You go first

Meaghan Mercer’s article in Medscape today, Shock — Administered Uninterrupted Chest Compressions, is probably registration-protected, so I’m sorry if you aren’t a member and can’t read the whole thing. Here’s the nut graph, though:

When clearing the patient for defibrillation, this causes an interruption in chest compressions causing the central perfusion pressure (CPP) to drop, and it can take more than one minute of good-quality chest compressions to restore them to pre-pause levels. CPP has been found to be the best single predictor of ROSC, with values less than 15mmHg predicting a failure. Therefore, we are greatly increasing the morbidity and mortality of our patients with each second off the chest. Circulation published the article “Hands-On Defibrillation, An Analysis of Electrical Current Flow Through Rescuers in Direct Contact with Patients During Biphasic External Defibrillation,” in which they investigate the amount of leakage voltage and current to a rescuer receives during defibrillation. They found that the current measured in the rescuer’s body ranged from 19 to 907µA. In most cases, the leakage current measured below recommended safety standards and none of the rescuers felt a shock.

I’ll translate that for you: you know that scene in every TV show and movie where someone yells “clear!” and then everyone else moves back? Yeah, maybe not so much anymore. We’ve been kicking this around at work for the past year or so, and we’re all kind of curious about whether or not it actually changes anything, but speaking as someone who has caught a piece of 360J once upon a time and didn’t feel right for about an hour afterwards, I think I’m going to wait for someone else to try this first…

Out of my head

During last week’s leader’s debate on the radio, John Cummin, the head of the BC Conservative Party, made a comment about the carbon tax being disproportionately burdensome on northerners and business. His argument, as best I could tell, was that the tax needed to be repealed because it was driving prices on goods in the north up, and making it expensive for businesses in the oil and gas sector to dig stuff out of the ground and make money. I say “as best I could tell,” because as you might have guessed, I was busy shouting at the radio while all this was going on. (I note that I am, in this respect, turning into my father — not my father when he was my age, mind you, but my father now. This is exactly as distressing as you think it is.)

Driving up the price of stuff is the whole point of the carbon tax. I know it wasn’t sold like that, and I know we all hate the idea of paying more in taxes, but this is the one good thing the BC Liberals have done for this province over the last three terms. The one bad spot is that they made it revenue neural, in theory returning all the money to taxpayers, so it doesn’t actually hurt anyone, which sort of defeats the purpose of having a carbon tax. It’s supposed to hurt! It’s supposed to get you to make different choices! And, as it turns out, there’s some evidence that it’s doing exactly that. One might also think that part of the reason we haven’t seen as dramatic a shift as expected is not because the tax doesn’t work, but because it’s currently too low — only the Green Party seems even remotely interested in taxing carbon at an appropriate rate. And they’re not going to form the government, so who cares what they think?

I understand the complaint that taxing carbon and building that cost into the price of goods in northern BC is annoying and probably unfair. But here’s the thing: living in northern BC is actually expensive on the basis of carbon emissions! It costs a lot, in dollars and time and CO2, to get stuff up there, and if we were going to design a province from the ground up on the basis of what made sense from an emissions control perspective, putting a bunch of people way up north is probably not a choice we’d make today. Incidentally, the carbon burden of northern Canada — the costs of shipping diesel fuel up north, the emissions from burning it — are a good argument to look at alternative sources of power and heat up north. Given the climate that leaves pretty much only one option, but good luck with that. If we’re going to get real about climate change people are going to have to get over their paranoia about nuclear power, and if you thought selling the carbon tax was a tough job… Maybe George Monbiot can help out.

Living up north carries costs. I get that for a lot of people it wasn’t an explicit choice — you were born there, your life is there, so you stay put — but it’s a choice nonetheless, and I’m all in favor of making the consequences of those choices as visible as possible, so people can make informed choices. It’s the same thing that happens when northern BC suddenly realizes it doesn’t really have a good strategy to deal with trauma, or any other kind of serious, acute medical problem. It’s not discriminatory, and it’s not by design, it’s just the way it works: providing that kind of service to that geographical area is incredibly difficult, and we as a province have judged it unfeasible. (From a clinical perspective even throwing money at this problem won’t help; it’s part of the reason why we don’t have an interventional cardiology program in Prince George — the numbers aren’t there to get the operators the volume they need to maintain competency, and that would also be true of any trauma program, which by its nature is interdisciplinary.)

It sounds like I’m kind of ragging on folks in northern BC (and northern Canada, more broadly). I’m not. I am, however, pointing out that our settlement patterns are sub-optimal from an environmental, financial, and health care provision standpoint, and I’m amazed that there are folks in this day and age who seem to feel as though this is somehow unfair.