K.I.S.S (From P.N.I)

(Slept too late – so no time to blog for both Paper Not Included and here – so here is what I've written over there)

Publishers are missing the two important things that they should have for every ebook release.

Ease of access and wide access.

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Ease of Access
Why do I use iTunes to download my music instead of torrent sites? Why do I pay for albums instead of typing “band name + torrent” into Google?

First – because it is wrong and illegal, but secondly and perhaps, for many people, more importantly it's because iTunes is easy. I can buy an album with one click – I don't have to worry about it being in an odd format that my iPod won't play, I don't have to worry about it being a fake file or it being a low resolution thing that sounds bad.

*Click* = *bought*.

I don't have to type in my credit card details whenever I buy something, I don't have to log in with a password – I boot up the software, press a button or two and suddenly the file is downloaded and synced to all my devices.

It's this ease of use that makes Amazon so attractive to use – Find the book, press the 'buy it now' button and it uses your stored credit card to purchase the file and then send it down to all your 'Kindle' devices (be that Kindle, PC or iPhone – still waiting on that Mac option folks…).

In contrast look at Waterstones site – I have to type in my account details to log on to the site, then find the book using the frankly awful search engine (want to look for ebooks? well you need to do an 'advanced' search, and then we'll still return paperback and hardback results), then add it to your basket, then view your basket, then checkout, then type in your credit card details (plus expiry date, and security code). Then, and only then, are you able to download the books you want.

It's actually simpler to google for a torrent.

(I won't go into the problems of DRM, as that's a whole other discussion).

So, if you are a non-Kindle user, you are stuck using an awful website.

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Wide Access
What is the other reason for going to the torrent sites? Regionalisation.

All my friends are blogging about a great book that's been released in America, they all love it and the subject matter is right up my alley.

I go to buy it and, lo and behold, 'this book is only available in the US'.

Now, I could wait, in the hope that they will eventually release it in the UK, and hopefully I won't have forgotten all about it in the year that this takes to happen. When I do forget about it maybe the publisher will pay all over again for the marketing that will raise it's profile on my radar.

Or I could physically import the dead tree edition from America, pay excessive shipping, import taxes and hope that when it is delivered it's not been dropped into the moat at Kellett mansion.

What is more realistic, and simpler option, is to search for a torrent of the file download it and hope that it is either a decent scan, or the ebook with the DRM stripped out. Then should the book ever be released over here – buy the actual legal copy in order to reward the author and publisher.

And that's if I (a) remember, and (b) am honest.

Are you starting to see why regionalisation of books is a really bad idea. It is pretty much always possible for me to get your book via torrent, and no draconian Digital Economy Bill will stop the committed pirate, especially when 'committed' means 'able to click a button or two'.

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A Proposed Solution
As I have mentioned in the past, the real game-changer about Apples iPad is the iBookstore (or however it is capitalised) – a simple and easy way to download books, with a decent economic model for the publishers and simple syncing with a device.

Sadly it seems obvious that Apple will restrict their books to iPad DRM format – thus leaving the Sony Reader, and countless other devices, out in the cold. You won't be able to read your iPad books on anything other than an iPad.

This is my suggestion – and it's for all the publishers in the UK, if not the world.

Beat iTunes.

Get together, and get together quickly before the iPad gains too much traction – form a jointly owned company, association, or whatever. Create a piece of software that is cross platform, both on the user's end (PC/Mac/Linux/iPhone/Blackberry/maybe even Xbox and the like), and on the formats that it supports (iPad, Kindle, PDF, EPUB, Mobi, Plaintext).

Make it amazingly simple and easy to buy a book – 'reduce the friction' as I believe they call it in the business lingo world. Make it so easy to buy a book that an impulse buyer, like me, can easily slap down my money and have the book sent to me within seconds without having to type in my credit card details for the umpteenth time.

Do away with regionalisation with ebooks. If you are spending some of your marketing budget on internet awareness (and if not, why not? Internet users read almost by definition), then why are you saying that you don't want the money from people in America, in Europe, in the Southern hemisphere?

Sure – you won't make the money on selling the regional rights to a publisher in country X, but won't you make up that money by expanding the market and from word of mouth marketing (and remember, those world royalties are going straight to you, not via someone else who takes a cut – disintermediation). Plus ebooks can be 'in print' forever – check out that long, long tail.

I'd also say do away with DRM, but that's a discussion for another day.

If you create an iTunes for ebooks – then you control how your books are sold, not Apple, not Amazon, but the publisher. Split the cut however you like, fiddle around with minimum and maximum prices to reach the ideal selling point, suck money directly from my credit card as I always have the purchasing client to hand and clicking on one button gets me my book.

Is it really that difficult to build a bit of software that is,

Simple enough for my mum to use.Good, effective search.Frictionless purchasing and downloading.Multiformat.Multiclient.A large and persistent library.Without pointless barriers due to geography.

If publishers do this I can guarantee that the percentage of ebook readers that resort to torrents will drop. They won't go away (because for some people free is all they can afford), but it would stop people like me from wondering if breaking the law on this one occasion is maybe worth it.

Hell, make it simple enough and more people will download ebooks – and with a per-unit-purchase price of pretty much zero, that's all profit.

And if publishers don't want to work together then at the very least Waterstones need to start from the ground up and completely revamp their web experience – perhaps starting with a cross platform piece of software that will act like iTunes…

Blokes With Bandages 2 – Training

There are two important parts of training, that of the initial training that you have to do and the other being the continual development, refreshment and assessment of our skills that should be constant through our career.

Initial Training

The LAS is a place where you never quite know the skill level of the person that you find yourself at the scene of an accident with. In part this is due to the varied training programmes that you have in order to be employed by the service.

For instance, I was trained in sixteen weeks. I was sat down in front of a Powerpoint presentation while a trainer read out what was on the screen. We also had to practice some physical skills – the use of a carry chair and CPR were just two of those skills.

There was very much a 'systems' approach to my EMT education. 'This is the heart, this is what goes wrong with it and this is what we do with these patients, this is the brain, this is what goes wrong with it, this is what we do to patients who have this problem.' There was little teaching of the underlying reasons, causes and biology behind the diseases.

As an example – I was taught that diabetics with high blood sugars will continue to eat because their 'cake gland' goes into overdrive and this is why they eat lots and get fat.

Other parts of the course seemed to have floated in from elsewhere – for en example we had to know what 'astroglia' were.

The course was full of 'Need to know' – i.e – a patient having a heart attack is given oxygen. Then there was the 'Nice to know' – i.e. the reason why we give oxygen to these patients.

In other words – you Need to know certain things to be an ambulance person, but if, just if, you have a bit of an interest in it, this is something that is Nice to know but not essential and as it isn't on your exams you shouldn't worry too much.

Of course, now you have the guidance that we shouldn't give people having heart attacks oxygen in most cases we don't have the theoretical background as to why this is a good idea – and so 'old hands' continue to give it because it's what they were taught.

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The other day I delivered a baby in the back of my ambulance. My maternity training consisted of one afternoon of a bored looking midwife telling us that basically it would be best if we just take everyone to hospital and try not to touch anything. Oh, and if you have an umbilical cord poking out, stick a damp dressing on it and transport the mother on her head.

I seem to remember spending a whole day on mental health problems. The majority of that was issues with violence and the legal requirements to get someone Sectioned.

I can't remember if we learned about alcoholism, I suspect that it was a half-day thing – way too short given the number of our patients that are alcoholic. Certainly no time was given over to the care of the binge drinker.

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But it's changing, I think.

I say that I think because reports from the new people we are getting coming out onto the road vary wildly.

The LAS is, rightly in my view, going down the route of having people study to degree level. This means that, hopefully, there is more to the course than powerpoint and playing with dummies. Hopefully they are learning some theory, some basics of reflective practice, some idea of how to critically read a research paper.

But then the LAS continue to do in service training. This isn't to a degree level, and yet the staff come out the same.

I have no idea what is going on, and if I work with a new member of staff I have no idea what they have learned.

My crewmate, one of the first Paramedic degree students knows very little about mental health problems. But she likes working with me because I teach her the knowledge that I've been taught as a nurse, or learnt on my own.

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Before I worked on the ambulances I was a nurse, and if there is one very important thing that my nursing diploma taught me it was that you need to keep learning, and it gave me that enthusiasm to keep learning.

I don't see that at the moment, either in the old-fashioned staff (how I was trained), or in the new degree level students.

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The problem with our initial training (and the majority of my colleagues went through the same training I did) is that it is very much rote learning, and rote learning by people who are often not teachers. The trainers are mostly people who have been through an internally run 'instructors course'.

Before joining the NHS I trained for four years to be a teacher of children.

Because of this rote teaching, there is little room to give students an enthusiasm to continue learning. There is no teaching of the skills of how to learn, how to read research, how to develop yourself – and as I will show you later, developing yourself is pretty much the only development that you can rely on having.

Because of this teaching – the bare basics, the lack of underlying theory and the rote – if 'A' then 'B' then 'C' and then take to hospital. There is created a staff body that sees itself as, not healthcare professionals, but as 'blokes with bandages'. There is no questioning of current practice, there is no provision of the skills needed for self directed learning and there is no desire or enthusiasm for further learning.

The Solution

We are partly towards a solution at the moment in that a lot of people are joining the service after a three year Paramedic Science degree course. What we need to do is work towards getting every member of staff that has road duties that same degree course on a part-time basis. No-one should lose their job because of trouble in passing this, but it should be compulsory that everyone should work towards it.

If not a degree, then the absolute minimum we should be aiming for is a diploma level education.

It is only with better training that we can properly have staff that are competent and feel secure in leaving some patients at home rather than clogging up the A&E departments, which is the future service that we are going to have to provide – if only to differentiate ourselves from the private ambulance firms that are itching to get NHS contracts.

We need proper EMS educators. The sadly true joke was that road staff became instructors because they wanted to shag as many students as possible. Hopefully this is changing, I've heard too many first hand accounts of trainers trying to get students into bed – and not just from the LAS…

We need educators that are smart, well-trained, and enthusiastic. Road skills and experience is certainly useful, but being good on the road doesn't necessarily make you a good teacher.

A well educated work-force is a happy work-force. Raise the morale of the staff and performance will raise, and education is just one way to raise the morale of the workforce.

We cannot continue to turn out people who have learnt by rote and who are uninterested in further learning, we cannot continue to turn out people who see themselves as semi-skilled workers.

Not unless all you want from your workforce is bums on seats to hit that eight minute target.

UPDATE – I meant to put this link in about a Service being forced to halt it's training because it isn't up to standard…

Blokes With Bandages 4 – Role Models

Role Models

In the final part of my series of whinging, moaning and general grumpiness I'd like to look at the one thing that road staff truely have no-one to blame except themselves.

Where are our role models?

It took Mary Seacole, Florence Nightingale and others like them to start to drag nursing up from it's roots as a 'Doctor's Handmaiden' into a profession of it's own.

Likewise you have Sir Robert Peel and his effect on policing, Elizabeth Fry and her prison reforms and countless scientists from Gallelio up to Prof. Brian Cox and Dr. Ben Goldacre.

So, who is the role model, the innovator, the spiritual leader of the ambulance services?

Josh from Casualty – a fictional character?

What name do we think of when we, as a profession, ask ourselves – who is the paragon of ambulance work, who is the person we should aspire to be like?

I can't think of anyone who fills those shoes and the people who I think are great EMS are rarely heard from.

I think that it is about time that we started looking for role models, or start aspiring to be one ourselves.

What Random Acts of Reality turned into