Monday, February 22, 2010

Consider the wallet before dialing 911

Thomas Freedman used an article by the CBS Sacramento affiliate discussing a new requirement that residents pay for 911 calls in his in his latest column as a segue into a discussion of America's "lean years". Residence are given an option of paying $48 a year for unlimited 911 service or $300 per call. While the discussion of lean years is interesting, Freedman never returns to it. I find this issue a little too jarring to move on so quickly. Though most people would intuitively feel like paying for the use of 911 is a bad thing, it's worth unpacking the subtleties in order to understand who is really most affected by this change. But first, some obvious questions:
  • Do non-resident also have to pay if they dial 911? One would assume so, but the article doesn't actually say that. This question is particularly relevant in Tracy where a veritable web of intersecting major highways exist. (As an aside, these are extremely high speed merges with many confused drivers. For some reason I've also gotten a lot of heavy downpours in Tracy. It's never seemed safe.)
  • If multiple calls are placed to 911 regarding the same incident, is each caller charged? Again, when you think about the frequency of highway accidents in Tracy, this starts to seem like a racket.
  • What if the caller isn't the one in distress?
This last question deserves a little more fleshing out. In the case of a horrific car accident, someone would still call (one would hope). What about weird screams, people that just don't look right, those sorts of things? These are cases where 95% of the time it turns out to be a false alarm, but sometimes not. A good friend of mine once called 911 after witnessing an altercation on the side of the highway, would the risk/reward analysis be the same if there was an exorbitant cost associated with it? A man stumbling on the street who "just doesn't look right" may just be strange, or they may be having a diabetic emergency or acute Valium withdrawal, both life-threatening.

Surely this new policy is born out of severe budget woes. It's likely, though, that the answer to the "why 911 and not something else?" question is related to a mentality of frustration associated with the response to none emergency situations. Professional EMS providers get frustrated responding to relatively minor calls. City officials likewise bemoan the amount of money spent on these calls. This is a mental trap, however, that we shouldn't let ourselves fall into.

The National Outdoor Leadership School provides a conceptual definition of risk that lends insight into this issue. They define risk as the product of the probability that something bad will happen and the consequences of the accident. Risking a toe-stub while walking around barefoot (likely accident, minor consequences) and riding in an airliner (extremely unlikely accident, near certain death) are both low risk activities. Going for a serious bike ride is a considerably higher risk activity. If only 5% of EMS calls are life-threatening, this is still an extremely high likelihood (if you participated in an activities with a 5% risk of death each day, you'd make it an average of two weeks before kicking the bucket). Since consequences are, by definition, life-threatening, every 911 call is extremely high-risk.

One population that will be unevenly affected by this change is geriatrics. A doctor giving a lecture in our EMT class last week quoted his father saying "being old is not for the timid." Although their bodies maybe frail, old people tend to be tough as nails. They don't complain of pain until it's serious and, for a variety of reasons, resist going to the hospital. To make things worse, symptoms of life threatening conditions in geriatrics are more subtle than in younger people. While a 40 year old having a heart attack might complain of crushing chest pain with pain radiating down their arm, the most common symptom of heart attacks in older people is shortness of breaths. Other symptoms include back pain, general malaise, even toothaches. Abdominal pain in geriatrics could be caused by constipation or an upset stomach, or it could be a deadly GI bleed. The point is that these are symptoms that could be confused with "just growing old". In a population that's on an ever dwindling budget, older patients may think twice about spending $300 on a 911 call for nondescript symptoms similar to their daily aches and pains.

The beauty of our 911 system is that it's prepared to handle any type of emergency. While people may not realize that 911 is prepared to handle emotional and behavioral emergencies, it is surely prepared to deal with them. If you see a glowing yellow liquid flowing into a storm drain, you can call 911. If your neighbor hits their head, you can call 911 even if they want none of it. If in doubt, you can call 911. That is, unless you're in Tracy, where you should probably think about it first.

Monday, February 1, 2010


James’s parents rented a modified Jeep SUV with an extra row of seats in place of a trunk—what my British uncle would call a “people carrier.” And we filled it. The whole Mack family went: mother, father, sister, girlfriend. Even his girlfriend’s dog went. I had proposed the trip to Pinnacles, suggesting that we might see Condors , so I went too. The National Monument is also an honest 2 hour drive from Stanford, an ideal distance for a day trip.

California Condors appear, at least superficially, like glorified turkey vultures. Their most obvious distinguishing feature is their size. They are the largest birds in North America. Their wingspan stretches nine feet. More subtle, though more useful for identification, is their shape. Turkey vultures fly with their wings forming a “V”, almost as if their chests and shoulders are not strong enough to support their lift. Their clumsy shape causes clumsy flight—they rock back and forth never quite seeming to find their balance. Condor’s, with their square flat wings, look like little Cessna 172’s. To propel themselves, they flap their wings in a slow curl, tips first reaching inward. They are graceful in flight, finding thermals and soaring to heights greater than 3000 feet. A streak of white, like a mini-wing, serves as a final confirmation of the identification.

Condor’s also reflect the general thesis that the more specialized and adapted a species, the more prone it is to extinction. In 1986 only 22 of these birds remained in the world, all of them in captivity. The main culprit in their demise was the pesticide DDT, which was brought to public’s attention by Rachel Carson’s Silent Spring. The truth, however, is that these large creatures are fundamentally delicate. Their size alone virtually guarantees a smaller population and their digestive systems are vulnerable to damage by a number of agents. Recently they’ve suffered problems with lead poisoning which paralyses the smooth muscle of their stomach and causes the bird to starve to death.

The largest conservation effort ever dedicated to the preservation of a single species is the reason that California Condor’s haven’t gone extinct. State, federal, local and private agencies have supported the birds with a tab of $35 million dollar since World War II. The result of these funds are the 350 birds currently in existence—an even hundred thousand per bird—188 living in the wild and all of them bred in captivity save one recent hatchling. Not everyone has agreed on the cost/benefit analysis of the effort. Each bird is tagged with a number and a radio beacon and its location monitored daily. When a bird dies, the park service learns of its death the same day. Adding to the difficulty and slowness of the comeback is the fact that they reach sexual maturity after 6 years and average only one chick every other year after that. Condor’s stay with their mate for life but will find another if their partner dies.

Given their unlikelihood of surviving Humanity, there is a certain irony in their post-apocalyptic facial appearance and choice of habitats. They live the sorts of places that might have been on the short-list for the filming of “Mad Max”: Pinnacles, Baja, the Grand Canyon. Pinnacles is the jumbled remains of the 250 mile journey these rocks have undergone through the motion of the San Andreas fault. The rocks themselves are breccias, angulated detritus lithofied into conglomerate. Their origin is volcanic. Their ground-up feldspars imbue a bright pink to the rock. The jumbling has created caves, not in the sense of hollowed out limestone karst but boulders that have fallen together and sealed the gaps from light. Water moves between the rocks causing waterfalls and slides within the caves. It is an ideal habitat for bats, whose breeding habits occasionally call for the closure of the caves.

I urged James to call the park prior to the trip to check on the status of the Condors. I had seen them on multiple occasions, both in Pinnacles and across the coastal range in Big Sur (an easy enough trip for a Condor but far more difficult in an automobile) but always by accident. I’ve never set out with the specific goal of finding a species and been successful. I’ve stumbled across plenty of gopher and king snakes, even a few rattlesnakes, but to go out looking for them on the most perfect snake day in the spring causes your odds of finding one to fall drastically. Also of concern was the fact that the best spot in the park for seeing the birds is the High Peaks. As the name suggests, the hike to the location is somewhat strenuous and exposed to the sun. All of this turned out to be moot, however, when the Condor’s appeared soaring over the ridge at the entrance of the park within minutes of sitting down for a picnic.

With the California Condor (as well as the Western Bluebird and Yellow Billed Magpie) added to the life-lists of all in attendance we decided to take a short hike and explore the caves. It occurred to me while fumbling for my cell phone (for use as a flashlight) that we were probably at the limit of what James’s parents were comfortable with. The comfort limit, I decided, was the optimal place to be with the curve rising gradually on one side and plummeting quickly on the other.

As someone reasonably knowledgeable on issues of local natural history and ecology, I wanted share some information that would make the experience more meaningful for James’s family. It turns out that it’s fairly difficult to achieve this, striking a balance between too little information and sharing every disconnected morsel you’ve ever learned. The line between the two declinations is probably a story or a stimulated sense—subtle features that fit into a greater picture interest people, and things with physical beauty, aroma or taste tend to delight. Several wildflowers filled the latter group. There were milkmaids (Cardamine Californica), which are beautiful but seem tamed and almost afraid to offend, Shooting Stars (Dodecatheon sp.) whose flowers are upright in the normal sense of a flower, but whose conical shape makes them appear geometrically as facing downward, and Blue Witch (Solanum Umbelliferum), a toxic member of the nightshade family with 5 pedals fused nearly identical to a potatoes’ flower.

There is a pleasure in finding things out, as Richard Feynman said, that I experienced in learning a new species. I was surprised to see pine trees at the monument. Lena mentioned that they reminded her of ghost pines. I climbed a rock for a better vantage point to key the species out and did so as best I could. Keying plants is like those “Choose your own adventure” books. A series of questions are presented (“ Are the leaves alternative? If yes, proceed to 8.”) Some of the questions are difficult (“Cones stay on the tree for greater than 2 years.” I didn’t have that sort of time.) When I had finished keying the plant out I landed on Ghost Pine and it occurred to me that Lena should be more confident. The final identifying feature was massive clawlike scales and that certainly fit the bill. The cone is large and heavy and the individual scales have a chestnut-like texture. With the name in mind I looked back at the tree and did find something ashen and ghostly about it. It seemed to fit in a post-apocalyptic environment, an environment suited for Condors.