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Podcast 027: Thinking in Emergencies

In This Episode: Thinking in emergencies, as didn’t happen in Hawaii — but here’s how to do it better at home using the first tool in the “This is True Thinking Toolbox”.

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Show Notes

  • Here’s the computer screen from Hawaii, showing just how horrible the user interface is:

If the improvement is this bad, imagine what the original was! It’s a start, but they have a long way to go.

  • My blog post with more about just how screwed up this is: This is Not a Drill.
  • I also did an “EMS Story” on the CPR call we discuss that’s worth a read: Honest to Goodness Good Stuff.
  • And here’s the basics of what to do when you do call 911:


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Transcript

Randy: Welcome to Uncommon Sense, the Podcast companion to the ThisIsTrue.com newsletter with the mission to promote more thinking in the world. I’m Randy Cassingham.

Kit: And I’m Kit Cassingham.

Randy: This week is a two-parter. First, we’ll discuss a story from issue 1231 of the newsletter, which will be included on the Show Page at thisistrue.com/podcast27. Second, as promised last week, the first installment of what I’ll be calling the This is True Thinking Toolbox, where now and then in an episode we’ll discuss tools to help you think — or, if you’re already a great thinker, you can use the tools to help others think more, or do a better job at it.

First, the story. I’m not going to read it this time, but it will be on the Show Page, because pretty much everyone has the basic idea of this one, as it’s been in the headlines for days: it’s the false alarm in Hawaii about the supposedly inbound ballistic missiles. Hawaii has been on edge because it’s more obviously in striking distance of North Korea’s missiles than the mainland is, and that’s why they’ve reactivated their Cold War-era early warning system in the first place.

Kit: Wow, that’s astounding. And I guess if I lived in Hawaii, I’d be edgy about North Korea. I’m edgy about North Korea here in the center of the mainland!

Randy: Yeah, they’re a lot closer, and therefore within striking distance. I wrote a blog post about this on Monday. I’ve worked on software teams at the government level, most specifically on user interface design on a built-from-scratch system at NASA’s Jet Propulsion Laboratory. Part of my job was to break it. Seriously: they’d say “OK, Randy, we just put a new release candidate on the server, see what you think.” And 20 minutes later, I’d get back to them with something like, “You know, when you do X, it breaks down in this way, or crashes, or allows unauthorized access to Y.” And invariably they’d respond, “How in the heck did you find THAT?!” I don’t know: I just had a knack for trying different things just like real-world users would, and so they had better plan for those weird things, or worse. Like clicking the wrong thing, even if it was obviously wrong. Because humans will do that, either because they’re curious or they accidentally clicked something other than what they wanted to. And if they didn’t have error traps set up to deal with that, then they’ll get unexpected results.

The big problem in Hawaii was, the state Emergency Management Agency knew they wanted to be able to quickly send out warnings if the unthinkable happened. And they wanted a way to test the system without actually sending a warning. So they built that, and apparently did put an “Are You Sure?” dialog in, which is a good start. But I suspect that they used the same “Are You Sure” screen for every function that the terminal had. And naturally the operator, who has to click the Test selection every day, simply gets used to just instantly clicking YES on that confirmation screen every time. So even when he hit the wrong function, which was to send out a real alert, he automatically clicked YES — that was his “muscle memory” — and that warning went out.

Kit: Why do they need an “Are You Sure?” sequence for a test?

Randy: Well you don’t. And it’s a really bad idea because that trains the operator to hit it without thinking — click then click, every day. The test shouldn’t have such a loop; it’s the real thing that should be unusual — that should be different. Click test, the test happens. But only when you try to send a real alert should you get an “Are You Sure?” because that is the unusual action, that should require the second thought.

Kit: I read your blog post on this, and I know that’s not even the worst part of the design.

Randy: That’s for sure, and this is where it gets really stupid! The state had authorization from FEMA, the Federal Emergency Management Administration [note: it’s actually an Agency], to send these warnings to every cell phone in a dire emergency. What they didn’t have was any way to send any other message to every cell phone. When it’s not an emergency, you have to go through regular channels to send a message. Even if the message is “Hey, don’t panic, that’s a false alarm.” They had to first write the message, and then get approval to send it. And that took 38 minutes — 38 minutes of people in a panic thinking that World War III was about to begin.

Kit: So, they didn’t anticipate an error, and therefore didn’t plan for what to do if and when it happened.

Randy: Exactly. And because of the way the system was designed in the first place, such an error was almost inevitable. Just before we started recording, a reader sent me the actual screen with the selections on it, and it’s really worse than I thought. They screen in cluttered with selections. They can also send out other messages — pre-canned, pre-written messages — and I could tell that this was the new, modified version, because right at the top is the new function: “Ballistic Missile Defense False Alarm”.

Kit: So is there any logical order to what’s on the screen?

Randy: Not really. The order is: False Alarm, County-Wide Amber Alert, State-Wide Amber Alert, TEST Message, State-Wide Civil Defense (or incoming missile) Warning, Tsunami Warning, Missile Defense Drill (which is the one they were supposed to click), Landslide closing Hana Road, Amber Alert Demo Test, and a High Surf Warning on the North Shore.

Kit: “Surf’s high! Head north!” No — they don’t even have these in alphabetical order. There’s—

Randy: There’s no rhyme or reason whatsoever.

Kit: Not that I can see. So not only tests and such, but road closures? They were on the same screen as “Incoming missiles, prepare to die?”

Randy: Astounding, isn’t it? And since this is the newly altered screen, we can’t really be sure what the order was before; they may have separated the missile warning from the missile drill selection by sticking Tsunami in between them. I’ll put the photo on the Show Page so listeners can look at it. What’s not shown is, what’s the next step: what does the confirmation message look like? I don’t know for sure, but my guess is, it really is the same confirmation for every selection.

While it’s great that they very quickly added the ability to send out a False Alarm notice, that should be just the very first step. They really need to get a user interface design expert in there to completely revamp this whole system. Calling this screen an amateur effort is a slap in the face to amateur programmers. I’m not a programmer and I could made this ten times better in my sleep.

Kit: Yet it’s a live system that’s supposed to be helping people, not sending them into accidental panic.

Randy: Right, and this isn’t even to early prototype quality. It’s amazingly poor, and no surprise at all that it led to a false alert. And then there’s this, the latest just before we started recording: the password to log on to the system is “Warningpoint2”, with a capital W and that’s the digit 2.

Kit: OK… how the heck do you know that?

Randy: Well, I’m not a hacker. The Hawaiian Emergency Management Agency has been doing a lot of press interviews on how they’re fixing the system, and a reporter just happened to notice that the password was stuck to the screen, on a Post-It note.

Kit: Oh no!

Randy: See what I mean when I say this is an amateur operation?

Kit: My 93-year-old dad didn’t keep his passwords on the screen, or even on his desktop!

Randy: Yeah: a Post-It note, and then they’re inviting outsiders in. Unbelievable!

Kit: Of course! OK, so tell me about the first tool in the new This is True Thinking Toolbox.

Randy: Anyone who has been reading for awhile probably knows tool number one: “Think first, react later if at all.”

Kit: Which isn’t necessarily easy.

Randy: No, it’s actually very hard, especially when you’re first trying to do it. It’s our natural inclination to dig in and fight back when confronted with something that challenges our preconceived notions. Or, as the case may be, an emergency.

Kit: Like the sign at the fire station.

Randy: Yeah, sadly it disappeared when they rebuilt the station last year. It said, “Respond to the emergency, don’t react to it.” They know that reaction is literally dangerous — it’s how firefighters get killed. The sign was a reminder to think — how best to respond? Especially in small fire departments, where you have volunteers who don’t necessarily have a lot of experience. The pager goes off and they get excited: this is what they’ve been training for! Someone they probably know could lose their house! Get going! Fix the problem! Emergency! Emergency!

Kit: Indeed!

Randy: And it’s in that almost panicked state that they can make huge mistakes, like running into a burning house without thinking about taking a hose with you, or putting on your air mask, or making sure your partner is backing you up. Or even driving carefully on the way to the scene. All of these things take a calm, settled, and thinking brain, and it’s hard to do if your body is coursing with adrenaline. It’s not just fire departments, but soldiers seeing their first combat, and medics faced with pretty serious illnesses or injuries that they need to stabilize and treat before the patient dies. It’s heavy stuff — literally life and death.

Kit: I love the way that you and I rehearse the possibilities on our medic calls. What could be wrong, what gear do we need to take in — trying to think outside the box, outside what Dispatch has given us, so we can stop and think and be prepared.

Randy: Right. So when Kit and I get a call, usually we’re going together. We both work out of the house so we’re typically together when a call comes in. And we’re volunteers, the pager goes off at any time — I’ve got it on my best right now — and they give us something, some nature of the call because the person who calls 911 tells Dispatch why they need an ambulance in the first place. We’ll talk about it on the way to the call. “What do you want to do?” And the most classic one is, as the garage door was rolling up at 1:00 in the morning, Dispatch gave us an update that CPR is in progress.

Kit: That’s always a bad message.

Randy: Yeah: that means your patient is dead. And you’ve got a limited amount of time to try to reverse that. And we were about 10 minutes from that person’s house and we knew we were the closest medics to that call — by far.

So as we were rolling to that call, we talked about what it is we were going to do. So, basically, I’ve been on a lot of these calls before, so I suggested to Kit, “When we get there, whoever is doing CPR, they’re going to be tired.” It’s going to take us 10 minutes to get there, so I suggested you go in first, just bolt and go in while I get stuff together, and take over the CPR for whoever’s doing it.

nd I was pretty quick on your heels, I didn’t dally. I came in with the defibrillator and other stuff; oxygen. Sure enough, you were on the floor, doing CPR. And the other thing we do, when we train on CPR calls, the person who is there doing the chest compressions knows that I need to get in there and put these sticky pads on their chest — we don’t use paddles anymore, we use these sticky pads. So you leaned over, and I got that one pad on. You leaned the other way, and I got that pad on. Then it’s “hands off” while the defibrillator charges up and gets ready to shock.

The amazing thing was that when the guy came to service the defibrillator later, he actually downloaded that call and he asked me, do you know how long it was from the time you turned the defibrillator on, and the time you hit the shock button? I said I have no idea, but it was pretty quick. He said 23 seconds — and that includes the charging time.

Kit: We’re a good team.

Randy: It was excellent. And that’s just the training that we have, that we practice this stuff. So that we don’t have to react, we already know what to do.

Kit: We’re thinking, and we’re responding. And I’ve noticed you stay really calm on medical calls, even though you’re only a part-time volunteer.

Randy: Well, it’s part of already having this tool in my toolbox for so long, and it’s part of my having worked in the field full-time for several years, often running 8 or 10 calls a shift. You don’t get the big surges of adrenaline because that would be exhausting — you know, 8 or 10 calls a day? No! You learn to keep your head on your shoulders — to think — so that yes, you can respond to the emergency, not react to it.

You and I had a really good medic instructor here for many years—

Kit: Yeah, we did.

Randy: …a former combat medic, Steve, and he was himself the very model of the calm, thoughtful approach. I loved it that he reminded his students — now our colleagues — that no matter how bad an emergency is, it’s not our emergency: it’s the patient’s emergency. Whatever is going on is the patient’s problem, not ours. That puts us in a position of figuring out how we can help them through it, because responding to their emergency might make the difference in whether they live or not.

Kit: You know one other area that Steve drilled into us is when we’re on the side of the road, we not only have to be paying attention to the patient, but the scene around us.

Randy: Right.

Kit: “Scene safety.” So you’ve got to be alert, that cars are barreling down the road “at” you…

Randy: And they’re not looking at you, they’re looking at those “flashy lights! What’s going on! Ooh, there’s a mess!”

Kit: So there’s several areas we have to be mindful of. And Steve did a great job of that, and our present trainers also are good at reiterating those important messages.

Randy: Right. It just shows all the different things you have to think about: not only taking care of the patient, but taking care of yourself and making sure that you and the patient are safe. You’re not going to get hit by a car “again!” — because that’s how medics die too.

Now obviously, not everyone is a medic or a firefighter. But all of us still need these skills, because we never know when a loved one, like maybe your kid, will have a medical emergency, or is even trapped by a fire. What’s going to help: screaming and running in circles, or calmly summoning help from 911, and then being the first first-responder? The answer is pretty obvious, yet so many people just panic.

Kit: I am always amazed at the things people panic over. We had a helper here who cut her finger while trimming some flowers, and she panicked.

Randy: That’s right — I remember.

Kit: People panic because their kid cut themselves with a knife, and it may not have even been bad, but people panic!

Randy: And I think it’s because they’re just not thinking about these things; they don’t think ahead. You know, accidents happen. Your husband or wife can have a heart attack, they can have a stroke. What are you going to do when that happens?

Kit: Call 911!

Randy: And be calm about it! Give the address. Say what’s going on. Get the front porch lights on if it’s night.

Kit: Get the door unlocked.

Randy: Get the door unlocked. Get the dogs put away. All these things: it’s things that you can do to make sure that when we get there, we can take care of the problem, not having to find the front door — where IS the front door? It’s dark out there. Do you have an address sign up?

Kit: A visible address sign!

Randy: Yeah. That call we went in, that I told you about, the CPR call, we got delayed because they didn’t have a sign at the end of their driveway…

Kit: And the neighbors had their lights on.

Randy: Yeah, so we went down their driveway first. “Nope, that’s not them, they’re obviously not up, looking for help.” So we had to go back up, and then down the next driveway. And the thing that really makes me sad: even though we pointed out to them, we got delayed, your husband almost died, because there was no address sign. And they still don’t have an address sign.

Kit: Yeah. Well, there’s part of that thinking that fits into the toolbox that’s not happening. They’re not responding to the stimulus they’ve been given.

Randy: So even though we’re not all medics and firefighters, here’s where you can practice this kind of thinking, rather than reacting: it’s just as important to think, rather than react, when, say, arguing with your spouse.

Kit: I was wondering if you were going to get to that!

Randy: Well it’s something most everyone can relate to. And don’t get me wrong: I fall into this trap too—

Kit: Uh huh!

Randy: I’m not perfect—

Kit: Huh uh!

Randy: …this is really hard stuff. So let’s think about it now, when we’re not in an argument or emergency. Anger leads to reaction, not thinking, so if you and I are having a disagreement, I actually welcome it when you point out — and you do do this! — that I’m getting heated, because I do want to think rather than react: thinking helps get issues cleared up a lot faster, and it keeps us from saying things we might regret later, which is what happens when you’re reacting rather than thinking.

Kit: It sure is a lot easier to just not say things that you don’t really mean, than to take them back. I mean, apologizing and making up for hurtful words, is a lot of work.

Randy: Yeah, and you know, even if you apologize, they’re still there, they’re still hanging in the air.

Kit: Yeah.

Randy: So it took some practice, but here’s what I do when you tell me I’m getting heated, or reacting too strongly, or whatever: I summon up all my willpower to just stop cold. I take a breath, I call upon my meditation practices to take my tension down several notches, which happens pretty rapidly. And because you are also thinking, you give me a moment to do that, you give me the space. You understand that we’ll make more progress if we speak calmly: we’ll get to a new understanding, or a resolution, or agreement, much faster.

Kit: Yeah, and it works pretty well for us. And some of this is reminding me of a tortoise and hare: we talked about the firefighters dashing off, or the medics, or even us. Sometimes the tortoise does win the race.

Randy: Right. It all comes down to what’s most effective, and is flying off the handle and getting irrational more effective? No.

Kit: Hey, that’s what gets you into the This is True column, is flying off the handle!

Randy: sure enough.

Kit: Or throwing the handle, with the knife still attached!

Randy: So there’s the first tool in the This is True Thinking Toolbox: actively remember you need to think first and react later, if at all. Uncontrolled emotion is dangerous — to your health, to your relationships, and maybe even to your life.

Kit: Well, and to other people’s lives as well.

Randy: Absolutely. And I’m going to put both parts together now: we have several good friends who live in Hawaii, and a couple of them are also Premium subscribers. One sent me a message after the false alarm, and he was really calm. He said, referring to his wife, “Funny thing, both she and I got the alerts and decided it was way beyond our control. If our defense department couldn’t eliminate the threat, then it really didn’t matter….”

Kit: Huh! Good on them.

Randy: “…Absolutely no panic.” And that’s a wonderful example of thinking rather than reacting, in an emergency situation that was so big, it was rational to think you could very well die in the next few minutes. It’s astounding.

Kit: And I’m not sure which of our friends, but I hope that the other friends, whoever you’re not talking about, had as calm a response. I’ll have to write and ask.

Randy: Yeah, I hope so. If you have a story to tell about how thinking first, rather than reacting, helped you, let us know on the Show Page, at thisistrue.com/podcast27. I’m Randy Cassingham…

Kit: And I’m Kit Cassingham — keep thinking!

Randy: …and we’ll talk at you later.

[Easter Egg]

5 Responses to Podcast 027: Thinking in Emergencies

  1. Gilah in Israel January 18, 2018 at 1:34 pm #

    For a non EMR person I’ve been getting a lot of practice with medical emergencies as I’m the primary person that several friends have called upon in an emergency. I’m getting better at anticipating what to do. I’ve even survived being in the middle of a month long series of missile attacks. Unfortunately, I found when I was the one with the emergency my mind didn’t function like it should. I can NOT stress strongly enough that you keep your emergency medical information at hand. I had trouble remembering my medical information when I needed it (probably because of mild shock). Something I’ve learned that may be of use to others…if you have medicines you are allergic to but know of similar medicines that treat the same problem that work for you, add them to you list under a category that indicates they can be used on you safely.

    Good advice. In the graphic on this page on what do do when calling 911, the second bullet notes that even before you ever need help, you should have a sheet with up-to-date medical information available to speak for you, since you may not be able to or (as you say) may be confused or disoriented. Yet very few bother — and that puts your health at risk. Allergies to medicines should be the first thing you document! -rc

  2. Chuck in Palm Desert January 19, 2018 at 12:51 pm #

    Interesting discussion. I have caught myself making that second automatic click without checking to see if I’m answering the right question. Fortunately, it hasn’t resulted in disaster. (Yet.)

    I just listened to this one and, when you got to the part where you mention people going into a frenzy because they cut their finger, I had to think about how glad I am that I had parents who, during my childhood, never panicked at the sight of blood. I think that, aside from having a calm nature, some nurture does come into play here. I’ve hacked myself quite enthusiastically at times, as I’m sure most of us have, and generally I just wrap it up and then assess whether I might need to go in for a couple stitches. I generally treat my friends’ emergencies the same way. I’m positive my parents’ calmness rubbed off on me.

    Regarding your friends in Hawaii, as a native Californian, I was reminded of the time when a group of us were playing poker one afternoon. As the deal passed to me, we were hit by a 3.-something earthquake. Several of my friends jumped up in great alarm and prepared to head for the door. I just kept on dealing cards, figuring I’d wait and see how strong and how long the shaking was going to be. One of those who stayed at the table said, “Well, you obviously have your priorities in order.”

    You did, of course, raise a couple points I should have covered but don’t at present, so thanks for that, and thanks also for the note on how to make a 911 call. For some of us it’s obvious, but folks need to be reminded now and then.

    All good thoughts, and glad to give you a couple of other things to think about! -rc

  3. Mark, WA. January 24, 2018 at 8:51 pm #

    I still remember my mother’s attitude when we got hurt. “If you can scream that loud, you can’t be hurt very bad.”

    I understand her point, but it’s not strictly true. Broken bones can definitely hurt! -rc

  4. SimonTek IN January 24, 2018 at 11:16 pm #

    The benefits of becoming an EMT: during a surgery recently, felt my body go cold, and was able to tell them that I was going into shock while they were working on me.

    Wow! Would love to know more of that story. -rc

  5. Christian, Seattle January 25, 2018 at 1:06 pm #

    Two comments from my experiences:

    As a pilot, we are trained to respond, not react. With the exception of two conditions (depressurization and smoke/fire in the cockpit), the first response is to wind your watch or get a cup of coffee (figuratively). In other words, break the adrenaline rush by deliberately doing something slow. Then next step is to identify the issue, and attempt to determine the root cause, because addressing the wrong cause may make the situation worse. Then get out the checklist and follow it to the very end. And while all of that is happening, make sure one of you is flying the airplane, and not trying to solve the problem.

    The second issue is that when tensions are running high between two people, STEP BACK, turn slightly, and lower your arms. It breaks the energy bond that has been forming and allows the parties to breathe.

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