, oxygen is the only drug we can give, besides oral glucose (but I can't remember whether or not this is considered a drug.)  Hell, if the patient has an Eppi-Pen, technically, we can't administer it!

Sometimes you feel pretty useless.

*Actually, EMT-P's are allowed on the squads, but they are EMT-B certified, and can only practice the EMT-B level stuff.

John