'Waking Is Rising and Dreaming Is Sinking': The Struggle for Identity in Coma Literature

This thesis explores the representation of coma within contemporary fiction and non-fiction, including Irvine Welsh’s Marabou Stork Nightmares, Alex Garland’s The Coma, Stephen King’s The Dead Zone, Iain Banks’s The Bridge, Tom McCarthy’s Remainder and Jeff Malmberg’s documentary-film Marwencol. Initially examining these representations of coma through the lens of ‘trauma theory’, I examine how it is frequently depicted as a purely psychological trauma, often ignoring the physical consequences of brain injury and the impact this can have upon the patient’s identity. During the course of my investigation, I draw links between diverse theoretical fields rooted in literary criticism, philosophy, classics and medicine, creating my own critical framework against which representations of coma can be critiqued and which allows me to explore both authors’ and audiences’ fascination with the condition. Ultimately, I examine how misrepresentations have led to the proliferation of confusion and misinformation surrounding coma within the public arena and I look at the potential damage that this has for the real ‘survivors’. My approach is focused on close-reading, drawing out comparisons between archetypal tropes, common in depictions of coma, that have led to the condition being conflated with others states or disorders of consciousness (from the sleep and dream-states, to the chronic disorder of consciousness, the persistent vegetative state), which further contributes to the overall distortion of public perceptions of the condition. As part of my research, I have run a writing group, the members of which are all survivors of coma and brain injury. I have published collections of their work and I draw on this resource of first-person testimony to critique fictional misrepresentations. In doing so, I have produced an addition to the field of trauma-narrative analysis, examining a medical condition that, whilst depicted frequently in literature and the media, has remained largely unexplored within the sphere of literary analysis

Experiences of Homelessness and Brain Injury

Keywords: brain injury, homelessness, co-productio

‘Is she alive? Is she dead?’ Representations of chronic disorders of consciousness in Douglas Coupland's Girlfriend in a Coma

Depictions of coma have come to dominate literary and filmic texts over the last half century, a phenomenon coinciding with advancements in medical technology that have led to remarkable increases in the survival rates of patients with chronic disorders of consciousness. Authors of coma fiction are preoccupied with the imagined subjective experience of coma, often creating complex, dream-like worlds from which the protagonist must escape if survival is to be achieved. However, such representations appear to conflict with medical case studies and patient narratives that reveal that most often survivors of coma have no recollection of the coma itself. Providing a close reading of Douglas Coupland's Girlfriend in a Coma (1998) against the context of medical literature and diagnoses, this article examines how the coma patient is represented, often depicting the realities of a prolonged vegetative state, in contrast with other popular representations of coma. It explores how the author develops a work of ‘fantastic’ fiction (a genre defined by the structuralist critic Tzvetan Todorov), using the condition of coma as a metaphor for a postmodern existential crisis, while simultaneously employing mimetic techniques that raise important medical, ethical and philosophical questions surrounding the ontological status of the comatose patient. It is argued that coma fiction, even in its misrepresentation of the condition, can help us to engage with and interrogate how we think about chronic disorders of consciousness, thereby providing a valuable insight into our attitudes towards illness and mortality

International Examination and Synthesis of the Primary and Secondary Surveys in Paramedicine

BackgroundTo guide their care paramedics routinely rely upon two assessment and treatment algorithms, known as the primary survey and the secondary survey.  No clear consensus of the concepts (assessments and interventions) that are, or should be, included in these algorithms exist internationally. Methods This paper evaluated Australasian paramedic clinical practice guidelines (CPGs), as well as six other international paramedic CPGs (USA, Ireland, UK, South Africa, Qatar, and the United Arab Emirates) in order to identify which concepts are currently described in best-practice recommendations for paramedics.  The authors also contributed concepts that they felt were important additions based on their experience as veteran paramedics and paramedic educators.Results The resulting amalgamation of concepts identified in each term was then formed into two mnemonics which, together sequentially list approximately 100 specific clinical concepts that paramedics routinely consider in their care of patients. We describe these as the “International Paramedic Primary and Secondary Surveys”.Conclusion The primary and secondary surveys presented in this paper represent an evidence-based guide to the best practice in conducting a primary and secondary survey in the paramedic context.  Findings will be of use to paramedics, paramedic students, and other clinicians working in remote or isolated practices

2018 Research & Innovation Day Program

A one day showcase of applied research, social innovation, scholarship projects and activities.https://first.fanshawec.ca/cri_cripublications/1005/thumbnail.jp

Australasian paramedic clinical practice guidelines for managing cardiac arrest: An appraisal

Introduction There are 10 government-regulated ambulance services (paramedic provider services) in Australasia who are members of the Council of Ambulance Authorities (CAA). These CAA-member services each produce clinical practice guidelines (CPGs), which guide the practice of their paramedics. Common to each set of CAA-member CPGs is a guideline that addresses cardiac arrest due to ventricular fibrillation and pulseless ventricular tachycardia (pulseless VT/VF). This study sought to answer the question: ‘Are current CAA-member CPGs developed with sufficient methodological rigour to consistently produce guidelines that, according to validated, evidence-based best practices, can be recommended for clinical use?’ Methods This question was addressed by performing a comparison of existing CAA-member CPGs for pulseless VT/VF against the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. All CPGs were anonymised and sent to each appraiser along with the AGREE II appraisal sheet. Appraisals were conducted independently for each CPG and returned to the lead author for collation. The anonymised results were then shared among all appraisers for consideration and discussion. Appraisers were free to change their appraisal after considering the comments from the other appraisers, and results were then converted into a final percent score for each CPG in accord with the recommended AGREE II instrument methodology. One appraisal question, in addition to the AGREE II criteria was added to each appraisal; the response to this was analysed separately. Results Nine CPGs were evaluated according to the AGREE II instrument. The appraisers gave passing marks to only two of the six domains in the AGREE II instrument: Domain 1 – Scope and Purpose (73%), and Domain 4 – Clarity of Presentation (74%). Less than passing marks were awarded for Domain 2 – Stakeholder Involvement (27%). Scores of less than 10% were awarded for Domain 5 – Applicability (8%) and Editorial Independence (1%). Conclusion Based on the findings of this paper, the authors conclude that it cannot be assumed that current CAA-member paramedic CPGs are developed with sufficient methodological rigour to consistently produce guidelines that, according to validated, evidence-based best practices can be recommended for clinical use. However, most of the authors agree that the CPGs reviewed could be recommended for clinical use with relatively minor modifications. It would be useful to determine whether end users of the CAA-member CPGs agree on the importance of characteristics of CPGs that the AGREE II instrument appraises

Spatial and temporal variability in seasonal snow density

Snow density is a fundamental physical property of snowpacks used in many aspects of snow research. As an integral component in the remote sensing of snow water equivalent and parameterisation of snow models, snow density may be used to describe many important features of snowpack behaviour. The present study draws on a significant dataset of snow density and climate observations from the United States, Australia and the former Soviet Union and uses regression-based techniques to identify the dominant climatological drivers for snow densification rates, characterise densification rate variability and estimate spring snow densities from more readily available climate data. Total winter precipitation was shown to be the most prominent driver of snow densification rates, with mean air temperature and melt-refreeze events also found to be locally significant. Densification rate variance is very high at Australian sites, very low throughout the former Soviet Union and between these extremes throughout much of the US. Spring snow densities were estimated using a statistical model with climate variable inputs and best results were achieved when snow types were treated differently. Given the importance of snow density information in many snow-related research disciplines, this work has implications for current methods of converting snow depths to snow water equivalent, the representation of snow dynamics in snow models and remote sensing applications globally. © 2013 Elsevier B.V.Kathryn J. Bormann, Seth Westra, Jason P. Evans and Matthew F. McCab