American Exceptionalism...

...in accidentally harming children by giving them the wrong doses of medicine apparently...

Children’s liquid medicines should only be measured in metric units to avoid overdoses common with teaspoons and tablespoons, U.S. pediatricians say.

Tens of thousands of kids wind up in emergency rooms after unintentional medicine overdoses each year, and the cause is often badly labeled containers or unclear directions, said Dr. Ian Paul, a pediatrician at Penn State Milton S. Hershey Children's Hospital and lead author of new metric dosing guidelines from the American Academy of Pediatrics (AAP).

"Even though we know metric units are safer and more accurate, too many healthcare providers are still writing that prescription using spoon-based dosing," said Paul. "Some parents use household spoons to administer it, which can lead to dangerous mistakes.”

For example, he said, accidentally using a tablespoon instead of a teaspoon would triple the dose.

To avoid errors associated with common kitchen spoons, the guidelines urge that liquid medicines being taken by mouth should be dosed using milliliters (abbreviated as "mL").

Also, prescriptions should include so-called leading zeros, such as 0.5 for a half mL dose, and exclude so-called trailing zeroes, such as 0.50, to reduce the potential for parents to misunderstand the dosing.

While the AAP has been pushing for more accurate dosing of children's medicines since the 1970s, the new guidelines are the most extensive call for metric dosing to date and are intended to reach drug manufacturers, retailers, pharmacists, prescribers and caregivers.

"For this to be effective, we need not just the parents and families to make the switch to metric, we need providers and pharmacists too," said Paul.

The image above is of course a map of countries that have still not adopted the metric system*.  Those other two countries in red are Liberia (yes, that Liberia) and Myanmar/Burma (yes, that one too).  And the latter announced in 2013 its own planned conversion to metric, which will leave just the US of A and Liberia in this particular little club.

And this of a country that adopted decimal currency in 1792.  To much of the rest of the world, the idea of using an Imperial-based system of measurement is as strange as still using the likes of guineas, florins, crowns, and groats.

A smidgen of history on the US' flirtation with metric:

In 1821, after studying the various units of measurement used by the 22 states, Secretary of State John Quincy Adams determined that the U.S. Customary System was sufficiently uniform and required no changes. Most people thought actually that the metric won’t survive Napoleon’s rule. They were wrong however and by the time the American Civil War ended, most of Europe had turned metric, besides the proud British of course.

In 1866, an act of Congress, signed into law by President Andrew Johnson, made it “lawful throughout the United States of America to employ the weights and measures of the metric system in all contracts, dealings or court proceedings.” The act however was merely an act of recognition, which didn’t necessarily translate into practical use.

Following the second WWII, the world officially entered a stage still in expansion: globalization. As America was importing and exporting millions of goods, it found itself in a predicament when trading with other countries, most of whom used metric. American companies had to make twin labels, train workers and students with both systems and re-purpose thousands of machines across various industries. The costs were and still are enormous. With this in mind, some Congressmen proposed the US finally switched to metric. In 1971, the U.S. National Bureau of Standards issued a report titled “A Metric America” recommending that the U.S. transition to the metric system over the course of 10 years. In response, Congress enacted the Metric Conversion Act in 1975 to commence the conversion process. However, these good intentions were extremely poorly applied because someone had the bright idea to strip out the 10-year deadline and make the conversion voluntary. Of course no one wanted to willingly change to metric.

Could it be that due to the size of its economy, the US has made a calculation that it would be more expensive for it to convert than not, unlike the conclusion the rest of the planet has come to ?  Perhaps.  More likely, it's just plain...cussedness.  Or, as it's more commonly explained:

Freedom!

* And yes, of course there are variations & exceptions in the degree of adoption, such as items sold in 'Liters' in the US, and the continuing use of MPH in the UK.

Always with the Unintended Consequences

So, it seems like the investigation into the Germanwings crash in France is pointing towards the possibility that one of the pilots was locked out of the cabin, and unable to re-enter and prevent the ultimately fatal descent into the mountains.

a) This is horrifying
b) I'd predict that one phrase likely to be popping up sooner or later is 'who could have predicted' or one of the popular variants thereof.  Ya know, as with Condi circa 2001/2.

Were there no warnings of unintended consequences back 'round about 2002, when the FAA was frantically rethinking airport security, specifically to prevent the one particular vulnerability exploited on 11 September, 2001, without so much consideration towards the...entire rest of aviation history ?  This isn't ancient history.  I'm thinking...someone out there probably considered this sort of eventuality, and that's it's only a matter of time before a reporter unearths it.

And as for more recent history, well...

Air Canada, 2006: http://www.canada.com/ottawacitizen/news/story.html?id=37a9dd60-18a9-4155-a6bb-8a8e8976bc04
Air India, 2013: http://www.usatoday.com/story/todayinthesky/2013/05/16/air-india-captain-locked-out-after-cockpit-door-jams-mid-flight/2165305/
Transavia, 2013: http://www.telegraph.co.uk/travel/travelnews/9838956/Pilot-locked-out-of-cockpit-as-co-pilot-slept.html
LAM Mozambique Airlines, 2013: http://en.wikipedia.org/wiki/LAM_Mozambique_Airlines_Flight_470
Air New Zealand, 2014: http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11288373
Ethiopian Airlines, 2014: http://www.flyingmag.com/news/bizarre-ethiopian-airlines-hijacking-ends-copilots-arrest

That's all I found in a fairly brief search, but the prevalence of stories from 2013/4 is interesting perhaps.  Just related to the timing of the uptake of the newer technologies ?

I suspect the plane in the 2006 incident may have not had the current level of fortification, given that the crew in that story were able to 'remove the door from its hinges.'  Has some interesting verbiage nonetheless:

Eventually, the crew forced the door open by taking the door off its hinges completely, and the pilots safely landed the plane -- although in the event that the pilot was unable to access the cockpit, the first officer is also fully qualified to land the aircraft.

Air Canada Jazz said the incident is a first for them. But in Canada, a pilot getting locked out of the cockpit is a "non-reportable" incident, meaning airlines have no obligation to inform Transport Canada about it as they investigate themselves.

However, airline analysts warn that incidents like these are disasters waiting to happen -- both in terms of accidents related to human error and vulnerability to terrorism.

Oh, and one bonus story also from 2006 that may relate to earlier theories of what happened to this flight: http://www.theguardian.com/business/2006/dec/19/theairlineindustry.travel

Disturbingly, there had already been related emergencies on other airlines. After a 2003 Ryanair episode with another Boeing 737, Irish investigators had warned of "the potential for a full-scale accident" in exactly the kind of pressurisation emergency that later caused the Greek crash. They said: "With the locked door policy endeavouring to solve one specific problem, it may be creating another one or more problems that could impinge on aviation safety ... The implications for flight safety in the specific scenario of flight crew hypoxia is not being addressed by a locked cockpit door policy. This is a ... problem."

Similarly in 2004, British investigators described how a fire broke out in the passenger cabin of a British Airways plane taking off from Heathrow. Cabin staff spent time desperately banging on the locked cockpit door to try to attract the pilots' attention. The British investigation report warned that "both the flight crew and cabin crew were initially hampered in their efforts to deal with the incident promptly due to their inability to communicate with each other across the locked flight deck door."

Chris Roberts, a recently retired senior airline pilot and manager, told us: "With the locked cockpit door in place, communications are more difficult." He says: "Some regulators and airlines have dealt with this adequately but in some cases there is still more work and more training needed."

By contrast, shortly before September 11 2001, when cockpit doors were still generally open, an Aer Lingus stewardess was able to save the day by rushing in three times to warn her captain that passenger oxygen masks had dropped. Air conditioning had inadvertently been switched off. The inquiry into that incident found that oxygen deprivation had probably confused the pilots: "The continued persistence of the [stewardess] in keeping the flight crew advised of the deteriorating cabin condition did, without doubt, contribute to the safe conclusion of this serious incident."

As late as January 2001, British Airways was adamant that locked doors were too dangerous to adopt. Following an incident in which a mentally ill passenger attacked the pilots of a jumbo jet, BA chief executive Rod Eddington said: "We will not be locking the door because it does not make sense ... Locking the door would cause more safety problems than it would solve." But September 11 caused a panic reaction. Locked doors were hastily installed on planes all over the world despite a warning from the then US national transportation safety board vice-chairwoman, Carol Carmody. She said in May 2002: "We must be sure that crew communications during emergency systems are not compromised ... Access to the cockpit can be very important in an emergency."

Oh, and I'd almost forgotten this one: http://www.popularmechanics.com/flight/a10270/in-light-of-mh370-evidence-could-plane-cockpits-be-too-secure-16611747/

John Magaw, the first person to head the nascent TSA in 2001, told CNN that an always-locked cockpit was a concern since the outset. He said he told airlines, "Don't lock those doors so that you can't get in from the outside if something happens, and it fell on deaf ears," alluding to a well-publicized case of pilots who "flew past the airport because they were both asleep." However, some pilots scoffed at the idea that a locked cockpit is a serious concern, noting that planes are programmed to fly safely and even land on autopilot in the unlikely event both pilots nod off.

 Former Jetblue CEO and founder David Neeleman, whose airline was the first to install the reinforced cockpit doors system-wide after 9/11, tells PopMech that the latest troubling scenario means that "perhaps there needs to be way to get back in that door."

"But nobody ever thought about having to protect the passengers from the pilots," he says.