Everyday Disasters: What Are the Odds

Lance: Las Vegas is very good at making probability feel glamorous. The lights help, so do the cocktails, the carpets designed to make us forget what time it is, and several generations of extremely attractive people explaining through a song that tonight could be our night. Put a man in a dinner jacket beside a roulette wheel, and suddenly losing $200 feels continental. The casino makes a convincing argument.

Lance: When someone wins, the machine lights up, bells ring, and everyone within earshot is informed that fortune has entered the building. When someone loses, nothing happens. They might press the button again or quietly leave to reconsider several recent decisions. Underneath all that velvet and electricity, the casino is working with some very old equipment: the human brain.

Lance: Dopamine rewards unpredictability, not scale. Pay out the same every time and we lose interest. Pay out at random with lights and noise, and we lean in. A near miss works the same reflex, reading as progress instead of failure. It’s the same instinct that once sent us after a wounded gazelle. The slot machine just asks for another $20.

Lance: We’re good at judging odds we can see. Clearing the puddle, catching the glass before it falls. But numbers like one in a million are harder to feel. More empty desert than math. Once we’re holding the ticket, it feels like someone has to win, and tonight we’re someone. In 2025, Clark County casinos reported 14 billion in gaming revenue.

Lance: The possibility of winning is the product. $14 billion is the business model. And still, we go. Because the jackpot is enormous and flashing and accompanied by bells. No one builds a 40-foot neon sign celebrating the possibility that we might leave with more money than we arrived with. The same brain that can turn a remote chance of winning into, “Why not me?”

Lance: Also helps decide which dangers deserve our attention. The spectacular ones arrive with headlines and dramatic music. The familiar ones tend to disappear into the furniture. We avoid the beach over a shark sighting, then run another load through a dryer whose vent hasn’t been cleaned since the Clinton administration.

Lance: Clothes dryers are involved in thousands of fires each year. Failure to clean them is the leading cause. That doesn’t mean the beach is free of risks, planes don’t crash, or storms don’t come. Rare things happen. Sometimes they rearrange the world. But danger, with excellent publicity, occupies a great deal of our imagination.

Lance: The risks built into an ordinary Tuesday have to compete with the what’s for dinner household negotiation. Those risks often begin with something almost normal: a smell we can’t place, a sound we haven’t heard before, or a friend who says she’s fine when she clearly isn’t. It’s leaving us just enough room to explain them away.

Lance: Most of the time, nothing happens, and every time nothing happens, we become a little more convinced that nothing will. This is No One Is Coming. I’m Lance.

Act One: The Daily Wager

Lance: Most of us leave the gambling to Vegas, at least that’s what we tell ourselves. Then we pick up our keys, get behind the wheel, and enter a system built out of speed, distance, weather, and other people’s judgment, which is famously where things get complicated.

Lance: In 2024, American drivers made an estimated 230 billion trips. The National Safety Council estimates that motor vehicle incidents produced 13 million crashes. About 3 million of those resulted in injuries requiring medical attention, with more than 42,000 people dying from those injuries. Between medical care, lost productivity, and damaged property, motor vehicle incidents cost the country nearly $560 billion.

Lance: Those numbers should make getting into a car feel consequential. Instead, we’re much more likely to worry about getting on an airplane. Studies estimate that around 40% of adults experience anxiety over air travel. Estimates for fear of driving are closer to 10%. Driving rarely feels like the dangerous part of our day.

Lance: It feels like the thing we do on the way to whatever we’ve decided deserves our attention. Once the seatbelt clicks, our minds move ahead to the meeting, the grocery list, or whether we remembered to close the garage door. We drink coffee and mentally rehearse the day ahead while guiding several thousand pounds of machinery through a world full of people doing exactly the same thing. Dr. William Van Tassel leads driver training programs for AAA’s national office and has spent his career studying how people behave behind the wheel. He’s also a national champion sports car racer and former stunt driver, which makes his commitment to safe driving considerably more interesting.

Lance: When you’re riding with an ordinary driver, what are some of the tells that makes you notice whether or not they’re genuinely engaged or just sort of operating automatically?

William: One of the biggest clues I have there is how smoothly they’re driving.

Lance: Mm.

William: And if they’re driving smoothly, that tells me they’re looking well ahead, they’re thinking ahead as well. So they’re aware of what’s going on. They’re adjusting to that, whether it’s speed or, or space, say a vehicle ahead of them starts slowing down.

William: If they respond quickly, great, gently lift off the accelerator. Or are they waiting, like, “Oh my gosh, the car’s stopping,” and suddenly they’ve gotta kind of jam on the brakes. Uh, that’s a, a real big clue as to- … is the driver engaged or not? Are they paying attention? And another one is space, keeping space around your vehicle.

William: And on the road, your best friend is space. It’s hard to hit anything if you keep enough space around your vehicle. Challenge is everyone wants to crowd you, right? Every- all the other road users- Right … wanna get up behind you, to the sides. So we say, “Let’s have a big donut of space around you, and just keep that as a cushion all the way around your car.”

William: If somebody moves up next to you

William: or starts tailgating you, you say, “Well, somebody’s taking a bite of your donut.”

Lance: And I imagine that d- the amount of space depends on the speed, right?

William: Right. And speed really becomes your tool to help you gain and maintain that space. So let’s say you’re driving along, you’ve got a car to your right that’s roughly about the same speed.

William: You don’t wanna be driving with a car to your right, ’cause you may need to move into that space. Mm. So if you lift off the gas a little bit, relatively let that car move on ahead, ideally now the space is available to you. If you need to change lanes suddenly, if you wanna know that space is available to you before you do that maneuver.

Lance: The important decision happens before anything is wrong, while there’s still time to do something ordinary. Of course, that depends on noticing what’s happening around us. Unfortunately, exhaustion is one of the few forms of impairment we often attempt to cure with a playlist.

Lance: I had a friend who was working night shifts in Colorado, at a resort, and, she fell asleep and rolled down a hill. And woke up the next morning, and she was not impaired other than just being, working really incredible shifts. And she was very, very lucky. You know, there are popular fixes if you’re feeling drowsy, cranking music, cracking your window. Do those help?

William: Definitely not in the long term. You might get a few minutes boost there, but really the only thing that can play a role there is sleep.

William: And that drowsy driving, sleep deprivation issue is probably under-recognized, under-discussed as a traffic safety issue. Contrast that with alcohol and driving. We’ve all heard, “Don’t drink and drive,” right? Right. We all get that message, and we probably need to hear it again and again and again and again. S- but if we’ve been drinking, we probably know, okay, it’s not a good idea to get behind the wheel.

William: But with sleep deprivation, it’s harder.

Lance: Sure.

William: It’s hard to measure. It’s harder to, to feel when we’re sleep deprived, so it’s, it’s more challenging. And those sleep deprived crashes, they tend to be a higher injury and higher impact.

Lance: Oh, gosh.

William: Um, with alcohol, it’s certainly feasible that the driver would perceive, okay, I’ve got a, an issue.

William: There’s… I’m about to crash. And they might slow down or try- Mm-hmm … to steer, try to do something to minimize the crash. If you’re asleep, if your eyes are closed, you’re just plowing ahead full speed, and those tend to be higher impact, uh, more likely to result in death. So we should take that more seriously.

Lance: What’s the driving emergency that people think they’re prepared for and often handle completely wrong?

William: Sometimes we see a situation where a vehicle breaks down or has a flat tire. Even if that person is able to take care of the issue, they might choose to do that in an unsafe place. Driving along the highway, their vehicle’s now on the shoulder, and now they’re gonna be changing the tire, slide under the car, right along the roadside.

William: And even if they’re able to do that, they’re at extremely high risk. So far safer is to make sure you’re further off the road. Call AAA, call your auto club, and have them come and provide support. They’ve got all sorts of tools to become a lot more visible to approaching drivers. Unfortunately, too many people get hit, lose their lives.

William: It’s just too risky.

Lance: Driving is easy to underestimate because familiarity makes the risk feel ordinary. Then we pull into the driveway, turn off the engine, and step into the place that feels safest of all, home.

Act Two: The House Always Wins

Lance: Home is the place where most of us stop scanning the horizon.

Lance: We close the door, put down the keys, and let our shoulders drop. We know the sound of the floorboards, the way the heat comes on, and which door sticks when it rains. Home becomes less like a building and more like a person we’ve known for years. And like anyone we love, we get used to home’s little changes.

Lance: Something hums differently. A stain appears, and after a while, becomes part of the ceiling. The house ages around us gradually enough that familiarity can soften the edges of what we’re seeing. We know it. We trust it. We forgive it. And sometimes that means we stop noticing what it’s trying to tell us.

Lance: And this particular loved one is made of wiring, gas lines, stairs, and several thousand things capable of sending us to urgent care. In 2024, more than 30 million Americans suffered an injury at home serious enough to require medical attention. That’s more than the number of injured in public places, workplaces, and motor vehicle crashes combined.

Lance: Leah Bolden is a carpenter, contractor, and former building trades instructor with more than 25 years of experience. Through her YouTube channel, See Jane Drill, she has taught more than a million followers how to repair and maintain their homes without being intimidated by them. When you walk into somebody’s home, are there little things that you notice that an ordinary person like myself might not notice, and you think, “You know what? You need to deal with that.”

Leah: Well, I would tell you the first giveaway is, for me, visual cue is water stains. Mm. ‘Cause that kind of tells me that you’ve got a problem that you really shouldn’t ignore because there’s a health risk that’s attached to that, and that’s black mold. Mm. So on the surface, you may just see a water stain, but on the top side of the ceiling or if it’s a wall, the back side of that wall, there’s very likely black mold.

Leah: So I think a lot of times people fool themselves with, you know, ceiling leaks or plumbing leaks. Uh, they’re very dismissive of water stains, but that’s telling you that’s just a superficial story. Right. That’s not telling you the whole story. But I guess the second thing is smells. Mm. Smells that tell you that there’s a problem.

Leah: Sometimes people may smell something, but not be able to identify it. If you walk into your house and something doesn’t smell quite right-

Lance: Mm-hmm …

Leah: um, that’s a big hint, especially if it’s musty. That’s telling you you got a problem.

Lance: So, you know, I talked about my 20-something friends, and, and they dealt with a dryer fire. So what happens if a vent is clogged, right? Like, there’s, there’s this lint trap, but then there’s the whole venting system that nobody ever really thinks about. What are the warning signs before it catches fire?

Leah: It could be a couple things. Number one, your appliance, the dryer, could get really, really hot.

Leah: Mm. And that’s telling you that that vent is clogged, and it’s creating a lot of heat for the dryer. Or it could take you a couple of cycles to dry your clothes. Those are the two telltale signs. If you do a little investigating, and this is one of the things that I tell people to do because lint is so combustible, it’s highly combustible, people don’t realize it.

Leah: If they’re living in a home and the washer dryer’s on the first floor, they have access to that vent outside, and if you hold your hand up near it, you can tell whether or not you’ve got a lot of airflow. But if you’re not getting much airflow, then you know that it’s time to clean out that vent.

Lance: So if your dryer actually does catch fire, like, what do you do, and what shouldn’t you do?

Leah: Well, let’s go with the what shouldn’t you do. Yeah. Don’t throw water on it. Big, big mistake. Yeah. And what I would say is don’t try to unplug it. If it catches on fire, get the heck out, call 911, and let them handle it.

Lance: Arly Streed is co-host of the How to HandyMa’am podcast. She teaches women how to understand their homes, solve everyday problems, and recognize when a project has crossed the line from, “I can do this,” to, “I need a professional.”

Arly: The lint is the first thing that catches on fire, and that is usually in your vent, and that’s in your walls. So it’s not like you can smother it or throw water on it or something, that you’re probably not gonna be able to access it very easily. I would stop your dryer if you’re able, and evacuate.

Lance: What are other boring little things that are really important that if left not maintained can turn into dangerous things?

Leah: The carbon monoxide detector needs to have batteries, and so does the smoke detector. And what happens a lot, and I hear this all the time, is when those batteries start to die, you get that little disturbing beep, beep, beep sound. So what do you do? You take out the battery so you don’t have to hear it instead of replacing it, and so many people do that.

Leah: And then they forget. That’s what I would say.

Lance: That small decision helps explain a much larger number. Nearly three out of every five home fire deaths occur in properties where there’s no smoke alarm or the alarm fails to operate. Not every hazard is part of the house. Some are the tools we bring out because we’ve decided, “This will only take a minute.”

Arly: Ladder safety is really important, and people think sometimes on a step ladder or a four-foot ladder, like, “I’m only going up a couple of feet. I… This is fine.” So they don’t use as much caution. But when you are using a ladder, especially when you’re by yourself, you need to maintain three points of contact.

Lance: Three points of contact are easy enough to remember. The harder judgment is knowing whether we should be doing the job at all.

Arly: What is the line between, “I can do it myself,” and, “I need to call a professional”? I will quote my co-host, Samantha. “Can you deal with the consequences?” So if you are saying, “I can tile a shower by myself,” can you deal with the consequences of your shower leaking if you don’t properly waterproof it?

Arly: If you’re doing backsplash tile in your kitchen by yourself, can you live with the consequences of your grout lines not being perfect because you’re not a professional, or your tiles being improperly cut?

Lance: Most home repairs allow us a moment to step back, consider the consequences, and call someone who knows more.

Lance: It gets harder when the thing we’re trying to read is another person.

Act Three: Stranger Danger

Clip: Let me ask you something. Why don’t people trust their instincts? Something is wrong. Someone is walking too close behind them. You knew something was wrong, but you came back into the house. Did I force you?

Clip: Did I drag you in? No. All I had to do was offer you a drink. It’s hard to believe that the fear of offending can be stronger than the fear of pain, but you know what? It is.

Lance: Most of us are good at recognizing danger when it’s immediate. The harder moment comes earlier when nothing has quite happened yet and we’re still trying to decide whether we’ve misunderstood the situation.

Lance: Someone has been behind us for several blocks. A car makes the same turn we do, and then another. There may be an innocent explanation, and that’s precisely what makes these moments difficult. The part of the brain noticing the change has to compete with the part that doesn’t want to be rude, paranoid, dramatic, or wrong.

Lance: Over a 20-year career with the LAPD, Adam O’Neill moved from routine patrol work to high-stakes assignments, including undercover narcotics and gang units.

Adam: The goal of being situationally aware is to not create paranoia or to become distrustful of everyone around you. The goal is simply to be aware and to make a first move.

Adam: And so it’s when you come out of your house in the morning, it’s not being on the phone for that literally three seconds, right? Mm-hmm. Paying attention when you open the front door or your garage or wherever you get in a car, if you go to a bus stop or a train, and it’s just being aware of every place that you go into.

Adam: It’s literally just looking up. Most people feel rude. They have this social grace, and you have to get over that feeling of rudeness. That’s the first thing that you have to kind of train yourself, to listen to your intuition. Like, listen to it. You work in an office building and you work late that night, and it’s 7:00 o’clock, and most people leave that office building at 5:00 o’clock.

Adam: And you go and you see someone waiting for the elevator there. You see them, it’s someone you’ve seen before. You don’t know them really. You’ve seen them go to the bathroom before. Or something just feels off, right? Mm-hmm. You don’t have to say anything. You just walk by that person and, like, act like you’re going to the bathroom.

Lance: Right.

Adam: Then you go back to your office.

Lance: Sometimes you’re just out walking in a neighborhood and you realize somebody’s following you, right? So what do you do?

Adam: One, the first thing you do, you would get distance from that person. So that means you would cross the street, literally cross the street, right?

Adam: That’s, like, the simplest move. And almost certainly, if that person had nefarious or other type of, uh, things in mind, most likely they’re not gonna cross the street. Like, “Oh, that’s not my victim. This person’s over here,” right? Now, if they cross the street, okay, now you know something’s wrong. Don’t wait.

Adam: Like, there’s nothing to wait for at that point, right? Distance gives you time. Distance gives you options. And so then if you’re, let’s say you’re on a commercial street-

Shannon: Mm-hmm …

Adam: you simply would walk into a business, any business. Right. And you would walk in, and you might want to say to the person right at the counter or the restaurant or whatever it is, “Hey, I think I’m being followed.

Adam: Just want to sit here for a moment. But if this person comes in, I want you to call 911 immediately.” Yeah. Right? You know what I mean?

Lance: The first move isn’t confrontation. It’s a way of declining one. That becomes more complicated when both people are inside cars and the other driver is trying very hard to make their anger your problem.

Lance: So if someone is tailgating you and gesturing and trying to get into a fight with you, what’s the safest way to disengage? And what do you do if they start following you?

William: First, they’re focused on you, and that’s what you want to stop. You may have done nothing wrong, nothing offensive, and they’re just focused on you.

William: Anything you can do to communicate to them, “Hey, sorry. My bad,” even if you did nothing wrong.

Lance: Right.

William: Okay, that’s fine. It’s easy, doesn’t cost you anything, and they move on, then you’ve won. But if they don’t let go, then that could be a good time to drive to a firehouse or a police station. If those aren’t around, then maybe an all-night gas station or a busy store or something like that, right up to the entrance where there’s other witnesses, there’s cameras, and that might be enough of a deterrent.

William: That’s the idea. Yeah. Not to capture anything bad, to prevent anything.

Lance: What you don’t wanna do is lead them home. Ricardo Martinez has spent 13 years working in 911 dispatch. 911, what’s your emergency? He now hosts the Within the Trenches podcast and founded the I Am 911 movement, which tells the stories of the people who answer emergency calls before help is on the way.

Lance: If you’re walking around, you’re lucky, you have your phone with you, someone is following you or feels threatening, do you call 911, and what do you do?

Ricardo: You know, a lot of people in the past have done just that. If they feel uneasy, they will call. I remember people calling in while they’re driving, and they would say, “You know, I just left this gas station.

Ricardo: There’s this car following me. I don’t know. They’re just seem kind of suspicious.” And I would say, “Okay, well, where are you at right now? What’s the cross street?” And then we put it out over the air. We’ve got a caller in a, a red Atlas VW that’s being- Mm-hmm … followed by a black truck, and they’re currently going this direction.

Ricardo: Nearest cross street is, you know, whatever. They would try to get there as fast as they could to catch up to that person. Or- Mm … if they were close enough to maybe even the police department, we would have them go over there.

Lance: A car has a make, model, color, and direction of travel. The human body is less cooperative.

Lance: It gives us a stomachache and leaves us to decide whether to take an antacid, make a doctor’s appointment, or call an ambulance.

Act Four: Internal Affairs

Lance: We make some version of this decision all the time, usually while pressing the achy spot and opening a browser tab we’ll come to regret. We search for headache, then headache and fatigue, then headache, fatigue, and the weird bruise on my leg.

Lance: 10 minutes later, we’re reading a medical forum from 2009 and wondering whether Victorian wasting diseases have made a comeback. Could I, in fact, have scurvy? Would a jar of leeches help? When did I last sail aboard a pirate ship? Then we close the tab, take two ibuprofen, and decide to see how we feel in the morning, which is also our treatment plan for food poisoning, a pulled muscle, and most things that begin on a weekend.

Lance: Dr. Jared Ross is a board-certified emergency physician who began his career as a paramedic and firefighter. He spent more than 25 years working and teaching across emergency medicine, disaster response, and the care people receive before they reach the hospital.

Jared: People don’t wanna go to the emergency room, or they don’t wanna go to urgent care, and part of it is, like, they don’t

Jared: wanna make a spectacle of themselves.

Lance: What medical emergency do people really wait too long on?

Jared: Yeah, you know, when you asked me this question, I, I thought with my gut, and then I kind of checked- Yeah … the literature, and it’s heart attacks and it’s strokes. So if you look at the data, more than half of heart attack victims die before they get to the hospital.

Jared: Oh, my gosh.

Jared: And with strokes, the data’s even worse. Mm-hmm. That, um, about 70% of people who have a stroke in the US arrive at the hospital after the six-hour window for intervention has closed. And so you said it’s, you know, people are embarrassed. They don’t wanna make a spectacle of themselves. I think people naturally minimize symptoms, and we know that, that family decisions, especially when it comes to stroke, makes this much worse.

Jared: Right. That if you have a stroke, you wanna have a stroke around strangers, because those strangers will-

Jared: Right, “You’re fine, Mom.”

Jared: They, they will call 911. Well. And you will get quickly evaluated and treated. If, if you have a stroke with family, family’s gonna minimize everything, and so it’s a challenge.

Jared: Stroke especially is really a, a group decision because- Mm-hmm … it can be such a vague constellation of different symptoms, and people just don’t know what to do with it

Lance: This isn’t an argument against having a family. It’s an argument against holding a committee meeting while one member of the committee is suddenly slurring their words.

Lance: Dr. Shannon Markus is a board-certified emergency physician, public health professional, and assistant professor based in Austin, Texas. She specializes in translating complicated medical information into advice ordinary people can actually understand and use.

Clip: Sometimes family members can talk you out of things.

Clip: Sometimes-

Lance: Right … you know, like, oh, you seem fine, and you’re losing minutes. But if we turn that around, like, have you seen a really capable civilian or family member who really changed the outcome?

Shannon: Yeah, absolutely. Very, very commonly people take steps that are not necessarily seen as heroic, but they’re nudging their family member to go in- Mm-hmm

Shannon: for complaints that the patient might not be concerned about, but their loved ones are. And I can remember a, a specific time that actually happened this year. I had a 27-year-old previously healthy female who was combing her hair in her bathroom, and her fiance heard her collapse and immediately rushed to her side, checked, saw that she was incapacitated, not breathing, started bystander CPR, did high quality CPR, called 911.

Shannon: Ambulance got there, brought her in. We continued CPR. She miraculously got pulses back and regained a heartbeat and, uh, was admitted to the intensive care unit and less than one week later, walked out of the hospital- Mm … neurologically intact. And when debriefing and looking at that case, um, it came out that the fiance had been trained in CPR, had taken a course, and performed high quality CPR and took all the right steps and really saved their loved one’s life.

Shannon: We found out later that she had an underlying genetic cardiac abnormality, which- Wow … the whole story was just mind-blowing. It even gives me goosebumps just to think about that case.

Lance: That’s incredible. Let’s talk about that actually. So what are some of the steps? Like, how do you determine if it’s time to start chest compressions?

Shannon: Yeah. So if someone, say, collapses and th- they’re not waking up, first things first is actually you wanna make sure the scene is safe. Mm-hmm. So if there are, like, falling objects or they actually just had a car accident and you’re not in a safe place on the highway, you should not put yourself into a situation where you can then become a second patient.

Shannon: Now, if the scene is clear, and say, you’re in a grocery store and someone collapses and the scene is clear, you, uh, should shout and shake them to see if they would respond. And if not, um, call for help. So calling for help, say, “Hey, I need help here. Someone locate an AED or a defibrillator- Mm … and someone call 911.”

Shannon: Then you can get to focusing on the patient. Check their breathing. So do you see their chest rising and falling? Mm-hmm. Do you feel air coming out of their mouth? Do you see that they’re breathing? We don’t expect people to, if they haven’t been trained, to be able to accurately check pulses. It’s very difficult for medical professionals as well.

Jared: There was this big study that was done in Europe, kind of morbid. They took a bunch of volunteers and had them lay in beds in a room, and then they took a bunch of corpses from the morgue and warmed them up and put them on beds in the room. And then they had, like, doctors, nurses, EMTs, paramedics go around and try to figure out who had a pulse and who didn’t, and no one was, was really that good at this

Shannon: So really just checking for breathing, and if you don’t notice any, um, meaningful breaths being taken, um, or, uh, the breaths are not normal, um, then you should start chest compressions.

Lance: So what does abnormal breathing actually look like?

Shannon: The most concerning, uh, type of abnormal breathing, especially when someone is sort of not verbally responding to you- Mm-hmm … is something we call agonal breathing. Mm. So agonal as in agony. So their breathing is, is very labored, and they may take a huge breath and then kind of deflate, and then a huge breath and then a deflate.

Shannon: Mm. And, um, in medicine, we often call that guppy breathing. Mm. And that’s not to be funny or make light of it, it’s, it’s more referring to what a fish looks like when they’re out of water and they’re struggling- Right … to breathe. And agonal breathing is a brainstem reflex that occurs when the patient is, unfortunately, either dead, their heart has stopped, or they are in severe, severe distress.

Shannon: You should treat that as if the patient is near death. Um, and usually at that point you would start chest compressions.

Lance: So talk to me about our friend CPR. Is that something you wish everybody would take a class on?

Jared: Yeah. You know, I mean, it’d be great if everyone took a class on it, but in all honesty, what really matters is not having that barrier to a class of, like, signing up and going to a class.

Jared: Mm-hmm. The American Heart Association has put these kiosks into airports and convention centers where you just, like, 30 seconds learn hands-on CPR. And, you know, it’s just about getting the right position over the lower third of the breastbone, one hand on top of the other. You gotta lock your elbows out so your arms are straight, and then you’re on your knees and you’re throwing your whole body weight into doing those chest compressions, so pushing all the way down and then allowing their chest to recoil, ’cause what you’re doing is you’re pumping their heart for them

Lance: People often hesitate to call 911 because it feels like escalating the situation.

Lance: An ambulance arrives with lights, sirens, and neighbors who’ve suddenly found a reason to check the mail. How do you decide to call 911, or drive someone there yourself or, you know, maybe wait and see if it resolves? I

Jared: I think at the end of the day, you absolutely have to err on the side of calling 911 or, or for your, you know, international audience, calling your, your local or nationwide emergency number.

Jared: Right. And I think what’s really important is the idea that you wanna get the care as soon as possible. An ambulance is not just, you know, an Uber with flashing lights and a siren. It’s really a, a mobile mini hospital- Mm … with, you know, highly trained paramedics and EMTs who can deliver this life-saving care before you get to the hospital.

Jared: You know, it’s not just delivering that care, it’s not just getting you there, but it’s also making sure that you’re going to the right facility. You know, if there’s a concern for stroke, they wanna take you to a stroke-capable facility. You don’t wanna end up driving 20 minutes to your local ER, and then they have to call an ambulance to take you to another hospital.

Jared: And then they can alert specialized teams. They can get an electrocardiogram, an EKG or an ECG, which is an electrical tracing of your heart, and they can say, “Whoa, yeah, you’re definitely having a heart attack. Um, we’re gonna get an IV in you, start some blood thinner medications, as well as the aspirin, and then we’re gonna call the hospital and say, ‘Get the cardiologist in there. Get the cardiac cath lab running.’ And that way, when you show up, those balls are already in play, those things are moving, as opposed to you just showing up by private vehicle and those calls haven’t been made

Lance: Not every medical decision begins with someone collapsing.

Lance: Sometimes the person is awake and breathing normally, but a pill is missing from the bottle, or you’re looking at the pill organizer and realizing Thursday may have happened twice. Dr. Michael Chary is an emergency physician and medical toxicologist at Weill Cornell Medicine and co-director of webPOISONCONTROL.

Lance: His work focuses on what happens when medications, drugs, supplements, and ordinary household substances become dangerous. You think a, a child might have gotten into the medicine cabinet. You know, you don’t know if they’ve taken a pill or not, but say there is something like blood pressure medicine in the cabinet, what do you do? What’s the first thing you do?

Michael: So I think the first thing to do is, is establish a, a few facts. What the medicine is and how many milligrams, and there may be letters at the end of it like XL, SR, meaning extended release, and those, those are very important for us to know, too. And then you want to do a survey.

Michael: Is this the only medicine the person got in? If it’s a kid, maybe they were simply taking the tops off three bottles. In general, medicine doesn’t taste good. You say that these are, quote, exploratory ingestions, um, kind of the same way they might pick up a Lego and put it in their mouth.

Lance: Right.

Michael: And usually once they get in there, they’re like, “Oh, this does not taste good.”

Michael: Um, so I think that you should start by establishing the facts as to the best of your knowledge what went into the kid and when. Then what does the kid look like? One option is to go directly to the emergency department, but another one that, that’s evolved out of the call centers is, is something called Poison Control.

Michael: The number’s 1-800-222-1222, so a bunch of twos, but there’s a one. Or just, you know, Google the number and click Call. You will be routed to the poison center based on your area code, and there you’ll talk to pharmacists and medical toxicologists, MDs, who will do their best to figure out was a toxic dose given, or is there such a huge discrepancy between what the person currently looks like and, and the reported ingestion that maybe they should get some in-person evaluation.

Michael: I think if the child is acting unusually, and I’m saying that deliberately broadly because every, every child’s unique enough, if you notice the kid is more sedated than usual, acting abnormal, that’s just to go straight to the ER. But in cases where they look fine, you’re like, “Did they get… I’m not sure.

Michael: You know, what’s the worst-case scenario?” You wanna run scenarios, that’s one. And then similarly, if you’re taking medication and you accidentally take a double dose of it, um, that’s kind of the most common adult error, then I think it’s worth, uh, checking on that app. Don’t induce vomiting. Don’t go somewhere to have your stomach pumped.

Lance: Poison control gives us something a self-guided internet search can’t: expert advice based on what was taken, how much, when it happened, and what the person looks like now. You can speak to a specialist by phone or use webPOISONCONTROL to determine whether the situation can be monitored at home or needs immediate medical care. But some emergencies remain dangerously easy to mistake for sleep.

Lance: In the United States, the lifetime odds of dying from an accidental opioid overdose are greater than the odds of dying in a car crash.

Shannon: Opioid overdoses, you know, people may stand by and think, “Oh, they’re going to sleep it off,” or, “This is a normal response to the either medication or drug that was taken.”

Shannon: But really assessing that patient or person very closely to, um, ensure that they don’t need a reversal agent like naloxone or need 911 called is- Mm-hmm … really, really important for people to know.

Lance: So what are some of the signs if there is, like, an opioid overdose?

Shannon: If you are a, a bystander and, and see someone go down or you’re around people who are doing street drugs, the main thing is, is respiratory depression.

Shannon: Mm-hmm. That’s what opioid overdose causes, and that’s how opioid overdose kills. We should be breathing 12 to 20 times per minute. And so if someone is breathing only five times a minute, that’s extremely concerning for opioid overdose. Naloxone, so this is an opioid reversal agent. It is widely available now.

Shannon: In many states and cities it is available without prescription, and there are lots of grants to be able to obtain naloxone for home use. And this is hugely lifesaving, not just for anyone who may be dealing with opioid, um, misuse or addiction, but also for people who are prescribed narcotic medications and may have a situation where they have unintentionally overdosed.

Shannon: Even just a few days ago, actually, in Austin, we had a group of people who all overdosed at the same time, presumably from the same street drugs. Right. And, um, there were bystanders who had naloxone on hand who saved their lives. And multiple of these patients required multiple doses. And so they were able to apply n- naloxone to these patients, um, prior to EMS arrival, which, um, was amazing.

Shannon: And so I really recommend having that. Even if you don’t have anyone in the household with narcotic use, it can come in handy.

Lance:

Act Five: Stacking the Odds

Lance: Preparing for an everyday emergency is a collection of small decisions made while the water is still inside the pipes, the car is still in the driveway, and no one is bleeding.

Lance: We can’t predict exactly what will happen, but we can leave ourselves fewer decisions to make when it does. Let’s begin with the box that’s been sitting inside a cabinet claiming to be ready for all of this.

Jared: People are always like, “Oh, I need a first aid kit,” and they go to whatever store and- Right … buy a, a first aid kit.

Jared: And at the end of the day, what’s in there, it’s, it’s just marketing. They want those numbers up. Mm-hmm. So it’s like 100 count first aid kit or 500 count first aid kit. Well, 90% of the items in there are Band-Aids that are, you know, this big. Right. Right? So-

Shannon: Right …

Jared: it’s just a bunch of junk, and maybe there’s- Yeah

Jared: a few things in there that are useful. So I know it seems like it’s, you know, more time and more money, but it’s worth getting stuff. Like, what’s the stuff that I’m really gonna need?

Shannon: Most people have, like, the typical stuff, like, like bandages and tape and gauze, and hopefully gloves, and a thermometer, et cetera.

Shannon: Mm-hmm. Um, but those will only get you so far, right? Cuts and bruises and things like that. I always recommend that people have some over-the-counter medications, like an antihistamine in the case of an allergic reaction, um, and then over-the-counter pain killers, like acetaminophen or ibuprofen and aspirin.

Lance: Their fuller recommendations include stop the bleed supplies, a tourniquet, wound packing gauze, large pads, and adhesive wrap, as well as a printed first aid guide and an EpiPen if anyone in the household has severe allergies. There’s no universal first aid kit. A household managing diabetes, asthma, or a serious allergy may need different supplies, and the kit in the car has a different job from the one in the bathroom.

Lance: What matters is knowing who the kit is for, what’s inside it, and how to use it. The first aid kit is not the only thing in the house worth figuring out before an emergency.

Lance: What do you wish women in particular had been taught about their homes or, you know, living even in an apartment, like, what they knew?

Leah: So there are things you have to know, especially if you’re a homeowner. If you’re living in an apartment, you’ve got maintenance there, you can call them, but sometimes you just have to act quickly, and a lot has to do with water.

Shannon: Mm.

Leah: You need to know how to shut off a fixture like a toilet or shut off the water flowing to a sink.

Leah: You need to know where those shutoffs are if you’re in an apartment. And if you’re in a home, you need to know the same thing. Where are the water shutoffs? But you really need to know where the main water shutoff is and how to shut the water off. I would say that’s probably the number one thing, ’cause that’s a thing that can flood your home really quickly and cause a lot of damage very quickly if you don’t know what to do

Lance: Leah also recommends locating the electrical panel and learning which breakers control which parts of the home.

Lance: Labels are helpful. Accurate labels are even better. Kitchen probably leaves more suspense than a situation requires. And if the home is new to us, Arly recommends one more job before we settle in.

Arly: Let’s say that you’re moving into a new place. Yeah. Number one thing you’re gonna do is you’re gonna change all of your locks.

Arly: All of them. It’s a little bit different if maybe you have a landlord or something and they control that, but if you are owning your own home, you should change all of your locks. Um, and you don’t know about the previous owners, too. They might have had a spare key or something like that, so-

Lance: Right …

Arly: I always say, you know, change your locks.

Lance: Some preparation lives in a cabinet, some begin with knowing who can open the front door, and some are built into the way we do an ordinary thing. If you could give three habits that every licensed driver could take on, which three would prevent the most catastrophes?

William: How about I give you four?

Lance: Yeah.

William: Because we have four that we promote all the time.

Lance: Oh, I love that.

William: And we call it the AAA’s READ the road approach to driving. And each of those letters, R-E-A-D, stands for a technique. R, right speed for right now. E is eyes up, brain on. So we wanna be looking ahead, we wanna see everything that’s going around.

William: And brain on, we don’t wanna be distracted. We wanna be focused on driving. And then A is anticipate their next move. So anticipate the next move the nearest road user’s gonna make, whether it’s a pedestrian, another driver of a full-size vehicle. Figure out what they might do and then have a plan to respond if they do it.

William: Probably better to expect a driver to take the action that will put you at the most risk, so be ready for that. And then the last one, D, maintain a huge donut of space around y- your vehicle. So R, right speed for right now. E is eyes up, brain on. A, anticipate their next move. And D, donut, big donut.

William: Everybody likes donuts, so have a big donut of space around your vehicle.

Lance: Bill’s four habits are designed for the road. The principle behind them is useful almost anywhere.

Adam: Training is not memorizing a heroic response to every possible emergency, right? It is giving the mind a small library of useful first moves.

Adam: Under stress, people often lose time to disbelief, social hesitation, or too many choices. A short prior rehearsal makes a workable option easier to retrieve. And, like, how the brain works is once you have a basic understanding of something, it arrives.

Lance: In Vegas, the house wins because a small advantage is built into every hand.

Lance: We can do the same for ourselves. When prevention works, there’s no emergency, no narrow escape, and usually no way to know what we avoided. Nothing happening is the point. When something does happen, the decisions we made earlier may buy us time, give us other options, or help us make the call sooner. Then we have to be willing to act.

Shannon: I think the takeaway is to do something, right? Very often you hear stories of the opposite case where people are scared. They don’t feel that they have the qualifications or the ability to make a positive change in this person’s eventual disposition. Mm-hmm. And I, I think that’s wrong, and I, I hope that people can know that they have the ability to provide care in the best way that they can.

Shannon: Often that just means chest compressions. Mm-hmm. And so, you know, one of the biggest public health outreach initiatives is to get people just to have a basic CPR understanding. Mm-hmm. And that can be a 10-minute video on YouTube, like from the American Heart Association, of how to do chest compressions.

Lance: Doing something doesn’t mean doing everything. It means refusing to let the absence of expertise become the reason no one helps.

Leah: I just believe that people need to not be intimidated by what they don’t know, because everybody, even me, okay, started off from a space of not knowing. Nobody’s born knowing.

Leah: You can do it, but you gotta start with not knowing. And that’s just the way it is.

Lance: We won’t calculate every risk correctly. We won’t recognize every warning immediately. We may begin with no idea what we’re doing. No one is coming, but you can change your odds. Out.

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