the Kingdom of the Imagination

这个是我们在救护车上常见的一个标志。由于红十字的特殊含义（国际红十字会的标识），它已经取代了红十字，成为了国际急救医疗的通用标志。这个标志含义并不为广大公众知晓，然而这个标志所蕴含的意义却与广大公众的生命息息相关。这个标志含义不仅需要医护人员了解，更需要广大公众的知晓，同时也是一个国家公民素质的表现形式之一。

标志包括了紧急救护的6个步骤，以美国为例，叙述如下：

1. 发现（detection）：公民必须首先能够识别有紧急救护的场所以及如何联系他们所在社区的紧急医疗服务（Emergency Medical Service, EMS）。这能够通过多种途径实现，诸如拨打9-1-1，使用7位数字的当地急救号码，或者使用业余电台，或者高速公路的电话盒。

2. 报告（Reporting）：呼叫者要求特定信息并能够得到适当的救护资源反应。在理想的系统中，有资质的调度员（Emergency Medical Dispatchers, EMDs）询问一组预先制定的问题。如果某人正心脏病发作，他们则按照心脏病发作的流程询问适当的问题并给出适当的救护车到达前的指示（如心肺复苏，CPR）。在这条短语里，调度员还起到了现场和反应单位之间的连接作用，并且提供可以获得的附加信息。

3. 反应（Response）：这是EMS救护资源到达现场的反应过程。这个是一个分层反应，包括第一反应者、紧急医疗技术人员反应以及紧随其后的辅助医护人员。它可能意味着消防车和消防员也同时被调度以帮助升降搬运和移动患者或者把他们从损毁的汽车中救出。

4. 现场救护（On Scene Care）：相对于等待患者到达医院，许多救护措施可以在现场实施。书面流程（离线流程）和电话或手机联系急救医师（在线流程）已经拓宽了可以提供的现场救护范围。许多流程和药物可以在患者搬离现场前被使用。当EMS系统刚刚起步时，许多患者被送到医院。今天，在特定的情况下，诸如：心跳骤停，或者当患者没有严重的受伤或疾病时，并非所有的患者都被从现场带到医院。
 

5. 运送过程中的救护（Care in Transit）：以前患者曾经在灵车或旅行车中运送，没有人在其后提供医疗服务。随着联邦规则出现和EMS的成熟，尤其是经过设计的车辆携带有可移动的氧气、吸引、患者心电监护和通讯设备，以及患者急救所需的特定药物。旅行车和灵车已经被重达15000磅的特种车辆取代，这种车辆被称作“医疗怪物（monster medics）”。

6. 转送至特定的救护点（Transfer to Definitive Care）：在1990年，创伤医疗系统计划和发展行动出现之前，患者可能在急诊室见到一位特定专业的医师，诸如心脏科医师或者外科医师。他们通常没有经过训练去从事许多各种受伤和疾病的救治而被放在急诊室。今天，许多有广泛资质的急诊救护医师在急诊室等待帮助患者。护士现在也需要获得了急诊抢救资质和特定的创伤救护训练。医院现在创伤救护中有特定层面的设计。这意味着医院有额外的特定设备、房间和医师救治大多数创伤患者。专业的烧伤中心处理烧伤患者，专业的儿童医院仅处理儿童病患。获得特定医疗前已经经过了很长的过程，因为有了EMS，我们可以使用相对较短的时间。

引用

转载：人民日报高级记者/人民网特约评论员白剑峰
http://medicine.people.com.cn/GB/9546463.html

对于医务工作者来说，2009年6月是一个“黑色六月”。在短短的一个月时间里，先后发生了5起 “血溅白衣”事件。其血腥程度，令人惊悚。

6月1日 ，河南省武陟县一产妇在县妇幼保健院正常生产时，因产中发生羊水栓塞，不幸身亡。据悉，产妇羊水栓塞，属于高风险型病例，抢救的成功率极低。6月2日一早，亡者家属纠集了五六十人围攻保健院达数小时。几个大汉驾着院长强行让其披麻戴孝，在亡者灵前磕头哭丧，并实施暴力毒打，最后院长被打得倒地不起，蜷缩在水泥地上。

6月8日 ，浙江临海市白水洋国土分局局长之女金怡彤，在杭州市第一医院门诊公共场所自行坠楼。虽经全力抢救，但终因患者伤势过重，未能挽回生命。6月9日下午，其父金某率一百余人赶到医院，堵在科室门口围攻打砸，造成医院6人受伤。

6月11日 ，武汉江夏区疾控中心一名护士上班时，被一名男子在接种室内持刀割喉而死。江夏区卫生局证实，凶手此前到疾控中心打过狂犬疫苗，后多次骚扰该护士，称护士给他打的疫苗是“毒血”。

6月16日 ，北大第一医院某医生因拒绝为病人开虚假证明，被病人家属连刺五刀，身陷血泊。

6月21日 ，福建省南平市第一医院，一位“肾积水并尿毒症”的重症患者因呼吸功能衰竭、心脏骤停，经抢救无效死亡。21日凌晨3时，家属拒绝迁移死者尸体，将泌尿外科全科室封闭，泌尿外科的值班医生、手术医生和所有在院病人，都被关在病房。同时，医闹组织开始在门诊大楼、住院大楼摆放花圈，打砸泌尿外科住院病房。21日8点，整个医院处于瘫痪的状态。最令人不解的是，警 察到来后，无所作为，坐观待命。随后，市政府出面调解，医闹组织要求赔偿80万元，调解无效。6月21日下午，医闹组织召集了200多名社会势力，手持木棍及匕首冲至医院，封锁门诊大楼，摆满花圈，并焚烧纸钱，见到穿白大褂的医务人员即大打出手，有一名医生身中6刀，被送进医院抢救，另外有10余名医生、护士全部有不同程度砍伤。在此过程中，警 察得到的命令始终是“待命”，市政府给医院指示始终是“尽快调解”。6月21日晚23点，医闹组织再次召集6辆中巴车载满打手至医院，围攻办公楼至22日凌晨3点，声称再不按其要求赔偿，则将医院办公大楼炸毁。市政府经研究决定，责成医院赔款21万。事后，有人看见，家属在门诊大厅公开给医闹发钱。6月23日，医务人员忍无可忍，自发组织到市政府门前请愿，要求市政府作出解释，并严惩肇事凶手……

淋漓的鲜血，喷溅在白衣天使的身上，拷问着执政者的灵魂。在一个现代文明社会，居然会发生如此野蛮的“返祖现象”，实在令人惊诧！这些残酷的暴力事件，不仅直逼每一个有良知者的心理承受底线，也直逼一个社会的公平正义底线。是可忍，孰不可忍？

几年前，曾有深圳一家医院的医务人员曾戴钢盔上班，引起了全世界媒体的关注，被认为是中国医患关系紧张的缩影。然而，这一事件背后隐藏的深层问题，并未引起执政者的应有警觉，很多官员一笑了之，仅仅视为“炒作”、“作秀”。随着时间的推移，医患矛盾不仅未见缓和迹象，反而愈演愈烈。直至今天，靠暴力解决医患纠纷成为一个普遍现象。

其实，中国的医生是世界上最好的医生。他们拿着微不足道的报酬，干着最苦最累的活，长期忍辱负重。虽然也有怨言，却从未放弃职责。然而，就是这样一个守护生命的群体，却连自身的生命安全也无法保证，这究竟是谁的耻辱？

应该看到，医患矛盾绝不是医生和患者之间的“私人恩怨”，而是有着深刻复杂的社会历史背景。长期以来，我国医疗卫生体制改革滞后，医疗资源供给不足与人民群众日益增长的健康需求之间的矛盾突出，百姓“看病难、看病贵”的呼声强烈。同时，中国正处于一个在社会转型期，经济体制深刻变革，社会结构深刻变动，利益结构深刻调整，思想观念深刻变化，各种社会矛盾日益暴露凸显。而医院作为一个与百姓生命息息相关的“窗口”行业，自然最容易引燃社会情绪的导火线。

医学是一个高技术、高风险的行业，发生医患纠纷，不足为奇。如果医患双方都能理性对待，用法律手段解决问题，事情就会简单得多。但遗憾的是，由于种种原因，很多患者往往不愿意诉诸法律，而更喜欢“以闹取胜”。只要病人死在医院，活着的人似乎就有了赚钱的机会。不管是谁的责任，医院都要花钱摆平。否则，家属就会和职业“医闹”联合起来，摆花圈、设灵堂、围医院、打医生，仿佛有天大的冤屈。其实，很多“医闹”都是黑势力花钱雇来的，哭了半天还不知道谁死了。最后，医院迫于无奈，只好花钱买平安。于是，“医闹”和死者家属坐地分赃，各有所得。如此一来，“医闹”成了一个投资少、风险低、致富快的新职业，黑恶势力，趋之若骛。

“医闹”之所以越闹越欢，根源就在于地方政府部门的软弱纵容和公安机关的失职无为。很多地方官员认为，患者闹事，肯定是有冤屈，医院是公家的，赔点钱就“和谐”了。然而，正是这种是非不辨、黑白颠倒的“和谐观”，既导致了国有资产白白流失，又助长了“医闹”的嚣张气焰，使其有恃无恐，肆意危害公共安全。更奇怪的是，很多警 察看到“医闹”围攻医院，往往“坐山观虎斗”，放任自流。他们的理由是，“医闹”是“和平静 坐”，只要不流血，就没有执法依据。其实，这是为其失职行为找借口。试想，一个街头乞讨者都能被冠以“涉嫌扰乱公共秩序”被拘留，何况一群“医闹”真的干扰公共医疗秩序？为什么有时对待群众上访就滥用警力，而对待“医闹”围攻却要“慎用警力”？难道法律的弹性如此之大？

和谐社会的大厦，是建立在法治基石之上的。依法打击“医闹”，就是维护公平正义的法治精神，也是维护社会的长治久安。如果总是习惯于“花钱买平安”，换来的只能是表面和谐，其背后往往潜伏着更大的危机。因此，作为执政者来说，只有捍卫法律尊严，才是社会和谐之本。

当然，“医闹”之所以猖獗，也与患者维权渠道不畅、维权成本太高有关。打一个医疗官司，往往黑发人变成白发人，却未必能得到一纸公平的判决。因此，从长远来看，政府部门应开辟医疗纠纷处理的“绿色通道”，简化程序，提高效率，增强透明度和公信力，把患者的维权行动引入法制轨道，最终让“医闹”无事可闹。

仅一个月，连续发生5起骇人听闻的“血溅白衣”事件，这绝非偶然，而是医患矛盾恶化升级的“报警器”，必须引起各级政府的高度重视。假如有一天，医生都戴上钢盔、穿上防弹衣，那就真成了国家的耻辱了！

我们发现地球的自转轴并不垂直于黄道，而是倾斜了23.5度，地球的自转轴方向也在缓慢地移动。好比正在自转的陀螺，地球自转时会不断晃动，自转轴的方向 亦非固定不变，而是绕着黄道面的法线打转。这种摇晃称为「岁差」（precession），而地球岁差的周期约2.6万年。
地球自转轴方向古今有异
问题于是出现了。随?地球自转轴方向的转变，夜间所见的星座位置亦会随之移动。虽然2.6万年看似漫长，但它亦不过是人类有纪录的历史数倍而已。相比在 2500年前占星学刚出现的时候，黄道带上的星座已经移动了。2500年前春分（春天的开始，约每年的3月21日）那天的太阳位于白羊座内。但时至今天， 春分日的太阳已移到双鱼座内。
因此，若占星学说你是属于白羊座的话，那么你真正的星座应该是双鱼座才对。又如果你是在7月1日出生的话，在占星学上你是属于巨蟹座，但实际上你却是属于双子座的呢！
占星学的基础在于相信太阳和恒星之间存在一股神秘力量，而这股力量同时影响?地球。然而，天文学家发现太阳和恒星之间的距离非常遥远，往往达数百光年之 距，因此它们之间的引力可说是微不足道的。即使是属同一星座内的恒星也可以是互不相干的，原因是同一天区内的恒星跟地球的距离可以各自不同。
占星学家也许会辩说这股力量其实极之神秘，远超现代科学所能理解。然而，即使这股神秘力量真的存在，2500年前建立的占星学到如今偏离了整整一个星座已是不争的事实。因此，下次当你阅读星座运程时，便可能需要留意这点了。

Research now shows that the lack of natural talent is irrelevant to great success. The secret? Painful and demanding practice and hard work

By Geoffrey Colvin, senior editor-at-large

October 19 2006: 3:14 PM EDT

(Fortune Magazine) -- What makes Tiger Woods great? What made Berkshire Hathaway (Charts) Chairman Warren Buffett the world's premier investor? We think we know: Each was a natural who came into the world with a gift for doing exactly what he ended up doing. As Buffett told Fortune not long ago, he was "wired at birth to allocate capital." It's a one-in-a-million thing. You've got it - or you don't.

Well, folks, it's not so simple. For one thing, you do not possess a natural gift for a certain job, because targeted natural gifts don't exist. (Sorry, Warren.) You are not a born CEO or investor or chess grandmaster. You will achieve greatness only through an enormous amount of hard work over many years. And not just any hard work, but work of a particular type that's demanding and painful.

Buffett, for instance, is famed for his discipline and the hours he spends studying financial statements of potential investment targets. The good news is that your lack of a natural gift is irrelevant - talent has little or nothing to do with greatness. You can make yourself into any number of things, and you can even make yourself great.

Scientific experts are producing remarkably consistent findings across a wide array of fields. Understand that talent doesn't mean intelligence, motivation or personality traits. It's an innate ability to do some specific activity especially well. British-based researchers Michael J. Howe, Jane W. Davidson and John A. Sluboda conclude in an extensive study, "The evidence we have surveyed ... does not support the [notion that] excelling is a consequence of possessing innate gifts."

To see how the researchers could reach such a conclusion, consider the problem they were trying to solve. In virtually every field of endeavor, most people learn quickly at first, then more slowly and then stop developing completely. Yet a few do improve for years and even decades, and go on to greatness.

The irresistible question - the "fundamental challenge" for researchers in this field, says the most prominent of them, professor K. Anders Ericsson of Florida State University - is, Why? How are certain people able to go on improving? The answers begin with consistent observations about great performers in many fields.

Scientists worldwide have conducted scores of studies since the 1993 publication of a landmark paper by Ericsson and two colleagues, many focusing on sports, music and chess, in which performance is relatively easy to measure and plot over time. But plenty of additional studies have also examined other fields, including business.

No substitute for hard work

The first major conclusion is that nobody is great without work. It's nice to believe that if you find the field where you're naturally gifted, you'll be great from day one, but it doesn't happen. There's no evidence of high-level performance without experience or practice.

Reinforcing that no-free-lunch finding is vast evidence that even the most accomplished people need around ten years of hard work before becoming world-class, a pattern so well established researchers call it the ten-year rule.

What about Bobby Fischer, who became a chess grandmaster at 16? Turns out the rule holds: He'd had nine years of intensive study. And as John Horn of the University of Southern California and Hiromi Masunaga of California State University observe, "The ten-year rule represents a very rough estimate, and most researchers regard it as a minimum, not an average." In many fields (music, literature) elite performers need 20 or 30 years' experience before hitting their zenith.

So greatness isn't handed to anyone; it requires a lot of hard work. Yet that isn't enough, since many people work hard for decades without approaching greatness or even getting significantly better. What's missing?

Practice makes perfect

The best people in any field are those who devote the most hours to what the researchers call "deliberate practice." It's activity that's explicitly intended to improve performance, that reaches for objectives just beyond one's level of competence, provides feedback on results and involves high levels of repetition.

For example: Simply hitting a bucket of balls is not deliberate practice, which is why most golfers don't get better. Hitting an eight-iron 300 times with a goal of leaving the ball within 20 feet of the pin 80 percent of the time, continually observing results and making appropriate adjustments, and doing that for hours every day - that's deliberate practice.

Consistency is crucial. As Ericsson notes, "Elite performers in many diverse domains have been found to practice, on the average, roughly the same amount every day, including weekends."

Evidence crosses a remarkable range of fields. In a study of 20-year-old violinists by Ericsson and colleagues, the best group (judged by conservatory teachers) averaged 10,000 hours of deliberate practice over their lives; the next-best averaged 7,500 hours; and the next, 5,000. It's the same story in surgery, insurance sales, and virtually every sport. More deliberate practice equals better performance. Tons of it equals great performance.

The skeptics

Not all researchers are totally onboard with the myth-of-talent hypothesis, though their objections go to its edges rather than its center. For one thing, there are the intangibles. Two athletes might work equally hard, but what explains the ability of New England Patriots quarterback Tom Brady to perform at a higher level in the last two minutes of a game?

Researchers also note, for example, child prodigies who could speak, read or play music at an unusually early age. But on investigation those cases generally include highly involved parents. And many prodigies do not go on to greatness in their early field, while great performers include many who showed no special early aptitude.

Certainly some important traits are partly inherited, such as physical size and particular measures of intelligence, but those influence what a person doesn't do more than what he does; a five-footer will never be an NFL lineman, and a seven-footer will never be an Olympic gymnast. Even those restrictions are less severe than you'd expect: Ericsson notes, "Some international chess masters have IQs in the 90s." The more research that's done, the more solid the deliberate-practice model becomes.

Real-world examples

All this scholarly research is simply evidence for what great performers have been showing us for years. To take a handful of examples: Winston Churchill, one of the 20th century's greatest orators, practiced his speeches compulsively. Vladimir Horowitz supposedly said, "If I don't practice for a day, I know it. If I don't practice for two days, my wife knows it. If I don't practice for three days, the world knows it." He was certainly a demon practicer, but the same quote has been attributed to world-class musicians like Ignace Paderewski and Luciano Pavarotti.

Many great athletes are legendary for the brutal discipline of their practice routines. In basketball, Michael Jordan practiced intensely beyond the already punishing team practices. (Had Jordan possessed some mammoth natural gift specifically for basketball, it seems unlikely he'd have been cut from his high school team.)

In football, all-time-great receiver Jerry Rice - passed up by 15 teams because they considered him too slow - practiced so hard that other players would get sick trying to keep up.

Tiger Woods is a textbook example of what the research shows. Because his father introduced him to golf at an extremely early age - 18 months - and encouraged him to practice intensively, Woods had racked up at least 15 years of practice by the time he became the youngest-ever winner of the U.S. Amateur Championship, at age 18. Also in line with the findings, he has never stopped trying to improve, devoting many hours a day to conditioning and practice, even remaking his swing twice because that's what it took to get even better.

The business side

The evidence, scientific as well as anecdotal, seems overwhelmingly in favor of deliberate practice as the source of great performance. Just one problem: How do you practice business? Many elements of business, in fact, are directly practicable. Presenting, negotiating, delivering evaluations, deciphering financial statements - you can practice them all.

Still, they aren't the essence of great managerial performance. That requires making judgments and decisions with imperfect information in an uncertain environment, interacting with people, seeking information - can you practice those things too? You can, though not in the way you would practice a Chopin etude.

Instead, it's all about how you do what you're already doing - you create the practice in your work, which requires a few critical changes. The first is going at any task with a new goal: Instead of merely trying to get it done, you aim to get better at it.

Report writing involves finding information, analyzing it and presenting it - each an improvable skill. Chairing a board meeting requires understanding the company's strategy in the deepest way, forming a coherent view of coming market changes and setting a tone for the discussion. Anything that anyone does at work, from the most basic task to the most exalted, is an improvable skill.

Adopting a new mindset

Armed with that mindset, people go at a job in a new way. Research shows they process information more deeply and retain it longer. They want more information on what they're doing and seek other perspectives. They adopt a longer-term point of view. In the activity itself, the mindset persists. You aren't just doing the job, you're explicitly trying to get better at it in the larger sense.

Again, research shows that this difference in mental approach is vital. For example, when amateur singers take a singing lesson, they experience it as fun, a release of tension. But for professional singers, it's the opposite: They increase their concentration and focus on improving their performance during the lesson. Same activity, different mindset.

Feedback is crucial, and getting it should be no problem in business. Yet most people don't seek it; they just wait for it, half hoping it won't come. Without it, as Goldman Sachs leadership-development chief Steve Kerr says, "it's as if you're bowling through a curtain that comes down to knee level. If you don't know how successful you are, two things happen: One, you don't get any better, and two, you stop caring." In some companies, like General Electric, frequent feedback is part of the culture. If you aren't lucky enough to get that, seek it out.

Be the ball

Through the whole process, one of your goals is to build what the researchers call "mental models of your business" - pictures of how the elements fit together and influence one another. The more you work on it, the larger your mental models will become and the better your performance will grow.

Andy Grove could keep a model of a whole world-changing technology industry in his head and adapt Intel (Charts) as needed. Bill Gates, Microsoft's (Charts) founder, had the same knack: He could see at the dawn of the PC that his goal of a computer on every desk was realistic and would create an unimaginably large market. John D. Rockefeller, too, saw ahead when the world-changing new industry was oil. Napoleon was perhaps the greatest ever. He could not only hold all the elements of a vast battle in his mind but, more important, could also respond quickly when they shifted in unexpected ways.

That's a lot to focus on for the benefits of deliberate practice - and worthless without one more requirement: Do it regularly, not sporadically.

Why?

For most people, work is hard enough without pushing even harder. Those extra steps are so difficult and painful they almost never get done. That's the way it must be. If great performance were easy, it wouldn't be rare. Which leads to possibly the deepest question about greatness. While experts understand an enormous amount about the behavior that produces great performance, they understand very little about where that behavior comes from.

The authors of one study conclude, "We still do not know which factors encourage individuals to engage in deliberate practice." Or as University of Michigan business school professor Noel Tichy puts it after 30 years of working with managers, "Some people are much more motivated than others, and that's the existential question I cannot answer - why."

The critical reality is that we are not hostage to some naturally granted level of talent. We can make ourselves what we will. Strangely, that idea is not popular. People hate abandoning the notion that they would coast to fame and riches if they found their talent. But that view is tragically constraining, because when they hit life's inevitable bumps in the road, they conclude that they just aren't gifted and give up.

Maybe we can't expect most people to achieve greatness. It's just too demanding. But the striking, liberating news is that greatness isn't reserved for a preordained few. It is available to you and to everyone.

我很喜欢的一首小提琴小品，另一首《爱的忧伤》随后奉上。