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…

“Privilege” is one of those concepts that’s hard for people to understand the first time they run into it. Though it really means something along the lines of “advantages you have that you think are normal,” it’s often interpreted as “things that you have that make you a bad person.” And that’s rough, because privilege affects an awful lot of stuff in our lives, and our interactions as humans are improved when we acknowledge and try to cope with our own levels of privilege. Part of the problem, I think, is that most writing on the subject of privilege has to do with things like ethnicity, race, gender/gender identification, and class — not things that most folks are necessarily willing or even able to examine in depth.

There’s another kind of privilege, too, that may make the whole thing easier to grasp: professional, occupational, or skill-based privilege. If you’ve ever wondered why some people struggle with tasks or concepts that come naturally to you, and wondered why it seems so hard for them, you’re bumping up against privilege. This happens a lot in my line of work; a lot of it revolves around dying and end-of-life care. I have colleagues who abruptly demand to know why Mrs. R. doesn’t have an advance directive, or why Mr. F. is still a full code despite being 97 and having full-blown dementia, or why Ms. J. doesn’t quite grasp that her cancer isn’t going to get better. Depending on how energetic I’m feeling on any given day, I like to use these moments as teaching opportunities to introduce the broader concept of privilege.

Conversations about death, dying, end-of-life care, or catastrophic health care decision-making are easy for us. We have a language to talk about this stuff, we understand what happens, we’ve seen it enough times to know what we want (or don’t want, as the case may be); we are comfortable with this material and these topics because we are familiar with them, and that makes the conversation easier. We watch people die — despite (and — very occasionally, I should stress — as a result of) the things we do — and it doesn’t really faze us much. We’re well acquainted with the subject matter, and that makes it a simple thing to discuss. But most people don’t have that familiarity; truth be told, most people don’t want that level of familiarity, although fluency with a particular topic is generally a requirement to be able to discuss a subject intelligently.

It evidently falls to us to facilitate those conversations, with care and empathy and compassion and great patience. Some people will get it right away; others need more help. Some won’t get it at all, and will end up standing in a resus room at three in the morning wondering why it had to end like this. The new-ish focus on this kind of planning, death-panel demagoguery aside, is really all about dealing with an underprivileged population faced with seemingly insurmountable challenges they cannot even begin to grasp without assistance. This is hard work, and yet amazingly most of us do it instinctively, without a lot of effort, and it often goes well despite the sadness of the overall subject.

This is what privilege looks like on an operational basis. This is what it means to own your privilege, understand how it affects other people, and work towards helping the less-privilege cope with that disadvantage. No one would ever suggest that having this level of comfort with such a horrific body of knowledge is bad, or wrong, or somehow inappropriate — because it clearly isn’t. And it’s much the same thing with the other kinds of privilege, too: none of it, whether gendered or ethnic or moneyed or what have you, is inherently bad, but behaving as though other people don’t matter because they don’t have those advantages is.

Viewed through this lens, privilege becomes a lot easier to understand. Are your parents struggling with their new computer, even though it’s really simple to you? Privilege. Are you a pilot and unfazed by turbulence while your passenger screams and holds on for dear life? Privilege. As the privileged person, you don’t get to set the terms of the discussion, and you don’t get to be the one who defines what the issues are for the unprivileged. Your passenger tells you when the turbulence is too much. Your mom tells you when you’ve helped enough with her new PC. The family will tell you when they’re ready and able to make end-of-life decisions for their loved ones.

I offer this out to the community at large when confronted with the challenge of explaining privilege to people who, for whatever reason, do not or cannot understand what it really means. Find something you have in common that makes you different from most other people, that gives you an advantage over others, and use that as the lever to bring the conversation around to other, more entrenched notions of privilege. It works.

(Inspired by this, which also does a good job, and helped me get my head around some of my own privilege issues.)

Japan Times: Hosptals turn away patients at record rates

A record 16,381 people in serious condition were refused admission by hospitals three times or more while being transported by ambulance in 2010, up 3,217 from the previous year, the Fire and Disaster Management Agency said.

The agency said Friday the rise came because hospitals still aren’t prepared to receive an increasing number of elderly patients amid the graying population.

Among the reported cases, 727 people were rejected 10 times or more, with a 60-year-old man in Tokyo rejected the most, 41 times.

I need to keep this in the back of my head the next time I hear someone complaining — or I am tempted to complain — about hospital delays and wait times here.