ysabetwordsmith: Damask smiling over their shoulder (polychrome)
[personal profile] ysabetwordsmith
These are the topical notes for "Branded in His Memory."


"The words with which a child's heart is poisoned, whether through malice or through ignorance, remain branded in his memory, and sooner or later they burn his soul."
-- Carlos Ruiz Zafon

A pull-through is a section of road or driveway with a U shape that can have various purposes. Some are used for parking, like this food truck version at a corner. Others manage traffic, like this bus stop that diverts the bike path around an island. There's a town not far from me that has bus stops where it's the bus itself that pulls behind the island. All of them, if they have a lane free at the moment, can be used as turnarounds; some are available for anyone to use for that purpose, while others are restricted for official vehicles. These are especially useful in busy parts of town to reduce traffic hazards, so Cambridge Commons has some.

Technically a mass-casualty incident is any time the number of victims overwhelms the resources of the first responders available. Two medics responding to a car crash with three casualties would qualify. However, in common use, people tend to reserve MCI for situations with a lot of victims. An incident scene needs a number of tasks covered, and the more complicated the scene, the more personnel it needs. Here is one scale of severity in a document that explains how to handle MCIs:

Mass-Casualty Incident Levels
Level 5 MCI (3-10 patients)
Level 4 MCI (11-20 patients)
Level 3 MCI (21-50 patients)
Level 2 MCI (51-150 patients)
Level 1 MCI (over 150 patients)

There are 13 victims that Ansel treats in this scene, plus those who chose other options, plus Bert toward the end, plus people whose injuries haven't shown yet. That makes this incident at least Level 4. It is probably Level 3 by the time you add up all the offscreen victims. It is possible, but unlikely, for this to reach Level 2 after the pending victims have shown their damage.

This incident is unusual for having a large number of people with physically superficial injuries. Even though superpowered injuries always need closer attention than ordinary ones, nobody is at notable risk of dying. There are also dozens of people distressed by the events who need emotional first aid. Compare this to a massive pileup during a bicycle race -- there may be many casualties, but most or all of them will be walking wounded on a traditional triage scale. That makes it important to find other means of sorting people, since they can't all be handled at once by limited responders. Ansel's idea is actually one used by some medics: get the people who don't want your help out of the way and focus on the ones who do. There's usually some who bow out, and since they have both paramedics and a hospital in easy reach, it makes sense to divert people to other resources based on patient choice. Mobilizing the police department's minibus is a brilliant way to transport a significant number of walking wounded: they don't have enough ambulances for that, and T-America uses auxiliary vehicles to transport minor injuries precisely to avoid tying up their Advanced Life Support ambulance. (Bluehill's hospital has one ALS, two BLS, and three light transport vehicles.)

Christian Care Rescue Ministry stocks a MobileAid Hi-Vis XL Incident Command Team Kit for general emergencies.

Triage is the process of separating casualties according to severity. This flow chart gives an example of how it works. You can see the opportunity for mistakes -- an unconscious person might seem much worse than they are, while a walking person might be quite badly hurt but too shocky to feel the pain. Triage sacrifices precision for speed in hope of saving as many people as possible. It mostly works. Triage tags record information on the scene for use in sorting casualties and treating them at a hospital. A simple tag such as MET is good for major disasters or nonmedical responders such as police, and is usually the kind included in disaster response kits. A more complex tag such as AIIRisk is good for local disasters or trained medics. These tags can also be paired in primary/secondary triage with large numbers of casualties waiting.

Fault tolerance is the ability of a system to absorb loss or damage before it collapses completely. A surge plan details available resources, service goals, thresholds of activation, and steps to take when demand rises such as mobilizing additional personnel. Medical surge capacity appears occasionally in references to local-American facilities, but not all hospitals have a surge plan. Surge hospitals include closed medical facilities that can be reopened, nonmedical facilities that can be borrowed, and mobile units that can be deployed wherever needed. T-America requires hospitals to have a surge plan, most other emergency services do too, and so do other organizations that experience large variations in demand such as utility companies. Any business that has surges of activity will benefit from a surge plan, and it also works if you have several employees absent at once, so this is something lots of folks could create and use. In this case, a homeless shelter makes a fine temporary medical center until people can be moved to the hospital.

T-America makes wide use of high-visibility vests to indicate staff roles during an emergency. See the front and back of the Building Incident Command vest and the First Aid Officer vest.

(Some of these links are sad.)
Homelessness is a common and growing problem in L-America, not quite as bad in T-America. Discrimination against homeless people takes many forms. In essence, L-America treats personhood as a paid privilege rather than a right. There are communal and individual ways to help the homeless. Step one, don't abuse them. Best of all, ask them what they need most and give them that, because it varies based on local resources and weather.

(Some of these links are disturbing.)
Bullying is cruel behavior that can cause short-term and long-term harm to everyone involved. This gets even worse with the addition of superpowers. The way to stop bullying is to stop it: to interrupt it whenever you observe it happening and inform the bully that such behavior will not be tolerated. Follow the steps to recover from bullying. Learn how to stop bullying other people.

(These are definitely awful.)
Verbal abuse is hostile language which can take many forms. Know the signs and symptoms of it. Here is a page with many resources on this topic. T-America takes a similar view on language as on bodies: your right to swing your fist ends at my nose. There are constructive ways to respond to verbal abuse and recover from it. Various types of therapy can help. Be prepared to help survivors of emotional abuse. It is possible to switch from violent to nonviolent communication.

Racism is the belief that some ethnic groups are better than others, which leads to mistreating whichever ones the racist happens to dislike. No, just being white doesn't make someone racist, their beliefs and actions do. Yes, anyone can be racist, but the power to act on that belief varies greatly. In L-America, the trend is for white people to discriminate against people of color. T-America is somewhat better off, but still has challenges. It's a lot of work for Luther to drag himself out of his panicking hindbrain to deal with Ansel, and for Ansel to handle Luther without taking his snappishness personally. But it's easier if people are aware of the problems -- Luther has some idea of how to identify helpful white guys and safe cops, while Ansel understands racial triggers and doesn't expect Luther to be as polite or rational as usual. Black people struggle to cope with the anxiety often caused by racism. There are ways to fight racism and stop being racist.

A Comparative Pain Scale is extremely useful in describing the practical effects of pain in addition to its subjective discomfort. A scale of ten faces can be used instead of or in addition to the text/verbal chart. A simpler three-step scale is helpful with skittish or less-articulate patients or when there isn't time to go into as much detail. Ansel's kitchen-sink version with "a little, some, a lot" works just fine here.

(Some of these links are disturbing.)
Skin color has significant implications in health care, but not all practitioners account for that. Studies show the differences in assessments as a result. Also, dark skin is more prone to scarring than lighter skin. T-American first aid classes more often teach people how to accommodate variations in skin tone and ethnicity, whereas L-American resources rarely mention it. In this case, the vivid red color is a clue that skin is missing, as can happen with burns or abrasions on dark skin.

Because at least some of the pigmented layer is gone, the blanching response shows a little, but not as much as it would for lighter skin. The blanch test is useful in checking circulation integrity of skin injuries, but is harder to read on dark skin and may require special equipment. If you can see a healthy blanch response, that's pretty reliable. If you can't see it, then circulation may or may not be impaired, and expert care is advisable. Even professional training doesn't always cover ethnic skin care adequately. When possible, black people should seek skin care from providers who have a similar tone as their own or at least enough dark-skinned clients to treat it effectively. That commonality can make a big improvement in health care. But anyone can learn to account for the differences in basic first aid, even if just means referring someone to an expert when you realize you're out of your depth.

Similarly, black people are less likely to seek counseling. (This trend is stronger in L-America, but still present in T-America.) Black therapists have a higher retention rate for black clients, because shared experiences make it easier for them to connect with each other. This can be crucial when the problem is racially implicated, such as coping with racist slurs.

Classism means believing that people of some socioeconomic level(s) are better than others, and mistreating those of the less approved level(s). L-America generally hates poor people. Understand how to fight classism and recover from internalized oppression.

Bandaids for children often show cartoons or other designs. Tiana is the black Disney princess.

Sexism is the belief that some sex/gender(s) is better than the other(s), and using that to oppress people of the disliked sex/gender. L-America widely mistreats women. There are ways for women and men to fight sexism.

"Of all creatures that can feel and think,
we women are the worst treated things alive"
Euripides, Medea

"It's human; we all put self interest first."
Euripides, Medea

Fetal Alcohol Syndrome can occur when a woman consumes alcohol while pregnant. It has a wide range of effects including mental and physical disabilities. As shown here, two siblings can display very different symptoms based on where the damage hit them harder.

[personal profile] pantha adds: "Also, minor addition/correction for your notes: one can actually (more rarely) get fetal-alcohol syndrome from your father as well as your mother. The transmission is likely epigenetic (one of my fellow PhD students was working on figuring it out)."

Essential oils for relaxation include lavender, eucalyptus, and frankincense. This blend has a spicy-medicinal smell rather than the florals that some women like.

(These links are distressing.)
Homophobia is an unreasoning fear and hatred of gay people. Christianity is prevailingly homophobic, although some churches and individual are queer-friendly. Gay youth especially need mentors to show them that people can grow up happy, healthy, and queer. Learn how to deal with homophobia and work against it. People can stop being homophobic if they choose to work on it.

(These links are controversial.)
Ego-dystonic sexual orientation happens when someone's desire conflicts with their self-image. They may choose to work on accepting their homosexual feelings or on constructing heterosexuality. Conversion therapy is risky and rarely successful, neither is it very helpful to tell people with a dystonic condition that they are stuck being something they don't want to be with no treatment available. (Forcing any kind of therapy on anyone who doesn't want it is wrong, and tends to do more harm than good.) Giving people options lets them make an informed choice and thus feel more in control of their lives.

Trauma can lead to traumatic stress, including chronic conditions such as PTSD. Know how to help someone with traumatic stress. Here are some techniques for healing PTSD. Ansel's grandfather Conrad has largely overcome his own, and now reaches out to help other veterans by providing a safe and productive environment on the farm.

Feelings can lie to you in many ways. PTSD often comes with intrusive and distorted emotions. This can be addressed by asking questions, reframing, using logic, or changing diet. You can help a self-critical friend by sympathizing with their feelings without agreeing with them. Provide your own positive perspective and concrete examples of their worth to help reduce insecurity.

(These links are upsetting.)
Fat phobia is an unreasoning fear or hatred of plump people, leading to abuse of larger folks. L-America widely despises fat people, and plenty of folks don't even try to hide it. This degrades their lives and can even kill them. Learn how to overcome your own fat phobia and discourage it in other people. There are ways to raise body-positive kids and promote body acceptance on campus.

T-American emergency workers often carry packets of peppermints or ginger candy to help with nausea or low blood sugar. Many superheroes do the same, and emergency candy appears in many first aid kits too. Testamints have Bible verses on the wrapper, very popular with Christian clergy and other religious folks. Chuckie's is a brand of digestive aids including emergency candy (hard candy like ginger or honey-chamomile) and Chuckie's Tummy Tabs (a transdermal stick-on gel tab with antinausea medication).

(Some of these links are heinous.)
Troubled youth often experience condemnation instead of assistance. Harsh treatment such as boot camps, "Scared Straight" programs, or jail can backfire and make their behavior worse instead of better. There are more effective ways to help them do better, such as teaching them life skills and coping skills, or offering opportunities to participate in society so they will feel more connected. Learn how to help troubled youth.

Most people feel like they don't fit in sometimes. What you can do about it depends on why you feel that way. Good leaders help people belong, not just fit in.

Flickering is one form of superpower development, most often seen in young people, involving manifestations that appear and then disappear quickly. Different episodes may display the same ability consistently, related abilities within a field, or wildly diverse ones. None of this means that the person will "keep" any particular ability, although the more often one appears, the more likely it will become permanent. The intermittent pattern makes it difficult to identify and control any ability. Usually one or more abilities will stretch out for longer periods of time until the final manifestation becomes clear.

Acute stress reaction, or emotional shock, is a physical and psychological response immediately after traumatic experiences. Most cases clear up within a few days or weeks; if it lasts longer than a month, then seriously consider professional help. Contrast this with acute stress disorder, a mental injury with distressing symptoms beyond the usual. It may or may not get better; acute stress can lead to chronic PTSD. Acute stress reaction is usually treated with emotional first aid for yourself or others in distress, which reduces the possibility of someone needing medication or more serious therapy. T-America also has Emotional Trauma Care, which is what a hospital Shock Room is equipped to provide, in the interest of preventing PTSD.

Hand sanitizer has pros and cons. Cheap alcohol gels are among the worst. Professional aerosols are much better, and may include moisturizers, but you're still hosing your hands with chemicals. Dermatitis from hand sanitizer is best treated by washing with water and gentle soap, then applying a rich hand cream -- and you have to lay off the hand sanitizer until your skin heals. The shelter uses the bulk gel because it's cheap and effective, and it's okay if you just use it occasionally. If you use it repeatedly, though, it will wreck your skin.

Tiberius is often described as depraved and evil, although some historians argue against that. Tybalt is an antagonist in Romeo and Juliet. And yes, those are among the "Ty-" or "Ti-" names used in black culture.

A nonanxious presence is a useful skill for police and pastors. Learn how to cultivate that.

Prayer is one way to cope with conflict. Read about how to pray and explore some prayers for conflict resolution.

(no subject)

Date: 2017-09-29 04:08 am (UTC)
technoshaman: Tux (Default)
From: [personal profile] technoshaman
Where the heck did you get that bikes-go-around-the-bus-island pic? Two things stand out: It's Island Drive (i.e. on the left, instead of Continental Drive, on the right)... but it's not English. Very odd...

Thank you for labelling bothersome pics. Most of the time except for the truly gross I'm okay with things, but I'm kinda like Ansel was at the end of his day. Can I be done now with that kind of thing?

Also thanks for the keeping a level head in a crisis page. Very similar to what I've been learning as tools for *me*... it looks like I basically amp'em up to do service to others.

*fingersnap* Right. First rule of EFA supplies: Keep a ready supply of teddy bears. Or perhaps even assorted stuffies.

You've no idea how cuddly a shark can be until a stuffed one is your trusted, go-to companion in physical therapy. It turns out that Thurgood's snout is just the right shape for holding one's not-quite-working-right fingers in an appropriate shape while the rest of one's arm stretches out. Well, of COURSE they named a shark after a damn fine lawyer. Professional courtesy!! :D

I have a new shark. It's a nurse shark. I haven't decided whether she's Sonja or Ruth. But definitely a she-shark.

With respect to hand cream: If you've got a *really* bad case, use Euricin. You can get it in lotion, but the really good stuff is this uber-thick paste-like cream... wow. Totally unsuitable as a base for Blue. *wry*

A decent compromise on the sanitizer gel that's readily available is Purell with Aloe. Still, though. I wonder if EDs L- or T- have a protocol where when they get hit with an event that they give the front-line folks a day or two *just to let their hands recover*...

Re: Thoughts

Date: 2017-09-29 04:55 pm (UTC)
From: (Anonymous)
This reminded me of a recipe I once saw for making your own hand sanitizer. It was equal parts aloe and rubbing alcohol, then (optional) a drop or two of a scent you like. I can vouch for it being easy and not horribly abrasive, but I never did a lab test for effectiveness. Still, seems up your alley.

--Laura G

(no subject)

Date: 2018-03-01 05:13 pm (UTC)
pantha: (Default)
From: [personal profile] pantha
Ick. What a horrible superpower. I hope its effects wear off! Although, tiny silver lining, at least it has exposed said individual to be verbally abusive and thus got him out of that job.

(Also, minor addition/correction for your notes: one can actually (more rarely) get fetal-alcohol syndrome from your father as well as your mother. The transmission is likely epigenetic (one of my fellow PhD students was working on figuring it out).)

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