ysabetwordsmith: Damask smiling over their shoulder (polychrome)
[personal profile] ysabetwordsmith
This poem is spillover from the October 4, 2016 Poetry Fishbowl. It was inspired by a prompt from [personal profile] gingicat and other readers under "Through Infirmity of the Flesh" regarding changes in CPR practice; and folks with whom I've discussed how to modify first aid training for people with disabilities. Note that it takes serious digging to unearth solid references for the latest practices: I have now done this for you, with help from those recently-trained readers. This poem also fills the "successes" square in my 8-1-16 card in Group Dynamics and Character-Building. It has been sponsored by [personal profile] technoshaman, [personal profile] daisiesrockalot, and [livejournal.com profile] ng_moonmoth. It belongs to the Shiv thread of the Polychrome Heroics series.

Extra perk: Anyone with a current CPR card, or now in training, speak up and you can reveal a verse of any open linkback poem.

Warning: This poem contains graphic descriptions of CPR training, and other intense topics. Highlight to read the warnings, some of which are spoilers. It features messy medical discussions and demonstrations, disability issues including the awkward process of adapting to a new one, poor self-esteem, educational challenges, struggling with learning modes, frustration, self-recrimination, body dysphoria, flashbacks, reference to previously losing someone to a drug overdose, discussion of sensitive issues about skin tone and first aid, challenges of soup care, minor physical overstrain, and other issues. For the most part, though, it's an upbeat poem and it takes a close look at how an adept teacher modifies a class to accommodate the learning needs of a diverse student body. If these are touchy topics for you, please consider your tastes and headspace before reading onward.


"His Capacity for Self-Redemption"


Following the lecture on drug abuse
and terror weapons, Dr. Bloch began
setting up the promised classes on
cardiopulmonary resuscitation and
associated aspects of first aid.

He organized the materials around
the core concepts of adult CPR and then
added variations for children, infants, and
the new automated external defibrillators
that Warden Lincoln had authorized.

Dr. Bloch sent out a general message
notifying staff and inmates of availability,
with an overview open to everyone and
an application for interested students.

Those who registered for the classes
gained access to the instruction manual,
handouts, and other supporting materials.

Kincade King was the first to sign up,
since it had been his idea; Sanquez Abarca
and Verne Christensen came along with him.
Dustin Hall and Tremon Elliston were both
contraband traders, and Dr. Bloch wondered
if he had made an impression on them.

He was surprised that Ragno volunteered
for the class, given his missing arm, but
he approved the application anyway.

Alejándro Duran and Raul Bonaventure
were probably attending in support of Ragno.
Travis Vanburen and Everett Howard were
close to needing renewal of their cards.

Interestingly, Shiv had refused to take
the class, but then emailed Dr. Bloch
asking if it came with coloring pages.
Since Dr. Bloch had started teaching
him about anatomy, Shiv had become
fascinated with those materials.

So Dr. Bloch sent him an activity book
and the coloring pages for things like
the thoracic cavity and the heart.
Maybe it would pique his interest.

Before long, a total of twelve students
had signed up, so Dr. Bloch closed
the enrollment. He could always run
another session later if necessary.

Next he called around in search of
CPR mannequins he could borrow.

The local community center had a set
of basic ones for classes, and the hospital
loaned him a couple of scoring mannequins
with more advanced features. All Dr. Bloch
would have to cover out of his own budget
were the disposable supplies for the class.

In exchange, he volunteered to teach
a CPR class at the community center
and a lecture on providing health care to
criminals and other ruffians at the hospital.

For the first session, Dr. Bloch reserved
one of the classrooms and removed half of
the desks. He covered the open floor with
yoga mats to mark out practice spaces and
distributed the basic head-and-torso dummies,
then put the two full-body mannequins on
either side of the teacher's desk.

As the students filed in, Dr. Bloch sorted
them into the desks. "Mr. Vanburen, would you
mind tending the door again?" he said.

"Sure," the guard replied, and took
a seat where he could reach it easily.

"Let me start by saying that if anyone
feels dizzy or queasy, you can lie down
on a spare mat or take a bathroom break,"
said Dr. Bloch. "We're going to be working
hard, and that can have side effects."

Travis and Kincade both nodded. They
had worn themselves out saving Jimar.

"Thank you all for coming today. Learning
CPR shows compassion and prosocial behavior,"
said Dr. Bloch. "For those of you on the inside,
remember that saving a life can clear a lot of
debt to society. Don't spread that around,
because I don't want people signing up for
the wrong reasons, but you should know."

Kincade's jaw dropped. "Really?"

"Yes, Mr. King, that includes your effort,"
said Dr. Bloch said. "From your reaction,
I gather nobody has contacted you about
that yet. I'll give them another nudge."

The other inmates looked at each other.
"Thanks, doc," said Sanquez. "Most people
don't think that much of us. We're just thugs."

"Do not judge yourselves by past performance
or other people's opinions, and do not look to
anyone else to fix your life," Dr. Bloch said.
"It is his capacity for self-improvement and
self-redemption which most distinguishes
man from the mere brute."

"Aung San Suu Kyi, 'Freedom from Fear' --
we just read that in the community justice class,"
Everett said. "It's some pretty good stuff."

"Thank you for the reference, Mr. Howard,"
said Dr. Bloch. "I'd like to discuss our schedule.
A CPR refresher typically takes about two hours,
a regular class runs more like three, and if you
add in other first aid then it's four to six. We're
doing two hours a day for five days."

The inmates groaned on cue.

"What that gives us is more time for variations,
questions and answers, individual coaching,
scenarios, and practice," said Dr. Bloch.

Verne leaned forward. "Like what?
If someone can't understand the lessons?"

"That, or people want to learn more," said Dr. Bloch.
"For instance, if you request extra detail on infant and
child CPR, or someone wants to practice Heartlines."

"Yeah, that's a good idea," Verne said.

"We'll begin with a lecture, then I'll demonstrate
the techniques, and finally we will all try them
on the mannequins," Dr. Bloch said. "I have
Nurse Scott here in case I get called away on
an emergency -- he can't certify you, but he can
certainly supervise while you practice. As long as
you get at least three hours with me, you're eligible
for the test, so we have plenty of wiggle room."

Alejándro raised his hand. "Can we
practice outside of class too?" he asked.
"I'm not exactly the fastest learner."

"I have the basic mannequins for
the whole week, so you may come
to the infirmary and borrow those,"
Dr. Bloch said. "Unfortunately,
the scoring mannequins have to go
back to the hospital between classes."

"I'll take you up on that," Alejándro said,
and some of the others nodded.

"How many of you have prior experience
with CPR?" Dr. Bloch asked the class.

A third of the students raised their hands.

"Okay, let me review some recent changes.
Studies track results of CPR so that we can
identify best practices," said Dr. Bloch. "You
should use an automated external defibrillator
as soon as possible, and we now have those
here. Chest compressions are more important
than rescue breathing, so I'll be teaching you
hands-only CPR in case you lack a helper."

He went through the rest of the lecture,
introducing the concepts behind CPR
and describing the techniques in depth.

Sanquez listened raptly, clearly captivated
by all the detailed explanations, although
some of other students were frowning.

Everett took notes, which made some of
the others want to, only they hadn't brought
anything to do it with. Dr. Bloch had come
prepared for that too, and passed around
paper and pens to those who wanted some.

The students were putting in honest effort.
Alejándro had his tongue tucked between
his teeth as he took laborious notes, and
Tremon had wrinkles between his eyes.
Dustin leaned over to illustrate some point
for Ragno, silently pointing to his page.

Then Dr. Bloch took questions, making note
of who seemed to be struggling with which
aspects, and who wanted extra information
to build on their prior understanding.

When he noticed the students starting
to fidget, he wrapped up the discussion.

"Break time," Dr. Bloch announced.
"Everyone up, stretch out, and go visit
the bathroom if you need it. Nurse Scott,
please bring in the refreshments."

The students scattered, and soon
Nurse Scott came back with a bowl
of mixed crackers and two trays.

One held an assortment of bell peppers,
carrots, jicama, cucumbers, summer squash,
and cherry tomatoes around a trio of cups
which contained bleu cheese dressing,
vanilla yogurt, and French onion dip.


The other held sliced beef, turkey,
and salami along with brie, gouda,
aged cheddar, and gorgonzola.
Its centerpiece included jars of
fig jam, rosemary jelly, honey,
and an Italian condiment.

The returning students descended on
the offerings with great enthusiasm.
Sanquez pounced on the jicama and
everyone backed off to let him have it.

Ragno gave a happy yip as he found
the mostarda di Cremona, a blend of
candied fruit in mustard-flavored syrup.

Dr. Bloch hadn't known whether or not
the boy liked it, but it seemed like
a good guess and it played out well.
He snagged a sample for himself,
and decided it was tasty stuff.

Alejándro collected some appreciation
as they ate, because he worked in
the organic garden sometimes, which
had contributed most of the vegetables.

Before long, they had devoured
everything on the platters; there
wasn't a lot of food, just enough
to give people a little boost.

"All right, class, back to work,"
Dr. Bloch said, clapping his hands.
"Start with a basic dummy. When you
have the rhythm down, come up and
try it on a scoring mannequin so you
can get confirmation. If you can't get
it at all, then again, come up front and
the feedback will help you figure out
what you've been doing wrong."

The students spread out,
and within minutes they started
groaning and complaining.

"I know that hands-on practice isn't
your favorite learning mode, Mr. Howard,
but remember that you have the manual,"
said Dr. Bloch. "You can study after class,
and acquire the techniques that way. I have
more detailed reading material if you need it."

Surprisingly, Verne had picked up
the basics after only one presentation,
and his performance was so good that
Dr. Bloch brought him up to score it.

"Well done," he proclaimed. "Why don't I
give you a little preview of the variations
for children? Then we can switch one of
the dummies for you to practice that."

"Yeah, that'd be great," Verne said.

Hope of rebuilding his shattered family
had motivated Verne to make a lot of
improvements, a trend that Dr. Bloch
heartily wished to encourage.

So Dr. Bloch showed Verne
how to adjust the dummy from
adult mode to child mode, discussed
the differences in technique and
the reasons behind them, then
gave a brief demonstration.

Off to the side, Dr. Bloch
could hear Ragno swearing
softly and fiercely in Italian.

"Language, Mr. Rappalino,"
he warned. "Start practicing what
I just showed you, Mr. Christensen,
while I go deal with this."

Raul, who had more or less
become Ragno's assistant for
things he couldn't do one-handed,
was trying to coach him but didn't
know enough about CPR to help.

Dr. Bloch shooed Raul gently out of
the way, and then pried Ragno off
the dummy he was tormenting.

"You seem stressed," Dr. Bloch said.
"Sit down. Take some deep breaths.
Settle yourself, then we'll solve this."

Finally Ragno gave a heavy sigh
and relaxed. "Sorry, doc," he said.
"It's just so -- everything is harder,
and I get frustrated all the time."

"You have to work harder, because
you have to think up alternatives when
everyone else can do things the usual way,"
Dr. Bloch said. "Of course that's tiring."

"I can't do this," Ragno muttered.
"I should've known better. Coming
here was a stupid idea anyway."

"No, it wasn't," Raul said. "You
have to learn how to do things for
yourself, because you hate feeling
dependent on other people. Come on,
show Dr. Bloch what's going wrong."

"I can't get the stupid chest to go down
when I push on it," Ragno complained.
He leaned on the dummy with his hand.
"See? It just lies there when I do it,
but Mr. Bonaventure can do it fine."

Dr. Bloch watched, and sure enough,
the compressions lacked the depth
they needed to be effective.

"Here's the problem," said Dr. Bloch.
"You're not getting enough pressure,
and part of that probably stems from
having only one hand to lean on. Set
aside everything else and just focus
on this one thing. Search for a way
to put more weight behind your push."

"Like what?" Ragno said.

"It's your body; you need to figure it out,"
Dr. Bloch said. "Think about physics,
though -- bending your elbow costs you
force, getting more of your frame above
the dummy lets you use body weight
in a more efficient manner."

Predictably, Ragno tried lifting and
then dropping his weight on the dummy.

"No," Dr. Bloch said, putting his hand
over Ragno's. "Do not bounce. Here, let me
show you what a proper compression
feels like underneath your hand."

Working together, they managed
to get it right, but Ragno still couldn't
produce the same result himself.

"Let's switch to a scoring mannequin,
and I'll show you why bouncing is bad,"
Dr. Bloch said, waving him forward.

With a few keystrokes, the doctor
enabled the program to respond to
the mistake that Ragno had been
making with the basic dummy.

It only took a few strokes
before the hidden magnets
released with a disturbing crack,
simulating a broken rib.

Ragno yelped and backed away.

"No," Dr. Bloch said, gently
pushing him back to the mannequin.
"Once you start CPR, you don't stop
until your patient begins to move,
or help arrives, or the scene gets
too dangerous for you to stay."

"But I broke it!" Ragno protested.

"It's supposed to do that," Dr. Bloch said.
"Scoring mannequins are designed
to simulate real events in CPR.
It's not actually damaged."

"What if that happens to a person?"
Ragno said, shaking out his hand.

"Sometimes CPR breaks the ribcage,"
Dr. Bloch said. "Ignore it and keep going.
Remember, a person in cardiac arrest is
already dead; you can't kill them any deader."

"It still felt awful," Ragno said.
"I really don't want to do that again."

"Fractures happen more often with
poor technique, which is why I told you
to quit bouncing," Dr. Bloch said. "Now,
try to find a different solution, and let
the mannequin tell you if it works."

Ragno fumbled around, attempting
different positions. At one point, he tried
pressing the stump of his left arm over
his right hand, but quickly abandoned it.

"Still tender?" Dr. Bloch murmured.

"Yeah, but mostly when I bump it
or lean on it," Ragno said. "It doesn't
bother me all the time anymore."

"If you'd try a prosthesis, then you
could use more normal methods.
Even a nonfunctional 'social hand'
would give you something to lean on,"
Dr. Bloch pointed out to him. "You're
an excellent candidate because you
still have most of that arm."

"I can't," Ragno said, shaking
his head. "I know you want me
to do it, but they all feel wrong in
my head when I look at the catalog."

"Okay," said Dr. Bloch. "The rate
of rejection for prosthetic arms is high.
You don't have to try one if you don't
want to. I just wanted to point out
a potential advantage of that option."

"Yeah, I know," Ragno said. "I'm sorry
for snapping at you. It's not your fault."

"It's not yours either," Dr. Bloch said,
patting him on the shoulder. "You may
keep practicing on the scoring mannequin
for a while, until someone else needs it."

Then he made a loop of the room,
checking on everyone's progress.
Most of them were doing fine.

Dustin was having trouble getting
his hands into the right position.
Dr. Bloch showed him the landmarks
for finding the proper location.

Dustin's face lit up at that.
"Oh, now I get it!" he said.

Sanquez was struggling with
the tempo of the compressions,
unable to maintain a steady rate.

"Do you know the song 'Stayin' Alive'
well enough to sing it in your head?"
Dr. Bloch asked Sanquez

"Some of it," Sanquez said.

"If you can manage the chorus,
that's enough to give you the tempo,"
Dr. Bloch said. "It's fast without being
so fast that the chest doesn't have time
to rebound between the compressions."

Tremon leaned over to watch, and
his fingers tapped in time with the song.

Dr. Bloch encouraged him.

"Why do we do things this way?"
Tremon wondered. "I mean, the dummies
are okay, but it's hard for me to figure out
what the ribs and lungs and heart would
be doing under my hands, and that
seems kind of important here."

"Let me show you," Dr. Bloch said.
He brought out a cheap model of
an anatomically correct torso.

"Smooth," said Tremon as he
picked it up to see how it worked.

"Look at how this comes apart and then
goes together. It displays the relationships
of the organs inside the body," said Dr. Bloch.
"When you push on the sternum, here, then
that compresses the heart and lungs, here,
thus mimicking their natural functions."

As Tremon disassembled and reassembled
the model, several other students drifted closer,
picking up the pieces and turning them over
in their hands to examine the different parts.

"What's this puzzle for?" Verne asked
as he poked at the heart and the lungs.

"Anatomical models are essential tools for
kinesthetic learners, just like the coloring pages
are for visual learners," Dr. Bloch explained.
"If anyone is especially interested in studying
the anatomy behind CPR, let me know and
I'll borrow a more detailed medical model
from the hospital to show you more."

"Aww, yeah," Verne said with a grin
as Tremon nodded along, "and
can you get a baby one too?"

"They probably have a pediatric model,
and if not, I'll ask around," said Dr. Bloch.

He made a mental note to inquire whether
Shiv wanted a turn with the models, too.
That boy thought with his hands, and
it would be easier to teach him where
it was or wasn't safe to stab someone
if they had a model for reference.

"Now that you've seen how the organs fit,
try to imagine that inside your dummy,"
Dr. Bloch said, showing them
the hand positions again.

"This makes so much more sense
now," Tremon said. "Thanks, doc."

Dr. Bloch left Tremon practicing that
and moved along to Dustin, who was still
hesitating before touching the dummy.

"You need to be brisk about this,"
Dr. Bloch said. "Remember, you only
have four minutes before brain damage
begins to set in -- or rather, he does."

"I know, I know," said Dustin.
"It's just creeping me out."

"Plenty of people feel squeamish about
CPR," said Dr. Bloch. "It's nothing to be
ashamed of; you just need to account for it."

"Like how?" Dustin asked, looking down.

"Work through this on the dummy, so that
you don't freeze up with a real person,"
said Dr. Bloch. "Actually, stop trying to do
the compressions for now, and just handle
the dummy until you get accustomed to it."

"Okay, I'll try that," Dustin said, and
pulled the rubbery blue torso into his lap.

Dr. Bloch checked on Kincade and Sanquez,
who had -- without being told and before getting
any instructions for it -- teamed up together,
much as Kincade had with Travis earlier.

"You two look ready to come up and
try the scoring mannequin," said Dr. Bloch.

Kincade followed along willingly enough,
until he saw the device itself, and
then he stumbled back from it.

"What's wrong?" Dr. Bloch asked.

"The guy I lost, he was ..."
Kincade's voice trailed off.
He looked at the mannequin,
then looked away again, blinking
a little too fast and swallowing hard.

"... dark of complexion?" Dr. Bloch guessed.
The mannequin had the ebony skin tone
that was barely lighter than true black.

"Yeah," said Kincade. "Seeing it
on the floor like that just threw me."

"Is this going to be a problem?"
Dr. Bloch said. "You did fine
with Jimar the other day."

Kincade took a deep breath, and
Sanquez put a steadying hand
on his shoulder. "I think, in
a real emergency, I'd do okay,"
he said. "In class it's different."

He was still shaking, so Dr. Bloch
leaned in to say, "Sometimes people
handle a crisis well, but then they
fall apart later, when it's safe. I learned
to work through it in medical school. It's
okay, it's even a good safety feature."

"Doesn't feel okay," Kincade said.

"All right, let's deal with that so it
doesn't interfere with your class,"
said Dr. Bloch. "You usually go to
Father Elliott for personal issues, right?"

"Yeah," Kincade said. "He's pretty good,
and he doesn't lean on me too much."

"How about discussing this with him?"
Dr. Bloch said. "Maybe it would help
to get it off your chest, or he could
say a prayer for the friend you lost."

"I never thought of that," Kincade said.
"Thanks, doc, I may give it a try."

"If you're concerned about your response,
that's all right too," said Dr. Bloch. "Later on,
we'll be covering emotional CPR for people in
crisis, and that module expands on the basics of
emotional first aid. You might find some of that
helpful. Just remember, no matter how long it's
been or how well you've healed, a direct hit to
a painful memory will still make most folks flinch."

Kincade looked at the mannequin and swallowed
hard. "May be normal, doc, but I'm still stuck."

"Why don't we just switch to the other one
for today?" Dr. Bloch suggested. "Ragno
shouldn't mind trading places, and it will be
easier to see some things on his mannequin
anyhow, because that one's a Hispanic model."

"What's that supposed to mean?" Sanquez said.

"Oh, there's a projector and a program for
modifying the skin tones slightly with overlays
of light," said Dr. Bloch. "It mimics things like
cyanosis and a few other symptoms of distress.
But you can't see much of it on the darker models,
which matches the clinical challenges of treating
patients who have high amounts of melanin."

Sanquez turned his hands over and back,
comparing their light brown tint to
the darker sorrel of Kincade's.

"So how do we deal with it?" he asked.

"That, Mr. Abarca, is an excellent question,"
said Dr. Bloch. He clapped his hands.
"Everyone, please gather around. I'd like
to demonstrate something, and I could
use another volunteer or two who
have different skin colors."

Almost half the class raised their hands.

Dr. Bloch grinned. "Well, you're certainly
enthusiastic today," he said. "Let's just line
you up in a spectrum, I haven't had enough
volunteers to do that since medical school."

He sorted them out in order from darkest
to lightest, pointing out the differences
as he moved them into position.

"All right, we have Mr. King, Mr. Elliston,
Mr. Abarca, Mr. Rappalino, and Mr. Vanburen,"
said Dr. Bloch. "Notice how easy it is to see
bruises or scrapes on lighter skin, but then
it gets harder the darker the skin gets."

He pushed up his own sleeve to show
where he'd backed into a filing cabinet.
"This happened two days ago, and you
can already see the color on my elbow
changing from fresh red to darker blues
and purples," Dr. Bloch explained.

"Yeah, I whacked my shin on the bed
yesterday, but it barely shows," Verne said,
pulling up the leg of his pants to display it.

"Now in CPR, we tell students to watch for
symptoms like cyanosis -- that's a blue tinge
to the skin or lips, caused by low oxygen,"
said Dr. Bloch. "The catch is, it's difficult
or impossible to see on darker skin."

"Then what do we do?" asked Travis,
staring at his pale pink arm beside
Ragno's light olive skin.

Kincade chuckled. "We ain't black
everywhere like a chow dog," he said.
"We're still pink on the inside. I'd say
try looking there." He glanced at
Dr. Bloch for confirmation.

"That's very astute, Mr. King,"
said Dr. Bloch. "You can check
the color of mucous membranes --
the corners of the eyes, inside the mouth --
and fingernails while checking for a pulse.
A bluish tint means that your patient is
already in serious trouble."

"What about soups?" asked Travis.

He was manipulating Ragno's hand
quite gently, weaving the tinted fingers
with his own fair ones, and Ragno was
letting him. Dr. Bloch was impressed again
with Travis' knack for gaining the body-trust
of wary inmates so quickly and completely.

"What do you mean?" Dr. Bloch said,
watching the two of them interact.

"Well, the crayon soups come in a lot of
unusual colors," Travis said. "How do
you check for cyanosis on someone who
is normally blue? Has anyone made
CPR dummies that look like soups, so
we can practice handling those like we're
learning the black and Hispanic ones?"

Dr. Bloch sighed. "As far as I know, nobody
is making soup mannequins for CPR," he said.
"We just don't know much about soup care yet.
You can try checking mucous membranes, but
some crayon soups are colorful all the way
through. Be careful, though, because soups
can get sensitive about their appearance,
or skittish if they've run into hostility."

"So it's like, don't pat your black friend
on the head," Alejándro said. "Okay."

Hastily Travis let go of Ragno's arm.
"Sorry," he said. "I didn't mean to be rude."

"You were fine," Ragno said quietly.
"I would've said something if you weren't.
You're not grabby like some people."

"You and Shiv both have bodies
that look pretty normal," Travis said.
"What about someone with, I don't know,
wings or fur? How do we deal with that?"

"Use your common sense," said Dr. Bloch.
"There are minimal guidelines, so that's about it."

"I don't like fumbling in the dark," said Travis.
"Someone's liable to get hurt, and I already
messed up enough on that front."

"Does anyone else know more
about crayon soups and their care?"
Dr. Bloch said. "Ragno, what about you?"

The young man shook his head.
"I don't know anyone like that."

"I do, and I can make it count," Dustin said.
"Any time someone's soup stuff goes out,
that's a bad sign. Like if a guy's eyes glow,
and they turn dark, or if a girl's skin is red
and it sort of bleaches out, that can mean
they're too low on power to keep it up.
That happens when they're sick or hurt."

"Thank you for that vital observation, Mr. Hall,
that was extremely helpful," said Dr. Bloch,
making a mental note to award him points.
"I wonder if the mechanism is anything like
the one in fish and reptiles -- oh, never mind,
it's way past what you need to know for this class,
and soup care is esoteric stuff. Just remember
that fading traits suggest a patient in distress."

"There are other things too," Ragno said.
"Just because we might look ordinary,
doesn't necessarily mean we are."

"Like what?" Tremon asked. "I know
the doc said not to give street drugs
to telepaths, but what else?"

"Some of us have more than four minutes,"
Ragno said quietly. "I'm not saying you
should rely on it, just be aware of it."

"How much longer, if you don't mind
my asking?" Dr. Bloch said. "It's relevant."

"I don't know," Ragno said. "I just know
it can be a lot longer than usual. I almost
drowned when I was twelve, but I had
no lasting damage at all from it."

"Ten minutes? Twenty?" Dr. Bloch guessed.
"In frigid water, drowning victims can sometimes
be revived successfully after a long time."

Ragno looked down. "More like half an hour,"
he said, "in summer. Can we skip this part?
I just wanted to point out, a soup might not
be as dead as a nary would be, or they might
wake up and freak out about you pounding
on their chest, and somebody could get hurt."

"Duly noted, and I'll stop prying," Dr. Bloch said.
"Everyone, pay extra attention for signs of life in
soup victims. I do know that many superpowers
have a defensive mode that can act reflexively, so
Ragno's warning is a credible one. That doesn't
mean you should abandon a distressed soup,
just be ready to let go of them in a hurry."

Raul rubbed a hand up and down
Ragno's back. "Are you okay?" he said.

"Fine, I just usually don't talk about this,"
Ragno said, shaking himself off.

"If a soup tells you anything about their powers,
keep your mouth shut about it," Travis added.
"That means they really trust you. Also, you
could get them hurt if you blab it around."

Looking around the room, Dr. Bloch
realized that he had gathered some of
the most trustworthy inmates in the prison,
which boded well for the class. "Understood,
Mr. Vanburen, thank you for the reminder," he said.

"Can we just do the group therapy rules?"
Dustin said, raising his hand. "Presence,
Safety, Discretion, Respect, and Honesty.
I think that covers what we need."

"Yes, let's do that," said Dr. Bloch,
and the group scattered back to practice.

"I was thinking, I'm having trouble with this
because it's all a jumble and I'm not so good
with hands-on work. I'm great with information,
but I need that to be organized," Dustin said.
"Does this stuff come in a flow chart or a grid?
Dr. G makes lists in therapy, and it really helps."

"There are basic and advanced flow charts
for CPR, much like for triage, to help you make
the right decisions and follow steps in order,"
said Dr. Bloch. "I believe there are also grids
comparing one and two rescuers, or changes
over time. I'll look them up and send you some."

"Thanks, I really appreciate it," Dustin said.
"I'll practice more now, and after I've looked at
the materials, I'll try again to see if I'm better."

Dr. Bloch looped the room again, giving
pointers and encouragement as needed.

As he returned to the teacher's desk,
he noticed that Ragno was running into
difficulties again. "What seems to be
the problem now?" Dr. Bloch asked.

"I got the compressions right, sort of,
so I switched to rescue breathing,"
Ragno said. "I can't get the air in,
and I don't understand why. I
didn't have this problem before!"

"The basic dummies aren't as complex
as the scoring mannequins," Dr. Bloch said.
"With this model, you have to tilt the head
into the proper position, or the airway stays
closed and you can't inflate the lungs."

"Yeah, but when I move the head like
you said to, it just flops back where it was,
and I don't have a spare hand to hold it,"
Ragno said. "I can do the rescue breathing
with Mr. Bonaventure but not alone."

"Okay, think it through," Dr. Bloch said.
"A person with two hands could brace the neck
with one while pinching the nose with the other.
How could you meet the goals with one hand?"

"I tried propping it over my stump, but that
still hurts," Ragno said. "I don't know
what else to try, I'm not a doctor."

As much as he complained about
people treating him like a child, he
also tended to give up too quickly
and let others do things for him.

Raul reached for a spare yoga mat.
"Well, you could try --" he began.

Dr. Bloch held up a hand. "Wait.
Ragno needs to learn how to figure out
solutions for himself," he said. "I'll set
my vidwatch for five minutes, and if he
hasn't got any ideas by then, we can hint."

Ragno glared at him, but went back
to fiddling with the mannequin in hopes
of getting the airway to stay open.

Just after three minutes, he noticed
the spare yoga mat and started trying
to use that to prop the neck up. It took
him a few tries, but soon he managed
to make the chest inflate properly, and
the mannequin chimed approval.

"I did it!" he said, grinning at them.

"Well done, Mr. Rappalino," said Dr. Bloch.
"Remember this technique for the future --
and when you have any kind of problem,
try some different solutions until you find
something that works out for you."

"Thanks for keeping after me," Ragno said.
"I want to do things on my own, I just
don't know how to get there yet."

"You'll learn," Dr. Bloch said. "Meanwhile,
I'll consult with some other instructors and
see if I can turn up some more methods
that work for disabled citizen responders."

"People with disabilities really do this stuff?"
Ragno said wistfully, looking up at him.

"They do indeed," said Dr. Bloch.
"Quite a lot of dispatchers and radio hams
have a disability, because those don't require
much physical activity. They often add on
whatever other emergency skills they can
find ways of doing. You don't have to let
your limitations define you, just guide
the way you approach your goals."

"You heard the man, let's get back
to practicing," said Raul.

Another circuit around the room
revealed relatively few problems.
Most of the students had, if not
figured out the whole process,
at least decided on something
to focus on for the time being.

Elliott was alternating notes with
compressions, trying to identify
which pose worked better for him.

Verne had just about got the hang
of the child mode on his dummy.

"Next time, I'll show you how to do
the infant version," Dr. Bloch promised.
"I have basic dummies in that style, and
the hospital should have a scoring mannequin
that I can borrow for you to test on later."

"Wow, thanks," said Verne.

Then Raul whistled for him, and
Dr. Bloch hurried over. "What's wrong?"

"I don't feel too good," Ragno said.

"Headache? Nausea? Vertigo?"
Dr. Bloch asked, running a quick check
of the young man's body as he talked.

"Headache, yeah, and it feels like
the room's spinning," Ragno said.
"Plus my stump is killing me."

"You've been working hard,
which raises your blood pressure,
and rescue breathing lowers oxygen,"
said Dr. Bloch. "That's probably why
you feel that way. Lie down. I'll get you
some ibuprofen. If you don't feel better
in ten minutes or so, then I'll check again
to see if something else might be wrong."

Nurse Scott was right there with
the first aid kit and a bottle of water,
which Dr. Bloch passed to Ragno.

"Thanks," Ragno said. He took
the pills and a long drink, then
stretched out on the yoga mats.

"Here, put your feet up," Dr. Bloch said,
rolling a spare mat to tuck under
Ragno's ankles. "That should help
move blood toward your head."

As Dr. Bloch moved away,
Dustin flagged him down.

"Is Ragno okay?" he whispered.
"I try not to pester him, but you know,
sometimes I still worry about him."

"He'll be fine, he just overdid it
a little bit. That's normal at this stage,"
said Dr. Bloch. "What did you want?"

"Can I try the scoring mannequin?"
Dustin said. "I'm still having trouble
finding the right place to push, and
those look more like a real person."

So Dr. Bloch led him to one
and showed him how to find
the landmarks again, talking about
the anatomy and suggesting that
Dustin use the model again.

"Yeah, that helps," said Dustin.

Dr. Bloch checked his vidwatch and
realized that their time was almost up.
"Five minute warning, gentlemen," he said.
"Find a stopping place, and then you
should start putting things away."

The activity wound down,
then shifted toward cleanup.

Ragno sat up slowly, but seemed
to be fine, so Dr. Bloch merely kept
an eye on him as he rolled up
yoga mats and tied them.

Just then, Nurse Espinoza
arrived with several boxes of pizza.

The inmates all looked up in surprise.

"This is your public perk for participation,"
Dr. Bloch said as he spread the boxes over
the teacher's desk. "There's no point trying
to keep it a secret, since everyone will
smell it on you anyway. Dig in."

They all crowded around the desk,
calling out the flavors and then
grabbing slices of their favorites.

Dr. Bloch and Nurse Espinoza
passed around paper napkins.

The students chattered happily about
the class and their accomplishments,
exchanging good-natured complaints about
their assorted difficulties. Some of them were
even making plans to get together and study.

"You may borrow dummies from
the infirmary, or practice on a pillow,"
Dr. Bloch said. "Do not practice on
each other; that's too dangerous."

"We'll take care," Kincade promised,
and everyone murmured agreement.
"We really want to learn this stuff."

If there was one thing Dr. Bloch enjoyed
about working with a criminal population,
it was their capacity for self-redemption.

They might not be good men yet,
but he had faith that they could be.

* * *

Notes:

Kincade King -- He has brown skin and black eyes. He has black body hair, but his head is completely bald. He has prison tattoos over much of his front, his left arm, and a little on the right. Across his collarbones is a large banner saying "Lord Have Mercy" and his belly says "Warrior." Originally an enforcer, Kincade worked his way up to boss. His gang outside deals primarily in protection services and the occasional side of revenge-for-hire. He is currently serving time in the Nebraska State penitentiary in Lincoln, where he leads most of the black inmates. Kincade grew up in the inner city and has little education. He has quite a sweet tooth, and loves chocolate. He also appreciates cars, with a good grasp of models and mechanics.
Qualities: Master (+6) Gangster, Master (+6) Tough, Expert (+4) Leadership, Expert (+4) Strength, Good (+2) Adaptable, Good (+2) Car Fan, Good (+2) Favor Trading, Good (+2) Strategic Thinking
Poor (-2) Uneducated

Sanquez Abarca -- He has light brown skin, brown eyes, and black hair. He has two teardrops tattooed below the outer corner of his right eye, and another on the left, indicating that he has killed three people. His heritage is Hispanic and he is bilingual in English and Spanish. He is currently serving time in the Nebraska State penitentiary in Lincoln, where he leads most of the Hispanic inmates. His outside gang smuggles an assortment of things including drugs, weapons, and people; but they don't do much distribution to end users, they are middlemen connected to a vast network of other criminal organizations. Sanquez is getting older, though, and his battle damage is catching up with him. He has a lot of aches and pains from old injuries.
Qualities: Master (+6) Smuggler, Master (+6) Networking, Expert (+4) Logical-Mathematical Intelligence, Expert (+4) Reading People, Good (+2) Fan of Classical Spanish Music, Good (+2) Constitution, Good (+2) Tolerance
Poor (-2) Stiff and Sore

Verne Christensen -- He has brown skin and black eyes. Although his body hair is still black, the hair on top of his head is soup-dyed a vivid golden yellow. He has a scar through his left eyebrow. At the outer corner of his left eye are two teardrops, indicating that he has killed two people, and the base of his throat bears the word "Sacrifice" in large ornate letters. Verne got those protecting his boss, which makes him well-respected in the underworld. He is currently serving time in the Nebraska State penitentiary in Lincoln, where he is a favorite of the head honchos. His outside gang specializes in technological crimes, and he is unusually well educated for a criminal -- he actually has a bachelor's degree in computer science from the University of Nebraska in Lincoln. He just has an additional taste for physical conflict that doesn't sit well in corporate employment.
Verne also loves aspects of African-American culture. He celebrates Kwanzaa with great enthusiasm, and when free to dress himself he chooses bold African colors and patterns. His girlfriend sends him care packages, but she doesn't quite grasp his tastes, and keeps giving him plain sweaters. He appreciates them anyway. Verne and his girlfriend have a daughter together, a toddler whom Verne has never met because she was born after his conviction. This makes for some awkward family dynamics.
Qualities: Expert (+4) Bodyguard, Good (+2) African-American Culture, Good (+2) Hacker, Good (+2) Loyal, Good (+2) Reputation
Poor (-2) Awkward Family Dynamics

Dustin Hall -- He has tawny-fair skin, brown eyes, and curly black hair to his shoulders. His heritage includes Winnebago Omaha, Mexican, Nepalese, and American. He's been called everything from "spic" to "prairie nigger" -- also "spoon-licker" because he likes people with superpowers -- and is heartily sick of all of it. He is 21 years old.
Dustin used to handle supplies for Boss Batir in Lincoln, Nebraska until he was captured in a police raid on a weapons cache. He is currently in the Nebraska state penitentiary in Lincoln. There he networks with Ragno and some other inmates run the shadow economy of the prison. He's happy to deal in light contraband, doesn't really want to deal in weapons anymore, but feels conflicted about whether or not to return to his old boss. Who has done bupkis to help him in prison.
As a quartermaster, Dustin can find just about anything, anywhere, and enjoys the challenge of getting the goods. He is a people person, but until recently he hasn't been around very good people. He's very good friends with Ragno, and completely freaked by the chayne incident. Shiv made Dustin uneasy before the incident, and downright frightened after it.
Qualities: Expert (+4) Quartermaster Skills, Good (+2) Loyal, Good (+2) Supervillain Henchman, Good (+2) Strength
Poor (-2) Internalized Oppression

Tremon Elliston -- He has light brown skin, brown eyes, and nappy black hair. Growing up poor and black has left him with low self-worth, a problem worsened by his experiences with the legal system. People think badly of him, and he tends to agree with them. Tremon is a drug dealer who prefers to peddle medical-grade materials on the street, and he pays attention to the interaction between different types of drugs. He is currently serving time in the Nebraska State penitentiary in Lincoln.
Qualities: Good (+2) Prescription/Prohibited Drug Interface, Good (+2) Thoughtful, Good (+2) Strength
Poor (-2) Internalized Oppression

Alejándro Duran -- He has fair skin that tans dark, green eyes, and dark brown hair cut short with a short beard and mustache. His parents are Puerto Rican but they moved to Nebraska in 1975. His heritage includes Spanish, Greek, and a little American. Alejándro has a Ñeta gang tattoo and shares their loathing of abusers. He has a serious tendency to hold grudges, too. He is currently serving time in the Nebraska State penitentiary in Lincoln, where he allies with other Hispanic inmates. He is one of Ragno's contacts for trading contraband.
Qualities: Good (+2) Loyal, Good (+2) Observant, Good (+2) Smuggler, Good (+2) Subtle, Good (+2) Tough
Poor (-2) Unforgiving

In T-America, the Ñeta gang specializes in "mellow" drugs, primarily hallucinogens and downers. Ñeta means "worm" in Spanish but also is an acronym for Never Ever Tolerate Abuse -- a reference to their violent vendetta against pedophiles, sex offenders, and other abusers.

Ragno (Corrado Rapallino) -- He has light olive skin, black eyes, and short wavy black hair. He is missing his left arm from just below the elbow, after a superweapon incident; and he was left-handed, which makes the adjustment more difficult. He is Italian-American, and his ancestors came from Genoa. Corrado excels at dealing with people, primarily in the underworld but also in more honest areas. He's not picky about the divide between soup and nary either. While his physical strengths protect him from the worst risks of smoking, Corrado is keenly dependent on tobacco for pyschological reasons. He gets incredibly antsy and cranky without it. He also likes stringy foods and enjoys picking them apart with his fingers: licorice laces, spaghetti squash, any jerky that's soft enough to shred, string cheese, etc. Other favorites include Italian food, carbs, and cured meats such as pepperoni.
Amusingly, people often think his cape name -- which means "spider" -- implies that he has Spider Powers. He doesn't. He has supernal constitution, which enhances his resistance to disease or toxins, as well as enhancing his stamina. The name refers to his skill at building networks. Ragno views other people kind of like human tinkertoys: not for sake of manipulation, but to see how big a structure he can make with them. Although he does not belong to the Marionettes, he has worked with them and for them as muscle or button man as needed. Most recently, Ragno was a witness to an incident that the police would very much like to hear about. They offered him an excellent deal, and he turned it down, so the Marionettes are pleased enough to be working on getting him out of jail. Ragno is currently serving time in the Nebraska State Penitentiary in Lincoln. He is doing quite well as a smuggler of cigarettes and other contraband indulgences.
Origin: Ragno got his Super-Immunity from the Aegis vaccine base, and his Super-Constitution developed later. His body seems to be slowly optimizing itself.
Uniform: Currently provided by the Nebraska State Penitentiary, a zebra uniform with reflective white stripes. Outside, he wore street clothes.
Qualities: Master (+6) Loyalty, Expert (+4) Making Connections, Expert (+4) Tough, Good (+2) Alternative Economics, Good (+2) Iron Will, Good (+2) Leatherworker, Good (+2) Mobster, Good (+2) Wine Connoisseur
Poor (-2) Smoker
Powers: Average (0) Super-Constitution, Average (0) Super-Immunity
Motivation: To put the pieces together.

Raul Bonaventure -- He has tinted skin and brown eyes. His brown hair curls at the ends where it brushes over his collar, and his hairline comes to a sweetheart point. His heritage includes Italian, Spanish, and American. Raul is married with four children: a 5-year-old boy, 3-year-old boy and girl twins, and an infant girl. He serves as a guard at the Nebraska State Penitentiary in Lincoln. The salary is decent, but it's hard to cover a family of six people, especially with his wife staying home to take care of the kids.
Raul has a keen interest in trading, although he isn't very good at it yet -- everything from swapping collectibles to day-trading stocks. He has the potential, but not the skills, so he has made friends with Ragno, Dustin Hall, and the other reliable middlemen among the inmates. He helps them with their social skills, points management, or whatever, and they give him tips about making good trades.
Qualities: Expert (+4) Fairness, Good (+2) Prison Guard, Good (+2) Sociable, Good (+2) Strength, Average (0) Trader
Poor (-2) Too Much Month Left at the End of the Money

Travis Vanburen -- He has pinkish-fair skin, brown eyes, and dark brown hair buzzed short. He has a large frame and a layer of padding over his muscles. Travis has a little sister born when he was two and a little brother, Joey, born when he was five. Their mother passed away a few days after Joey's birth.
Smarter than he looks, Travis does best with emotional intelligence and also excels at convincing people to do what he wants. He is fair and honest. He works as a guard at the Nebraska State Penitentiary in Lincoln. On the downside, Travis often jumps into situations before he has all the information needed to make the right decision. He's serious about making amends for his mistakes, though. After beating up Shiv, he makes a point of apologizing.
Qualities: Good (+2) Brave, Good (+2) Conscience, Good (+2) Convincing People, Good (+2) Model Train Collector, Good (+2) Smarter Than He Looks, Good (+2) Strength, Good (+2) Wrestling
Poor (-2) Jumps to Conclusions

Everett Howard -- He has toffee skin, black eyes, and short nappy black hair with a beard and mustache. His heritage is primarily African-American with a dab of Chinese and one Oglala ancestor. Everett gets cold easily, and prefers to dress in layers. He lives in a modest suburban house with his wife and their four children. They participate in a lot of community activities together.
Everett teaches at the Nebraska State Penitentiary in Lincoln. His classes include Reading, Writing (nonfiction, fiction, and poetry), Literature, and Theatre. He also helps the inmates to analyze their academic strengths and weaknesses, then develop a plan to meet their educational goals. He uses primarily black and Hispanic authors, matching the ethnic mix of this prison, to show his students that people like them can make great literature and it can deal with topics relevant to their own experiences. Everett loves literature, loves his job, and often fails to remember that not everyone else is necessarily excited about the same things he is. As a result, he tends to get along poorly with introverts.
Qualities: Master (+6) Linguistic Intelligence, Expert (+4) Optimist, Expert (+4) Prison Teacher, Good (+2) Activist, Good (+2) Roleplaying, Good (+2) Tireless
Poor (-2) Excitable

Dasante Scott -- He has milk chocolate skin, brown eyes, and nappy black hair buzzed almost down to the skin. His heritage includes African, American, and Scottish. As a teenager, he worked odd jobs. Dasante earned a scholarship to become a Nurse Practitioner, and currently works at the Nebraska State Penitentiary in Lincoln. His quick thinking and knack for connecting people with opportunities have made him adept at filling in whatever needs to be done.
Qualities: Good (+2) Cheerful, Good (+2) Connecting People, Good (+2) Jack of All Trades, Good (+2) Prison Nurse, Good (+2) Strength
Poor (-2) Light Sleeper

* * *

"It is his capacity for self-improvement and self-redemption which most distinguishes man from the mere brute."
-- Aung San Suu Kyi

CPR classes yield a certification good for two years, and the information is constantly updated regarding best practices, although finding the newest material can be difficult in local-America. In Terramagne-America, information is more widely available but there are delay phases if someone fails a test, designed to incorporate further study: one week after the first failure they can retry, and one month after the second failure; but if they fail a third time, they have to wait six months and retake the whole class.

There's a ton of information on this topic. Knowing the anatomy of the heart helps understand how CPR works. Notice that Dr. Bloch is perfectly happy to put the bottom rungs on the ladder, letting Shiv study at his own comfort level instead of pushing for more. Statistics show dramatic value in CPR training -- prompt assistance can double or triple a victim's chance of survival. Study how to perform chest compressions and rescue breaths. Watch a video of adult CPR. Read about and watch techniques for two-person CPR.

CAB stands for "Compressions, Airway, Breathing." Best practice currently recommends starting compressions prior to checking the airway. However, I'll remind you of the EMT saying, "If you don't have an airway, you don't have a patient." Don't get so caught up in compressions that you forget to check the airway and the circulation, because if air can't get in or there's not enough blood to carry oxygen, your patient is going to stay dead. Hands-only CPR is recommended if there is only one rescuer or people hesitate to do rescue breathing. See a video of this method.

Age matters in CPR, as the techniques vary somewhat based on body size. Read about and watch a video of CPR for infants under 1 year old. Here are the methods and a video for children from 1 year to puberty (around 12).

People have a lot of misconceptions about CPR. Other worries include hurting the person worse. For most practical purposes, you cannot make a dead person worse! Rib fractures and dislocations do happen in CPR, more often with elders or children, or due to poor technique; but they're not rare in general. Keep going. Only stop for the standard exit routines.

Ideally, you should use protection while performing CPR, and better yet, practice with it in class before you need it live. A pocket face shield is better than nothing, cheap and light and portable. A pocket mask is better. There are instructions for mouth-to-mouth mask-assisted CPR and bag-valve-mask ventilation.

Many options are available for CPR training. You can learn in person or take online classes. These courses are free but require registration, because they give certificates of completion. This kind of instruction is ubiquitous in T-America; any community center, community clinic, or hospital will offer free classes at least once a year and usually more often. Paid classes are available almost any time; it's just a matter of finding a provider near you and checking for the next available class. Even most of those will waive the fee if you have a concrete need for it, like someone in your family has heart trouble. Here is an extensive archive of videos. Read about how to pass a CPR exam.

Automated External Defibrillators save lives by restoring an effective heart rhythm sooner, greatly increasing chances of survival. T-America requires them in some places, but the laws haven't caught up with best practice everywhere. Warden Daley didn't authorize expenditures for these -- they're not cheap -- but one of the first things Warden Lincoln did was discuss medical upgrades with Dr. Bloch. So now they have a professional model AED in the infirmary, plus a layperson model AED in the main hub, the gym, and finally near two clusters of cells in the standard wing and the privileged wing that house older and less-healthy inmates. That covers the places most likely to see a sudden cardiac arrest. Many T-American models have a full-color viewscreen with audio and video instructions, and can be connected to the internet for updates. Read the instructions or watch a video about using AEDs.

For prison security, the AED storage cabinets lock, which is not standard for emergency equipment in most locations; the usual security measure is just an alarmed cabinet. Each cabinet has a swipe slot that responds to staff ID cards, and the handful of inmates who pass the CPR class get a card that will open just those locks. After careful discussion of security vs. safety vs. prosocial encouragement, Dr. Bloch and Warden Lincoln decided to introduce access to advanced first aid supplies as an earned privilege, allowing inmates to move up a chain of responsibility by demonstrating their trustworthiness. This is typical of how T-America reintegrates former offenders into society, instead of locking them out permanently. It also gives them a very valuable pool of former criminals who can care for and mentor current ones, which promotes a variety of helpseeking behavior among people who frequently resist help from outsiders.

This feeds into a number of programs that combine online classes in prison with hands-on sessions meant to be completed after release, which give departing inmates access to job skills and certifications that greatly improve their chances of employment and therefore success. An example is the EMT program. In L-America, there's only one hands-on site, in Idaho. In T-America, a majority of states have at least one location for practical training in support of online classes, plus regional offices to cover the states that don't have their own. Nebraska's is right there in Lincoln; most states put theirs in the capital. This is how they get that ~10% citizen responder proportion.

There are other reasons for learning CPR too, including compassion and prosocial behavior. Superpowers and CPR have connections as well. This article also mentions in passing a hidden reason to learn CPR: a scary situation is less overwhelming if you know how to handle it. That lowers your risk of traumatic stress disorders, which are prevailingly caused by a sense of helplessness and horror during an emergency. Supernaries learn to function on a super level through intense training; CPR is one option for that. In T-America, the citizen responder proportion is around 10% of the total population. For them as well as superheroes, about 90% of them have earned CPR certification. However, many other citizens have had the training at least once, even though not many of them keep their certification current. Notification apps are ubiquitous, which means a majority of victims get bystander help before the ambulance arrives, and that greatly increases the survival rate. Heartlines is among the most popular in T-America.

Emotional CPR (eCPR) lies between the basic Emotional First Aid and the Emotional Trauma Care available in the shock room at a T-American hospital. ECPR includes a variety of skills for supporting someone in crisis. It is especially useful for law enforcement, and similarly, in prisons. By teaching the most stable and best respected inmates these skills, they will gain more tools for intervening before an emotional crisis turns into a physical altercation. Like the physical version, eCPR can save lives.

I got into a discussion with some readers about disabled people learning CPR and other first aid. Because what are you going to do if someone goes down and you're the only other person there? Stand around with your thumb up your ass, if you have thumbs? I was pleased to discover that there is CPR training for disabled students. It's pretty rudimentary by my standards, as revealed in things like this: "There are three main critical objectives that need to be met for CPR certification 1-to get on the floor, 2-To be able to give an effective breath (making the chest rise) and 3-to be able to give effective chest compressions." T-America has a modified course for people with disabilities. Instead of specific methods, it teaches problem-solving; and instead of scoring prescribed steps, it scores effectiveness rated on a gizmotronic mannequin. (Regular classes prefer to score by mannequin, but not everyone can afford those, so some do it by steps and instructor observation instead.) The written test is modified to discuss theory, regular steps, and also accommodations. A module is available for students who cannot perform the physical motions, so that they are trained to instruct others what to do. (Cheersquad has this version, which is based on dispatcher training.) Here is a look at CPR with limited mobility. This essay by a one-armed nurse discusses prejudice, the use of creativity to find alternative methods, and the importance of figuring out how to do things for yourself. However, not everyone is willing and/or able to learn first aid. If you're not, then you need to make an alternate plan for handling emergencies. You can choose a different job, like calling for help, or make sure you're always around someone else who can respond. It's okay not to be a responder; it's not good to ignore the issue altogether.

Adapting to an acquired disability takes a lot of work. Ragno is still struggling with grief and anger over his loss. That's primarily aimed at the physical limitations -- he doesn't blame Shiv -- so it will decrease as he relearns how to do more things. Resilience interventions can help people adjust to a new disability such as limb loss. Basically this is what Dr. Bloch does with Ragno: watch for problems, step in, and help him figure out his own solutions without either leaving him to flounder or doing everything for him.

Learning style describes the fact that different people acquire knowledge in different ways. There are various models of this, so I'll be rambling across those. Understand how to get the most out of your learning style and how to help children succeed with theirs. Here are some study tips. The basic CPR manual works great for read/write learners, who may flounder with hands-on presentation, and as backup for everyone.

Visual-spatial learners need to watch demonstrations, and also benefit from handouts such as activity books or anatomy and physiology coloring books. This poster illustrates the CPR steps. In these coloring pages, Safety Fred demonstrates CPR; there's a whole set of safety superhero pages. Here's a page showing rescue breathing. There are whole-body and thoracic coloring pages for anatomy. This page presents thoracic bones. These cover the anatomy of the heart and its functions.

Kinesthetic, tactile, or touch-dominant learners need different approaches. They learn well through 3D models. This is a cheap, basic model of human anatomy adequate for many purposes. This is an expensive, detailed model meant for medical students which also benefits advanced first aid classes such as CPR. Notice that Dr. Bloch has obtained materials in anticipation of diverse student needs, and brings them out as necessary. This is what it looks like when everyone's learning style is supported in a classroom. Not every class in T-America is this good, or half those guys wouldn't be in prison; but that's the ideal.

CPR mannequins come in different styles based on budget and clinical needs. I once had to practice on a dummy made from a bleach jug, a plastic bag, and a stack of books; which made a lousy experience even worse. Don't skimp. Dr. Bloch has obtained enough basic mannequins for everyone to practice at the same time, and two gizmotronic scoring mannequins for students to share once they understand the steps. The gizmos measure pressure, depth, and number of compressions; air pressure, volume, and number of breaths; and some aspects of correct practice such as hand position. They can be set to give various types of instruction, confirmation of good technique, or correction of poor technique. They also have simulation modes for different types of emergency (drowning, heart attack, etc.), statistical survival results (on rare occasions, a mannequin will 'wake up' and start moaning), and/or complications (vomiting, convulsions, etc.). Ribs are anchored with magnets and, if the force is sufficient, an algorithm sometimes releases the magnets to simulate broken or dislocated ribs. Full simulation is required for the advanced classes offered to medics but not for citizen responders. Turning on the sims and handling them correctly earns extra credit for citizen responders. These are much more expensive than basic models, but are typically shared among many instructors; Dr. Bloch simply borrowed a couple from the local hospital in exchange for teaching a weekend class in crook care.

Skin color has significant implications in health care, but not all practitioners account for that. Studies show the differences in assessments as a result. T-American mannequins typically come in a range of colors. The cheap ones may have only one tone, but it's a primary color such as blue, not an ordinary skin tone. Average mannequins have five skin tones such as pale, tawny, light brown, terra cotta, and dark. The gizmos have the full ten of alabaster, bisque, peach, amber, buff, olive, toffee, terra cotta, mahogany, and ebony. People are currently debating whether to offer 'crayon' colors to practice soup care, but so far nobody's manufacturing those. Soup mannequins exist only as gizmos made for soup organizations, mostly Kraken. Most people don't know about them. Cyanosis is a blue tinge to the skin which is more challenging to diagnose the darker a person's skin is. Typically a color gradient appears with pale palms on dark-skinned people; this is common but not universal in crayon soups. This slide illustrates checking mucous membranes for skin tone.

Yoga mats come in various styles. The prison buys cheap ones in bulk, not just for yoga classes, but for instances like this when it's useful to define workspaces for the students. You can use yoga mats for many purposes.

Study time in a CPR class varies widely. The most basic concepts can be conveyed through video in under 5 minutes,
other online options often run 60-90 minutes, 2 hours for renewal class, 3 hours for basic CPR, 4-6 for first aid, and 2 days for the advanced version for health workers. Dr. Bloch is teaching a course of 2-hour sessions spread over 5 weekdays. It starts with a lecture, then a question-and-answer session, short break, practical exercises, and finally wrapup. The added time compensates for the low education of most inmates, allowing for plenty of repetition, explanation, individual coaching, and practice. Plus they need extra in case an emergency requires Dr. Bloch to leave for a while. This schedule maximizes the chance of success.

Active learning styles include olfactory/gustatory, which is almost entirely ignored in L-America. Learning through the olfactory sense is just one classroom sensory strategy. Mental fatigue lowers test scores, as shown in ACT studies. Unsurprisingly, hungry students can't learn and don't recite well either. A different analysis of courtroom behavior revealed that a break and a snack revive mental energy and decision-making skills. There are other ways to avoid study burnout, too.

Vegetable trays and other appetizers are easy to assemble. Brain foods and herbs can improve cognitive function.

Jicama is popular in Hispanic cuisine, served in many ways. Sanquez loves this stuff, and everyone lets him have first choice of it.

Brie, gouda, and gorzonzola are all popular snack cheeses. When making a cheese plate, offer several categories of cheese so people can try different flavors and textures.

A meat tray benefits from some sweet or spicy condiments. Fig jam can be canned or uncanned. Rosemary jelly may have lemon or mint added to it. Mostarda di Cremona is an Italian condiment made from chopped fruit in a mustard sauce. You can buy some or make your own. A package of mixed crackers rounds out a snack tray very nicely. Try to keep them away from wet ingredients, as soggy crackers are no fun.

Calming down is an essential part of emotional intelligence. Understand how to calm down an upset person and some helpful things to say (other than "calm down" which is often counterproductive). Know how to cope with frustration and teach a frustrated student.

Prosthetic rejection is a serious concern. There are many reasons why people decide not to try a prosthesis. Rejection rates are especially high in upper limb replacements, often due to a vicious cycle. People argue over which type of prosthesis is best, which is largely determined by user needs and stump characteristics. Here is one catalog of replacement arms. The problem Ragno is having is not with attaching a prosthetic to his remaining arm, but attaching it to his mind. If nothing he's been offered feels even potentially usable, no amount of training can fix that. It's a proximal disconnect, they don't know why it's happening, and it frustrates everyone. And yes, this can happen, although it's rarely mentioned because most of the attention falls on rejection after a fitting. Some people are put off by the feeling of wrongness to the point they never try a prosthesis, or wait until a later model evolves which feels worth trying.

"Stayin' Alive" by the Bee Gees is often used in teaching CPR rhythm. Listen to it on video.

Traumatic stress can cause PTSD or other complains. Trauma appears on a spectrum of scope (single, ongoing, historic, war) and a spectrum of severity (normal ASR, ASD, PTSD, PDSD). This can make differentiation tricky in reaching a diagnosis. Gang life is pretty stressful; many members show symptoms of traumatic stress. Understand how to cope with PTSD or help someone with it.

Kincade's flashbacks come from watching a friend die. He has since taken action to prevent a recurrence, such as this CPR source, but the recent incident with Jimar has really hit a sore spot. Know how to deal with flashbacks or help someone through them. Remember, you don't have to eat the eggplant: it's okay to avoid triggers if fixing them would be more trouble than it's worth.

Chow dogs are famous for having black mouths and tongues. Humans are consistently pink on the inside, even if they have dark skin outside. Crayon soups can go either way, but it is more common for the exotic pigment to follow the typical human pattern than for it to apply solid coloration throughout.

Color changes may come from melanocytes (in mammals) or chromatophores (in fish and reptiles). Stress and illness can cause color loss in fish or reptiles. The same happens with crayon soups, sometimes quite dramatically.

Drowning is survivable ... sort of. While there are tales of people being successfully revived after amazingly long submersion, a majority of those survivors suffer significant impairment. Ragno's case is exceptional both for duration and for high temperature. His Super-Constitution protected him from an incident that would've killed an ordinary person, and that's exactly the sort of thing which tends to reveal people with superpowers. Know how to deal with drowning and near drowning.

There are basic and expert flow charts for CPR. This chart shows victim sizes and numbers. This slide of updates belongs to a slide show about guidelines. Dustin really thinks in organizational terms. He can memorize and handle ludicrous amounts of information, as long as it's sorted in some logical manner. He does really well with flow charts, databases, spreadsheets, and so forth. Some of this material is way beyond what other students could grasp, just as Verne picked up the physical demonstration very fast.

People with disabilities must think outside the box, just to accomplish everyday tasks such as cooking, but this is a learned skill. There are ways to teach self-determination and everyday problem-solving. An inclusive class environment helps this process, not just for students with disabilities, but for others who observe or assist them. Household activities such as cooking teach people how to develop creative solutions. There are steps, practices, and exercises for thinking outside the box.

(no subject)

Date: 2016-11-28 07:01 am (UTC)
technoshaman: Tux (Default)
From: [personal profile] technoshaman
Holy jumpin' CATS, you worked *hard* on this! About as hard as Ragno!

Right then, sharing the shit out of this both because this is the best of a whole string of good poems - the inmates are really doing well for themselves, Kincade and Sanquez in particular - and for all the *practical* stuff, the near-novella worth of *links*....

Re: Thank you!

Date: 2016-12-02 05:12 pm (UTC)
johnpalmer: (Default)
From: [personal profile] johnpalmer
I just wanted to add my thanks - I know how hard writing can be and this is a long piece, with a lot going on, and a lot of buttons you're pushing. It's some prime work.

(no subject)

Date: 2016-11-28 12:59 pm (UTC)
alatefeline: Painting of a cat asleep on a book. (Default)
From: [personal profile] alatefeline
*offers hugs*

This is good poem AND good teaching. It very much spoke to me and to ... prioritizing, which I need to do. Thank you.

Re: You're welcome!

Date: 2016-11-30 04:45 am (UTC)
alatefeline: Painting of a cat asleep on a book. (Default)
From: [personal profile] alatefeline
*nods* Makes sense.

And he's got HELP, which means prioritizing looks like pieces of a building being installed in order, instead of a triage tent with one medic in a disaster zone.

(no subject)

Date: 2016-11-28 04:47 pm (UTC)
redsixwing: Red-winged angel staring at a distant star. (Default)
From: [personal profile] redsixwing
Thanks - this is a really good link compilation, attached to an also-really good poem. I like Ragno's learning process, in this one particularly but across the entire arc.

T-America's focus on different learning modes makes me happy. I'll be exploring some anatomy coloring pages to get my landmarks right again.

I have a CPR certification as of July, but have lost the list of current linkbacks. Would you mind pointing me in the right direction?

Re: Thank you!

Date: 2016-11-29 12:04 am (UTC)
redsixwing: Red-winged angel staring at a distant star. (Default)
From: [personal profile] redsixwing
>>I have some ideas for other poems featuring this development, if you'd like to explore further -- going back to the first introduction of Raul as his assistant, or picking up Warden Lincoln's willingness to allow more adaptive equipment. <<

Ooh. Yes good. I will chew on these and attempt prompts.

>> "Thinking River Thoughts" only needs one verse to be complete.<<

Wow, congratulations! Okay, let's put it to that one. :D

omnomnom

Date: 2016-11-28 06:48 pm (UTC)
From: (Anonymous)
tasty links!

my CPR instructor said at the national conference the AHA was thinking about changing the regs for compressions again to be higher, up around or over 120 for 2 person adult CPR. I'm actively certified as of July this year.

(no subject)

Date: 2016-11-28 08:18 pm (UTC)
kyleri: (Default)
From: [personal profile] kyleri
Om nom jicama! I've wondered if a jicama-apple pie would work, but haven't gotten round to trying it yet...

Re: Yes...

Date: 2016-11-28 09:14 pm (UTC)
kyleri: (Default)
From: [personal profile] kyleri
Perhaps, if I remember, I'll prompt for that...

(no subject)

Date: 2016-11-28 11:06 pm (UTC)
From: [personal profile] daisiesrockalot
I'm certified for CPR as of January this year, I'd like to see more of "The Marble and the Sculptor"?

Learning Styles

Date: 2016-11-30 09:12 am (UTC)
heartsinger: (Default)
From: [personal profile] heartsinger
I really like this. I saw a video last month from a reasonably credible source that basically claims learning styles are not a real thing. I'm not sure what to think. One of their sources is here: http://www.psychologicalscience.org/journals/pspi/PSPI_9_3.pdf and the video is here: https://www.youtube.com/watch?v=V-S_53HmEUA if you're interested in knowing more. I didn't read the detailed version, so I may have missed something important.

Re: Learning Styles

Date: 2016-11-30 04:51 pm (UTC)
thnidu: my familiar. "Beanie Baby" -type dragon, red with white wings (Default)
From: [personal profile] thnidu
Brava!

(no subject)

Date: 2017-01-28 12:37 am (UTC)
From: (Anonymous)
Keep in mind that body type and gender matter too when doing CPR and using the machine. Female bodies (and their bras) can interfere and heavy to obese bodies can cause difficulties in locating the proper areas. Mannequins are useful to learn on, but they can't teach every thing. So it is vital to ask your instructor(s) how to help with people who do not match the male and fit dummy that they are practicing on.
-roserapier

(no subject)

Date: 2017-10-16 11:33 am (UTC)
pantha: (Default)
From: [personal profile] pantha
Wow. Excellent poem, excellent links. Thank you! <3

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