Tuesday, October 11, 2016

GoPro Hero5 Black and Hero4 Silver Comparison.

Here is my first comparison video between the two. I simply held them next to each other, almost touching. Identical settings, 1080p (this is a 720 output from FCPX) 60 FPS, wide field of view. Protune off, video stabilization on for the 5. 

HERO Comparison from Brett Friedman on Vimeo.

I've barely used the five. I got one two days before release and had to return it. There was a power issue. I finally got one yesterday. Even though both cameras use the same chip, and lens, the 5 black has a better look. A bit more contrast. It is now waterproof without a housing, which is cool, but it makes a few things difficult to do.

Because the ports are behind a waterproof door, I can't power the camera externally. I also can't run an external microphone, which I only did a few times and I have a work around for. The mount it comes with, which is sort of like a frame housing feels a little fragile. These are the only negatives I have found so far.

I love the new user interface. I love voice control.

The voice control is a game changer. I used to take my GoPro paddling and turn it on and let it run. Because it would be mounted on the bow, short of using a remote this is the only thing I could do. Now, to have the ability to tell it what to do?! Amazing.

Ill put up a more detailed review when I have had a chance to really shoot with it. But so far I am pretty excited.

Thursday, October 6, 2016

The overuse of Epinephrine

It's pretty much the nightmare scenario. You are out for a lovely hike. Then, all of a sudden someone gets stung by a bee. a minute later, they can't breath. This has two outcomes. Outcome A) You have an epipen which you administer saving your friends life. Option B) you don't, and you witness your friend die in front of you while you sit helplessly watching. Scary right? Anaphylaxis is the last topic taught on the WFA classes I teach. We regularly get the question, well, can I just buy an epipen and have it in my first aid kit? The answer, as I am sure you know, is no you can't. It is of course a prescription drug, that you need an allergy and a prescription for. (You know this because the Epipen has been in the news for the last six months as the price has skyrocketed, and the manufacturer has come under scrutiny for essentially price gouging.)

I taught two WFA classes in the last month, and between the two of them, I got to thinking. How common is this scenario? I started looking, and I learned a lot. 

Now, for the record, I am currently certified at the Wilderness First Responder level. But I have been an active working Paramedic and EMT. I know a lot about this drug, and have pushed it a handful of times when working on the ambulance. A handful of times, meaning 3. 3 times in 5 years. Doing 8 to 15 calls a day. I have also been teaching in the outdoors for sliding up on 20 years. Okay, I am at 17 years. I have taught day long courses, and month long courses. I have had thousands of students. Outdoor programs always carry Epipens, to avoid the scenario above. I have never pushed epi on an outdoor course. I have never even come close. 

I really should title this post, the over fear of anaphylaxis. Because that is what we have. For clarity sake, Of course anaphylactic reactions to allergens are a real and scary thing. If you have an allergy you need to carry an Epipen and you need to know how to use it. But the problem is we have convinced the world - or at least the population of the United States - that this happens a fair percentage of the time when adventuring. The problem is, there aren't any real studies about deaths from anaphylaxis in the backcountry. 

But there are studies for the front country, and they are very interesting. There are three studies that people use, two of them lasted ten years, and the third was 4 years. They looked at death certificates and Hospital and ED discharge information. Here is what they found. 

The authors found that case fatality rates were between 0.25% and 0.33% among hospitalizations or ED presentations with anaphylaxis as the principal diagnosis. These rates represent a total of between 63 and 99 deaths per year in the US, ~77% of which occurred in hospitalized patients. Rate of anaphylaxis hospitalizations rose from 21.0 to 25.1 per million population between 1999 and 2009. However, overall mortality rates appeared stable in the last decade and ranged from 0.63 to 0.76 per million population (186 to 225 deaths per year).

The primary cause of Anaphylaxis is reactions to medication - usually antibiotics. These numbers are staggeringly low. This is just not something that is happening that frequently. Despite what we are told, this really isn't something we need to be worried about. 

But, those numbers are for the front country. What about us enjoying the back country where we are exposed to the elements, and more importantly, Bees! There just isn't data... 

Or is there? I work for two very large outdoor companies. surely they keep records? right? They do. I emailed them both, and I am not going to share whose information I am relaying, frankly because I don't know if I am allowed to. But here is what I was told. For the decade prior to last year, instructors pushed epinephrine 5 times. 5 times in ten years averaging about 4000 students a year. That is .0125%. But importantly, I don't know what the cause of anaphylaxis was. But why does this exclude last year? because last year was an anomaly. Last year there were 11 instances of epi being pushed on a course. 

Almost all were the students own Epipens being used. Again I have no data as to signs or symptoms of the patient. But 11 instances in one year is .275% - It is statistically impossible for that many students to have gotten Anaphylaxis in one year on courses. Which means, Epi was pushed when a life threat wasn't occurring. 

Why would that happen? Because we have made everyone afraid of Anaphylaxis, and we think it occurs all the time. We are confronted by someone telling us they are allergic, and had an exposure. They will get an anaphylaxis reaction, and they will die. So we push epi. The big give away, that they are worried about something that isn't going to happen, is they can tell us. If you can say "I need my Epipen", you don't need your Epipen. Here are signs and symptoms of Anaphylaxis


The first signs of an anaphylactic reaction may look like typical allergy symptoms: a runny nose or a skin rash. But within about 30 minutes, more serious signs appear.
There is usually more than one of these:
  • Coughing; wheezing; and pain, itching, or tightness in your chest
  • Fainting, dizziness, confusion, or weakness
  • Hives; a rash; and itchy, swollen, or red skin
  • Runny or stuffy nose and sneezing
  • Shortness of breath or trouble breathing and rapid heartbeat
  • Swollen or itchy lips or tongue
  • Swollen or itchy throat, hoarse voice, trouble swallowing, tightness in your throat
  • Vomiting, diarrhea, or cramps
  • Weak pulse, paleness

We also used to think that it was common to have what is called a biphasic reaction, meaning you have a reaction, get hit with Epi, then you get better and up to 24 hours later you get a second reaction. We used to think it happened close to 30% of the time. Now we know it happens less than 1% of the time. (though web MD says otherwise, I trust my medical directors more!)

We live in a culture of fear. We are told to be afraid of something, and then told what to do about it, which invariably leads to us spending money. I am not saying you shouldn't carry an Epipen if you have an allergy. But if you don't have an allergy, you don't need one. 

The other thing you don't need is quick clot or a tourniquet. But I will leave that for another day.. 

Link 1 for data
Link 2 for data
Link 3 for early evidence of the culture of fear we live in.