The Evangelist at Your Door

By 1984, I was living in Seattle, and I had given talks and demonstrations – and even keynotes – for many national computer groups, medical groups, and training groups in the U.S. Then Europe caught wind of our CPR simulator. For the U.S. audiences it was a program with psychic benefits. Save a life, right there at a party, or in the street. The simulator let you try CPR hands on, and gave you feedback. In addition, the gaming crowd felt that it gave an extra dimension to computer advances. Later, when I also tried to put together games, some academics felt I had abandoned my noble callings with CPR. Don’t know that I felt as guilty as they wanted me to feel.

The European fascination with my CPR system began slowly. Personal computers were fairly new to that side of the world, and the first to see the CPR system were the technology scouts. At first it was just the odd foreign visitor to shows like the National Association of Broadcasters in Las Vegas, which attracted some quaint Frenchmen mostly turning their noses up at all American media , but then stopping fascinated when I broke out the manikin and the videodiscs and showed what real human-machine interface could do. Or the Germans, who were standoffish at these shows but had a finely honed curiousity about things mechanical and logical. The Japanese crowded around in groups as if my demonstration was a roulette table, and in fact, in Las Vegas at least, the roulette tables were never far away. There on the floor of exhibition halls, people could move in close and touch everything.

Other U.S. conferences were of a different nature, like the TED MED conference in Charleston in 1985. At the time Richard Saul Wurman had pioneered his Technical and Entertainment Design shows, which were goddawful expensive at the time — about $7,000 a seat by my recollection — attracting CEOs who wanted to hobnob with other CEOs and with none of the riff-raff of mid-level professionals who were curious to steal any bit of technical or market knowledge. Jonas Salk of polio fame was to be keynote at the Charleston affair, and several other medical luminaries were on the program, to present no more than ½ hour each as I remember. I remember being trapped in the Green Room with a guy who professed to be President Clinton’s nutritionist. I think Clinton had largely ignored him and ate a lot of Big Macs, but the guy carried on as if he had saved half of California from lurking calories. I guess we were all sort of prima donnas with our 30 minutes of fame. I’d met Jonas Salk once in California at the La Jolla Institute that my cousin John ran, when I was wandering in from Vietnam. Salk and I didn’t have much in common that first time, and this time around he was dead. Died about a week before his keynote at that TED MED conference.

Anyway, these various U.S. demonstrations sort of bred the European trips. Possibly the most interesting thing about my trips to Europe was that, unlike the States, most people did not know what CPR was. The first of my trips abroad was to London, to talk and demonstrate to the British Broadcasting Corporation Special Programs group. Hannon Foss was the leader of that and he held our talks in the same auditorium where they gave out the British version of our Academy Awards, so the seats were plush and the sound and lighting were impeccable. Hannon himself was a great big buoyant sort of guy who was curious about everything and enthusiastic about things he wished others to see. I was both a curiousity and a demonstration with highly visible message, just the thing for movie folks.

The first battle, however, was at customs. The British Customs agents had never seen a simulator manikin before, and tried to figure out how to classify it, so that they could tax it. Was I selling them? No. Why was I bringing it in? So others could see it. Did it have any animal properties? Not that I could see. They brought in supervisors and everyone had a good long look and these computers and manikins in boxes. In all it took about two hours to get through customs and I did not have to pay anything but could only stay in country 30 days. Who knows what damage a manikin could do if allowed to stay indefinitely?

And of course someone brought up the pedophile angle with the baby manikin. The London demonstrations had gone quite well and about a month later the BBC asked me if I could come back to be on “Tomorrow’s World” — which was their weekly look at technology that everyone watched religiously. I was boxing out that time slot and wondering if the BBC would send me a first class ticket to be on one of their more poplular shows, when I got a subsequent call from the producers, who had just shown my videotape to their board. They said with great regret that I would be disinvited, because a couple of board members thought the audience would not understand doing that sort of thing to a baby on national TV.

I think a number of things could have been different but for that BBC decision. It turns out that a year later the great, big-hearted Hannon Foss had a heart attack and, of all things, the local emergency people from the hospital did not know CPR and just threw him in the back of an ambulance. Hannon was dead on arrival. He might have been saved with the very CPR he was promoting through me. I guess I felt bad when I heard it, that had I been more effective I might have sparked instant awareness and a revolution in British emergency medicine – much of which at the time merely consisted of telling the patient to maintain a stiff upper lip. (Rigor mortis does that part quite well.)

Many advances in humanity may start with the well-crafted boondoggleMy CPR presentations were, in fact,  boondoggle programs across Europe – “new ideas” forums where people could see and experience the bizarre directions of the Americans and yet feel safe that these disruptions would take a while to really reach their shores. In each case however, I was able to generate an extra connection, especially with medical types but actually everyone, because the  Cardiopulmonary Resuscitation movement itself was much bigger than the simulator. CPR was a way to transfer life to the almost dead person, and often to resuscitate a downed heart attack victim on the spot. To this day I still get notes from someone who saw the CPR demonstrations and their boisterous old uncle collapse at a wedding, and they kept him alive. Or a description of the time an infant fell into the pool at a Hollywood afternoon pool party. A cameraman who had worked with me to capture interactive video of the baby rescue procedure, remembered where to put his fingers and how to hold the almost drowned infant, and brought it back to crying life there at the edge of the pool. To say these notes have enriched my life is an almost tearful understatement.

The French liked the idea of the interactive videodisc, and wrote up my demonstration in their computer magazine Memoires Optiques (Optical Memory). The crowd at the Memoires Optiques show was one of the most jolly I experienced in Europe.  But as silly as the British had been about the baby, the life-like manikin again served to bring up the subject of interactive pornography. Why wasn’t someone doing that? Some Cambodians there wanted to enter into a joint venture and provide the very lifelike plastics needed for a totally interactive experience. Although that sort of group, at a show, prides itself on entertaining absolutely every bizarre new idea, this time I really was not interested…A spoilsport, I guess, but I could not see telling my kids that’s what I do in life.

The Cannes International Film Festival was of course, focused on cinema, so I was just a curiosity. The translators had quite the problem explaining the system, which I only showed on videotape there. (It loses a lot with no hands on.) I will always remember Cannes because it was the first time I had a room with a little refrigerator full of drink mixes and little bottles of whiskey and gin and vodka so I could experiment. The winter weather was cold in Nice, and I even made a hot bath and lined up my new favorite drinks along the side of the tub, and practically melted in the booze and hot water. In my silly state, I marveled how thoughtful these people are, providing me with any drink I could want from my own little hotel stash. Honestly, I was so naïve I thought it was free. The bill when I checked out told me otherwise.

I met Aske Dam at one of the Las Vegas shows which he haunted, always trying to pick up new and cool technology to take back to Europe. Aske was one of those Europeans who spoke several languages and stayed at the leading edge of video technology. He brought me and the CPR System first to Copenhagen, where he had pioneered television Bingo and (I hope) made a few schekels at that. At a University in Copenhagen I met one of the princes of Greenland. Denmark had parts of Greenland as a protectorate, I think. And then a few days later, Aske heard from a group he wanted to me to present to in Norway. We talked a lot on the boat from Copenhagen to Olso.

Aske had run the 5,000 meters for Denmark in the Tokyo, Olympics and there met his Japanese flight attendant wife and had a son. They were divorced now, but the son was flying for a Japanese Airline. I put on the talk for some video producers outside Oslo in an enchanted forest where Aske’s current girlfriend was a glassblower. The ovens for the molten glass had to maintain a high temperature and it was on a fast flowing stream which was necessary, apparently, for cooling the molten glass. She had to tend the ovens every day and never let them go cool, so she and Aske did not travel much together.

On another European trip, because of some weather disturbance, my TWA flight from Barcelona to Amsterdam was going to detour and fly over part of the Mediterranean. In one of their international spats, Mohamar Khadafy told Ronald Reagan he would send out jet fighters to shoot down any US commercial aircraft that flew over the Mediterranean. Everyone waiting for my TWA flight absorbed that news, and hurried over to change their tickets to KLM. The KLM flight was quickly packed to overloaded and the TWA flight had only – me. I was probably too slow to get on KLM and unfortunately had to be in Amsterdam for an event, so I stayed on TWA and tried to make a brave front of it.

After all, I was an American and who was this Khadafy to try to bluff us out of the skies? Turned out to be my greatest ever airplane flight. They put me in First Class (all alone) and three female flight attendants all bought my courageous line and all vied to make me most comfortable… and to bring me drinks and grapes and nuts and lots of pillows. (And I’m certain that showed Khadafy what a real American man he was up against.)

Those days I was a sort of evangelist for interactive media. An evangelist has to have something to believe in, and I did. And an evangelist is out to make others believe as strongly. I cannot claim credit for the power of interactive media, or for the value of CPR to benefit lives in the emergency empowerment it gives the ordinary citizen. The combination, however, of the Good, and the Technical was a message that I hope resonated in its day, and can keep on being a standard for every new thing we see.

Copyright 2018 David Hon – All rights reserved

Travels with a Baby in a Suitcase

Certain people are always offering stale advice like “Do what you love and you will never work a day in your life.” Pretty easy blather to throw out, when even most popular singers and movie stars end up working more for the money than for love of their material. However, hopefully there is a point in life for most people where they feel like what they are doing is for a larger benefit than personal applause or maintenance of a family, as worthy as those may be. Some say that kind of work has “psychic benefits.” At that point the product you present takes on a newer, higher, better life. You are not seen as just “trying to make a buck,” but appear be making the world a better place.

I arrived at that point somewhere in the CPR saga around 1982. All of the political bridges had been crossed: if it could be done, let’s do it. So we did it and proved it and the Pittsburgh Health Sciences Group (one of the top in the nation) made an excellent study of the effectiveness of this CPR system compared to standard live instruction. 33% more effective. And the Long Island Rescue establishment tested it and said that because the CPR Learning System created such a high standard, firefighters who tested on that CPR system had to qualify only once in two years rather than every year . And the Canadian Armed Forces bought our second system.

The CPR Learning System, with its hands-on simulation of a heart attack victim, started to win random media awards, because nothing close to it existed to show the possibilities of interactive training and testing. Thus it started to get written about. Shortly thereafter, I spoke at education conferences at Harvard and computer software conferences at M.I.T. The U. S. Congress’ Office of Technology Assessment was heavily influenced by Harvard and M.I.T., and on their say-so put the CPR System up for Congressional Testimony to show the possibility of such leading edge medical certification.

For all of the interest, it was not feasible to drag the whole system – manikin, computer, display screens — to every show, but I was fortunate to have done it on a few early trips. Luckily, a few news agencies generated  excellent quick stories that I could could show with high credibility.  For instance, when I showed the system to a Congressional committee on New Technology, a CBS news crew was next door in the Sam Rayburn congressional hearing room for the Abortion hearings. They were trying like mad to find a visual angle to describe that dilemma, and a few of them wandered over at 9:30 to see this me — in a suit, on my knees on the floor — hooking up a manikin to a computer for the 10 o’clock session.

Instantly the CBS  news producer saw that our CPR simulator was going to be a visual story. They quickly got permission to tape my appearance with the system rather than slog through the Abortion hearings. Ordinary people cannot believe the whirlwind efficiency of these national TV camera crews, large cameras being placed, close ups taken of the screens for later editing in, cables rolling out around me to all corners of the room. It dawned on me that this had a history, that theaters clear from Shakespeare’s time had employed sailors to handle all the rigging of the curtains, just as they had sails in commerce and war and exploring the world. Now the ropes were cables and the sailors were TV crew, and rather than travel the world on explorations, what they explored here with their cameras would be going out across the world. Diane Sawyer made it a feature story on her evening newscast. (Just let Diane Sawyer do the talking….)

As a consequence, I was invited to make talks for all of the year 1982. Medical conferences wanted to see medical simulation; Computer conferences wanted to see a realistic simulation controlled by a personal computer; Training conferences wanted to see the teacherless training; Education conferences wanted to see the future of education; and Consumer Electronics wanted to see what this interactive stuff was all about. During 1982, I really chalked up some flyer miles. I was flown to some conference about 2-3 times a month to show (a little) and tell (a lot) about this new system. People were quite interested for their several reasons, but I had an underlying pressure.

What lay underneath these public forays was the need to find someone to take this orphan on. I was made the Director of Advanced Technology Development for the American Heart Association, and now I had to find a secure home for this phenom.  I wrote a patent on it, but someone had to fund commercial development and sell it to the public. Someone had to continue testing and publicity and all of those things a glittering new project needs to sustain itself past the first “Wows.” The AHA could not run a small business – or so they were advised – and so we had to find a business partner to carry the CPR System forward. My dual purpose, then, was as an evangelist for this kind of interactive simulation learning, and as a rainmaker to keep the project from dying prematurely. That meant hitting the conference circuits while the invitations were hot. Popularity Based Marketing, for lack of a better term.

I remember when American Airlines put the CBS story (about the CPR system in Congress hearings) with their short subjects preceding the inflight movie. I was living in Dallas, but I would get calls from drunk friends across the country who had been on coast-to-coast flights and awakened to see me in front of their faces. That footage also came in handy when I was giving keynote talks in faraway places, but did not want to travel with the whole shebang. After the Congress show I almost never took the Resusci-Annie manikin, because the airlines wanted to charge for an extra seat, or extravagant onboard shipping which would cost almost as much, with those heavy crates. Diane Sawyer’s short news story was enough to show gist of the system, but people wanted to see a bit of the real thing. Enter the baby…

Luckily, we did have an Infant Resuscitation model and I could carry this Resusci-Baby and an Apple II computer in my baggage, along with hookups for TV monitors. I needed to show how the manikin interacted with the computer through a special serial card to give instant feedback on the monitor, so we made a dedicated program just to demonstrate how the sensors from parts of the baby gave feedback that you would see on the screen as a computer graphic. The baby created some special challenges for us, since you could hold its small body in your hands to do some of the rescue work. When it had an Airway Obstruction, for instance, you were supposed to have the head down and feet up and to gingerly slap its back to free the airway obstruction. (A Hiemlich maneuver would, of course, injure this small a person.)

To sense this Airway Obstruction maneuver, the computer had to know the baby’s position in space, and whether its back had been slapped just enough to dislodge any obstruction, but not so much as to hurt the child. The computer could sense this impact. We had much of the positioning of the baby sensed by a series of mercury switches, which sloshed around in a circle when the baby’s head was down correctly. However, believe it or not, one of the main problems we came up with was how to end of the lifesaving procedure, when all the moves had been made and breathing had been restored and the little heart (with air puffs pulsing through its artificial veins) was beating just fine. A happy ending doesn’t just happen by magic…

Then what? How do you clear the screen and start over? We thought of adding a button. On the light pen touch screen (full model) you just touched a box that said “Quit.” But with this traveling model we needed a quick and easy way to start over and let interested spectators try a little hands on after the presentation. We tortured with how to do this, and then one afternoon it became obvious — to someone I think was the janitor. He was cleaning up and watching us go through our mental gyrations, and just blurted: “Shake the baby.”

Of course, Shake the Baby…and the program starts over. A lot of people who saw the demo in public thought that was — AHA! — a brilliant and elegant solution. Some cell phones’ flashlight features start now by shaking and it is probably the same kind of mercury switch. To think: this slightly awesome feature of smartphones today may have actually come from a bystander 30 years ago seeing us Shake the Baby to clear the screen.  Conference attendees talked as if we must been geniuses. Little did they know.

As I’ve mentioned, this traveling setup called for me to carry a videotape clip of the whole system (thanks to Diane Sawyer), plus the Apple II computer and the actual baby manikin. It was always possible to have a monitor or screen provided wherever I spoke, if their A/V people could follow specifications, and there were only a few emergencies there.  And then there was me carrying my baby in a suitcase…

Possibly the most fun on almost every trip was carrying the baby in a suitcase, setting the case on the conveyor belt, and watching the eyes of the security people when the X-ray displayed its contents. In many cities, the security guards pulled me aside to open the case for them, and a few times they called for backup, I guess in case I was a serial pedophile killer. Some security guys in San Francisco slammed me against a wall and began frisking me, causing the person standing in line behind me to say, “Wish I’d said that.”

I actually began to look forward to that return part of each trip. Visiting each new city brought forth a new set of reactions: some unique like nearly falling from a chair, some vocal (Holy…this or that), some clandestine like pushing a red emergency button with a straight face, and quite often gathering other security personnel to make a group decision on what to do about this threat. However, as they say, you can go to the well too often.

And then there was Dallas, where I lived and worked for the American Heart Association. Leaving on one trip to New York, with my practiced nonchalance I placed the suitcase containing the baby manikin on the conveyor belt. And watched out of the corner of my eye for it to appear onscreen, and, hopefully, disturb the tranquility of this routine job. A black security lady was on top of it. And me. In a very laid-back manner she said “Is them things wires, or veins?”

Tough question. I gritted my teeth: “Veins.”

She smiled, not quite the Mona Lisa wryness. “Well that’s OK, we just don’t want any of those bombs with wires in them going through here.”

Veins were apparently OK.

Copyright 2018 David Hon – All rights reserved

No Cab for Annie

Attempting things that no one else quite understands – and when you are just groping along yourself — has its certain virtues. There are few second guessers since even the objective of the project shifts daily. The key element that guided us when creating the CPR simulator was only “Will it work?” But even that criterion was flimsy. The fragility of the concept in those early days led us to what answered only by what we thought it could eventually do…A dream defined. The system, as I described designing with the CPR doctors, would have two screens, and a full-sized manikin which would lie on the ground. A light pen would allow the user to interact with the screen (much as touch screen does now). If the screen asked you to touch a random list of actions in the correct order, you did so with the light pen and the computer recorded your answers.

As the CPR Learning System took shape, it required two separate and distinct activities coming together.

1. It was imperative that we create a manikin ( mannequin anyone?) which was realistic enough to allow the student to practice moves in the right places, and to look for signs of life or ascertain the need for CPR. To accomplish this we had to take an existing manikin, used by current classes, and embody sensors to tell us that the student actually knew what to do, and could actually perform it on the manikin.

The realistic vinyl manikin used by American Heart in its CardoPulmonary Resuscitation (CPR) classes had been supplied for some years by a Norwegian company, Laerdal, which had a good business supplying these relatively inert teaching manikins to the American Heart Association, the Red Cross, various rescue units, and a fair number of hospitals. All of these organizations gave classes on the inert Resuci-Annie manikin, which did have lungs that inflated, a neck that would tilt back, and a breastbone that would provide realistic resistance to the student. Because they foresaw a new business blooming, the Laerdal people were quite cooperative with getting us manikins to rip apart and “sensitize.”

The sensors we implanted in Annie not only had to read the precise actions of the rescuer, they had to communicate that to our Apple 3 computer, by means of a special card we built to insert into that small inexpensive machine. (We had to design in a reasonable cost for these in from the start). The location of the hands had to be sensed, and the depth and duration of compressions had to be timed to make a graphic pattern on the second, non-video screen. The lung expansion was followed with piso-electric fabric, and the student was inferred to be checking for breath with a photo-electric sensor that assumed nearness of the students face or hand checking for breathing. We would have to do a similar set of sensors for a baby manikin, except we also used mercury switches to read position of the head (down below the feet when freeing an obstructed airway) and the neck position when the student/rescuer was blowing breath into the baby.

2. The interactive Video screen had to present realistic situations, and also the learning and testing segments, in one concise package. Jane Sallis, who I had worked with before at Texas Instruments, put in an incredible number of days on the CPR video disc. I told her every day we wasted in getting this done we should imagine dead victims piling up on our doorstep (; I was a fairly crude motivator, but she later admitted it worked). We had to plan perfectly for each of the 54,000 stoppable frames, which would then be given sound by our interactive audiotape, which we had pioneered at an earlier stage. In those days, any videodisc required exquisite planning because an original high quality videotape had to be sent to Japan by one of the three nascent videodisc makers, and all of their early processes took over two months. If this all sounds like it was high speculative, it was. But first, we had to get the support of someone like Sony, which we hoped would be able to market psychic benefits of being involved with a national rescue effort. It was at that point merely a demo interactive videotape with a wired manikin and pieces hanging out the sides. Mostly it was held together by sheer belief.

As I say, it was critical that we enlist a leading-edge partner with a videodisc operation, and I was the one who had to sell this all to Sony. For that I had to take a trip to New York City and the SONY building on 59th Avenue to sell this off the wall project. The prototype equipment and its trial programming had been iffy when I left and I was wary of prematurely blowing this opportunity, and thought I might stall it a bit, but Jane said that is what opportunity looks like – something no one else understands or wants and that you step up for.

I will always remember taking this kludgy conglomeration of spit and bailing wire electronics from Dallas to the slick, spiffy executives at Sony in Manhattan. The manikin – Annie –  in its large shipping crate, and the tape player we connected to the computer to manage the interactive experience with the sensitized manikin, all this in an awkward stack of shipping crates which I could put on a small platform dolly and get from here to there: Airport to hotel with a big tip for the yellow cab to put these crates in the trunk and the back seat. Then the next morning 17 blocks from the hotel up to 59th Street…except that the rain bucketed down as I stood in front of the hotel waiting for a cab, and the cabs never stopped. I figured if I rolled the stack out to a busier street there would be more chance of getting a cab. It continued to bucket and I continue to be ignored by cabs full of happy dry people who wondered what in the hell I was rolling along the street, parting streams of water now…walking toward a 10 am appointment with Sony that would determine the future of the CPR Learning System, and a lot else.

17 blocks and no cab would even turn down any street I happened to be on. “Just get a cab,” someone at Sony had told me as I sat in Dallas a few days before. 17 blocks crossing streets up to my ankles in running water, pushing the heavy stack of equipment no one wanted to pick me up with. Finally, a block away from the Sony building, a yellow cab stopped beside me. It would take more time to load and unload the stuff than push the stack this last block. “Fugetabout it” I said in my best New York accent.

It was one of those days which began with disaster, and as if responding like true champions – every piece of electronic equipment that had sloshed for an hour through the honking downpour mid-town Manhattan…every piece worked perfectly. The Sony people had seen about everything in the world and New Yorkers have seen everything in the world on their streets, and none of them had seen anything like it. They could understand what this interactive videotape system would look like when it used their videodisc. Sometimes, and just a very few times, you can find people who are ready to take the same leap you are taking, and understand exactly what you are doing. I credit Dan Harris and several more of those whose job it was to introduce the videodisc to the U.S. with “getting it” immediately, and pulling others in from all the floors to see this crazy system that was perfect for showing off the interactivity of their videodisc.

That was a successful meeting, though I was dripping wet through all of it and could have been electrocuted at any moment of my demonstration. I believe they got a truck to get the stack of stuff back to the hotel. That was the success of the day, and they quickly agreed to get our videodisc made and wanted to take the system to several shows where they were showing off the videodisc. That was a few months out, and required a lot of shipping, but those first shows such as the Consumer Electronics show in Las Vegas, drew a lot of interest for Sony, and for us. They had these little forums of people to ask questions in side rooms, and I was basking in the general appreciation and interested questioners when I got blindsided.

“Why do you have to use a young girl for the manikin? That looks extremely sexist to me…”

I looked out and there were several women, of all ages and diversities, nodding their heads at me.

“Well, the Laerdal people have done studies, with male manikins and mustaches…and the response is uniformly low for them and totally, uniformly – from men AND from women –  they are more comfortable with the young girl. “ I hoped I was convincing enough with this… but I was not.

“That’s a bunch of male chauvinist pig crap done by male chauvinist sexist marketing types…I don’t see we should believe this crap at all.”

A lot of female heads were nodding in support and grumbling louder too. I had never expected I would be on the verge of a protest march from having tried to do good in the world. So when the grumbling subsided for a second, I tried one last thing.

“I would like to tell you the real reason, the original reason for having the manikin be a young girl…”

“Because men like the idea of working on her…”

“No,” I said, “It’s because of her father.”

The crowd quieted, but the questioner remained standing, hands on her hips. Her hunched glare said Go on.

“Mr. Laerdal had a doll-making company in Stavanger, Norway, and was fairly successful at it. He had a summer home on a lake back in the Norwegian mountains where he took his large family and their friends on holidays. One summer day they were all swimming out into the lake and someone shouted Annie, and in a few minutes they dragged Annie, Mr. Laerdal’s lovely young daughter, up on the beach, and everyone tried to revived her, but she died there on that beach, that day. Mr. Laerdal was so aggrieved that he made a life-mask of his daughter Annie, and later decided to make a manikins to teach lifesaving. He closed his doll-making company, even though it was very successful, and dedicated the rest of his years and his fortune to making manikins in Annie’s image so that thousands – or maybe millions — of other lives would not be lost in that way. So that is the one we use…in a way…that’s Annie there today.”

The crowd was very quiet now, and began to shuffle away from the standing questioner, many leaving the room without further comment. She finally stood alone in the group of empty chairs, which sort of ended my presentation.

“So OK,” she said, “I’m not going to clap…but that sounds like a reason.”

Needless to say, the help of Sony was invaluable. They gave us one of their first four videodisc players to come into the country, and supplied all the videodisc processing once we had the original videotape. Later, these pieces would have to be programmed to operate together in one seamless experience. However getting to that point, riding like the wind on hypothetical constructs, was anything but seamless.

Copyright 2018 David Hon – All rights reserved

Birthing the Anatomical Keypad

It is one thing to be given the green light to explore possibilities. It is quite another thing to take that exploration and boil it into a single quest. No matter how obvious the need, if the solution defies people’s expectations, then the path becomes strewn with obstacles. I was doing sales training on Texas Instruments programmable calculators, and we had been having little success trying to bring programmables to the consumer market in large department stores. People were basically terrified of these devices. One bright associate at TI said that basically what we had to do was “de-terrify” people before they could appreciate programmability and become customers. Panasonic had an advertising slogan back then that was brilliant.

The slogan Panasonic used was “Just slightly ahead of our time.” This was a deterrifying slogan. People knew the technology Panasonic was offering was not so futuristic that they would not understand it or, even worse, look stupid trying to use it. It was many years later that the Business Analyst brought the TI programmable calculator into widespread use, and that was only after most of those customers already owned personal computers. It seems we humans don’t instantly make the connection between what we know, what we need, and what advancement you are proposing. A great deal of the process involves most people digging their heels in, resisting learning anything new. Customer Education then was the major problem with those extremely useful calculators TI was trying to sell.

Fresh off that resounding failure — with business people not knowing why they needed cube roots, and not wanting to admit they did not even know what a cube root was — I accepted the training manager job at the American Heart Association. There I began to see the need for an android CPR simulator. The path of CardioPulmonary Resuscitation (CPR) itself had been long and sketchy since it appeared as a painting in the ancient Egyptian Temple of Medicine and even in I981 was only just becoming respectable in lifesaving circles. The AHA was in Dallas, but Seattle, where I grew up, had created a mass outreach in training ordinary citizens how to respond to a heart attack with CPR, and from that example people everywhere began to understand that they might need CPR someday.

In no way did anyone anywhere know that they needed a simulator to proliferate CPR. Thus, parallel to making a piece of equipment that no one had ever envisioned, I had to make a case for something no one had ever voiced the need for. As a design pathway, I decided I would take all the problems that currently existed with teaching CPR to the millions who ( , according to the Gallup Poll,) said they wanted to learn it in the near future. Then – simple – I would flip each problem into a solution. That would set forth the basic design needs of the simulator. Here were the problems:

  1. Logistics – Whatever organization was teaching CPR had to find and schedule a room that would hold about 20 people for the lecture and hands on approaches. With small classes given at odd intervals, teaching millions of ordinary citizens would take an impossibly long time.
  2. Performance Feedback –Students did not have an easy method of understanding the effect of their performance in decision making and in manual application of CPR.
  3. Message Inconsistency – Whenever CPR was taught, even with one of the several manikins available, the material varied a slight bit, and sometimes a lot, depending on which instructor taught it.
  4. Testing Inconsistency – When testing was done on the students, the evaluation by the testers was highly variable even though they had checklists. Often other instructors, with their varying viewpoints, were the test evaluators.
  5. Performance Recording – Along with inconsistencies in Message and Testing, the records of which students attended when and received which scores becomes an immense record-keeping problem
  6. Instructor Burnout – Possibly the greatest detriment was volunteer instructor burnout. Instructor qualification took some time and dedication, but then the average number of classes each instructor taught was five, before they called it quits.

So this great, wonderful phenomenon of citizen CPR could assure that a capable person would be there the exact minute when a life was ebbing from the body down on a city sidewalk or at a wedding party. However, it was the problems, the obnoxious practicalities, that made CPR in ordinary citizens only a weak possibility. Logistics and continuity would doom its promise. That is why we needed a CPR Learning Simulator. Flight Simulators taught pilots to bring planes in safely. Why couldn’t a CPR simulator teach people to save lives, right at the spot of a heart attack and at the very moment the victim lost consciousness? The rest of a victim’s body could carry on much longer even with the heart stopped, but the brain was key. Many, many victims lost their brain function, forever, before the paramedics could arrive. The father, or uncle, or elder sister, or young girl in the pool — each had about five minutes until their brain began to die for lack of oxygen.

When I finally got my chance, just in time and with limited credibility, I presented the idea to the Emergency Rescue Working Group. The advantages of a CPR Learning System were clear. The vision was mine and with limited funding and 6 months to work on it before the midyear meeting, I got the opportunity to show it. I told them I would prototype the simulator with interactive videotape and be able to give everyone the clear idea that was possible. Notwithstanding the fact that interactive videotape had not been invented, and was thus an obvious design objective as well, here is how the final simulator had to solve the variety of problems we had observed.

  1. Logistics – If the CPR Learning System, based on simulation, could be available 24/7 in a small, dedicated room, vast amounts of scheduling and notification would not be needed, and thus many more students could be taught in a given week. The scale of CPR learners – and thus heart attack survivors – could be scaled upward with one-time investments, IF the equipment were affordable and available.
  2. Performance Feedback – The students should be able to see and feel the effects of their performance on a manikin in real time, and with that instant feedback on their every move, they could rapidly adjust their performance until it was satisfactory.
  3. Message Inconsistency – Although there were adequate textbooks and lesson plans, the variety of emphasis due to individual instructor differences, led at times to poor decision-making by somewhat confused students. A computer-learning program would be the same every time.
  4. Testing Inconsistency – Since CPR was beginning to be required by various paramedics, firefighters, police officers, and hospital workers, the end performance needed to be extremely consistent so that these various emergency workers, and hopefully ordinary citizens, would be compatible between anyone involved when there were seconds to spare in the life of the victim. A computer program based on input could solve this.
  5. Performance Recording – The difficulties in maintaining records, especially when CPR certification was required for various jobs, could mean people’s livelihood, in addition to complicating planning by emergency facilities. Computers are excellent at record keeping, and this presented a way to integrate a standard CPR on a broad scale.
  6. Instructor Burnout – The CPR Learning System could teach the students one on one without an instructor present, and thus the training could be in constant operation 24/7 through many weeks and months if the demand continued.

As it turned out, the interactive videotape for the instructional part could be controlled by an Apple 3 computer, with a special card that accessed individual frames in the way computer editing was conducted in making television programs. Not easy, and not even obvious. But doable. Clearly the straight video education could be presented. Also it could be interactive so that when the student touched the screen with a light pen, he or she could answer questions and if necessary, have remediation – in pictures and demonstrations – brought up immediately.

On the other hand, a truly difficult problem presented itself, the simulation of hands-on CPR with real results, with sensors in a manikin processing input data in nearly real-time, and showing ongoing results instantly on a second computer screen. We first attached a number of different sensors to an existing training manikin, Ruscussie-Annie, and made a display box with various lights for on-off touching and analog gauges for depth and length of compression. That way we could see the signals coming from our variety of sensors in the manikin. Friends and detractors alike came to call this supersensitive manikin the Anatomical Keypad. Then “cutting the cords” and attaching them to the special computer card to read and process them drew our modest cheers for ourselves. It was truly a birthing process of a new kind of training, and a sensitive manikin for CPR was born.

With 35 more years gone by now, the various toys and computer games make this challenge seem somewhat trivial, but at the time it was like playing God. It was truly the “laying on of hands” and we could actually tell, and document what would be happening to a victim, and evaluate a rescuers’ performance before a real victim lay before them.

Because real-time computer-graphic overlays of video pictures was not a reality yet, we needed two screens, one for the didactic instructions and decision-making protocols, and a second screen to show the graphic results of manual input to the manikin. The students would look up from his or her compressions and interact with a light pen on the screen, and be able to see their placement, depth, and timing in exactly the same moment they were performing CPR on the manikin.

When we returned to the 6-month meeting of the Emergency Rescue Working Group, the doctors were both fascinated and reticent. The real time graphics responding to their light pen were clearly impressive, but the doctors had two very serious reservations before we could move on. First, they said, we would need different CPR courses for nurses and cardiologists, of course, in addition to those for civilians and non-medical hospital workers. The first question, different course for different levels of medical knowledge could present death by complexity to the CPR Learning System. I immediately feared an infinite cacophony of levels of medical power impinging, creating a hierarchy of concerns and more separate course than I, or anyone, could put together to the satisfaction of the multitude of interest groups. I did not want to offend, but I answered as simply as I could:

“The victim doesn’t care.” I said. “The victim is unconscious and has only a few minutes to live.”

They seemed to focus on that. “ But one doctor said, “but there are special skills some of us know.”

I knew I could not let this CPR Learning System become an elitist toy. “I think the victim just wants to breathe, and just wants his heart to start pumping. If I am the only one there I will have to know enough to save him.”

Wrinkled eyebrows. How could I say these things not being a doctor?

Look at it this way,” I said. “Johnnie Rutherford won the Indianapolis 500 four straight years. He is probably the best driver in the world and he lives right here in Texas, right over there in Fort Worth. And yet I am really glad that Johnnie Rutherford has to have the same Texas State drivers license that I do, because that means he’ll drive on his side of the road and stop for red lights, just like I will. And in CPR, if I am doing it with anyone, I want to know you are doing the same things I know have to be done, right then, right there, with no second opinions.”

Ok, they agreed, we’ll assume a standard vanilla course will be prepared at first. Whew!

Then secondly, they could not, even with my technical explanation see why we could not just use one screen. I was technically constrained to the two screen approach. The overlays and interleaving that we now take for granted were not possible then, on a small portable computer and a commercially available videodisc player. One screen took the light pen input, and held the pictures, video, and artwork on a videodisc, 54,000 frames to be managed by computer.  On the second screen the computer gave easily understandable computer graphics that represented performance on the manikin.  However, I knew that I needed a better answer, and pulled this one from somewhere.

“If a group of doctors were creating the first human being, someone would say ‘why not just one eye’ or ‘why not just one ear?’ Because our bodies needed to operate in 3 dimensions, and two eyes and two ears let us perceive in stereo.”

True, but two screens?

“Yes, it gives the student a stereo learning experience, a right brain for what they see and a left brain for the data they need.”

Well, they did not run me off for that. And in a few months I got the funding for what would be an early 1980s demonstration that machines and people could work together in learning CPR, something which on the streets, in broad daylight, was most crucial to life and death. There were more obstacles to come, as usual, but this much we knew to be true.

See the early CPR simulator in the World Book Encyclopedia.

Copyright 2017 David Hon – All rights reserved

Earning the Digital Pinocchio

Things do not often happen for the right reasons, or in the right order, or to the right people. Usually there have been years of fits and starts until the constellations align, and something truly begins. Such was the case of the first computerized CPR simulator. A tremendous number of people wanted to learn Cardiopulmonary Resuscitation, or CPR, and a tremendous number of cities and fire departments and police departments and business wanted them to learn it. The Gallup Poll had the number of people who desired to learn CPR at about 90 million. But the logistics befuddled everyone. On a non-profit budget, the Heart Association (and eventually the Red Cross) had to rent rooms and sign up students and provide good instructors, even when the average “burn out” rate on those instructors was about five such courses. Even techies who knew in 1977 that the digital age that was coming, could provide no idea how to computerize that CPR experience that could save thousands of lives during the few minutes left after a heart attack..

I meandered through a few interesting careers before I found myself as the National Training Manager of the American Heart Association. Not counting a few days packing slug bait and a few years in the military, and a few years teaching college, I began doing real work for a few years at Texas Instruments, and then landed as the National Training Manager of the American Heart Association, which had recently departed New York City and landed in Dallas, Texas. It was 1977 and I knew they would need electronic medical journals and interactive training, but I accepted that I would first have to make a new kind of training department, one that defined results and worked backward to create classes that produce them. The old pros were leery of me from the start. I was “the next one” when they had had five training managers who had been unsatisfactory. The problem with that position is that they always promoted from within and every new manager had a trailer-full of political baggage, and in truth, few ideas how to add value to the task.

No such baggage on me, I traveled to talk with several Affiliate directors and asked them what they needed done in the training area. I did that in each of four regions and the drill was mostly the same. They then, one by one, told me how exactly I should do it and which of the other directors not to listen to or otherwise watch out for. On top of that festering pile of politics at every turn, their turnover rate was about 3 people per year in each position. So obviously these people going through the revolving door needed training. From training in the Marines, I guess I sensed it was time to cut through the froth and blather.

“OK,” I said finally, “What’s your biggest problem?”

“Fundraising,” was the chorus in five-part harmony. Eyes rolled at stating the obvious once again.

“So you want your new people to raise more money?”

This seemed always to bring more nods. They started to venture all their theories, but I cut them off.

“What is the single thing you can think of that would help that the most?”

Heads scratching, most finally agreed that they longed for their young managers to be able to write a fundraising plan to coordinate staff and volunteers and local businesses in one concerted effort. Their problem was that writing the plan was onerous and fragmented and never seemed to get done even halfway by the fundraising season. This left many volunteers thinking this was all disorganized chaos, and they walked. Repeat over several years. They’d never done a good one….Never even seen one.

“What if they could write the whole fundraising plan in one weekend?”

Consensus was that that would help a lot. So we agreed to design fundraising courses that would achieve that. They wanted to know how I could do that and I said I would design a simulated community, and they would write a plan, in class, and have it graded by experienced fundraisers. They would attend three days of lectures and group work to learn items that should be required in a fundraising plan. On the third evening, a Wednesday, each would be given a packet which contained a 20 page description of a community, with demographics, income sources, governmental structure, major businesses, language groups…the sort of thing I suspect the FBI gives you if you are a new agent in town.

At five o’clock, the students received that packet, two large pads of legal paper, and a manila envelope. I told them that by five o’clock the next afternoon they would turn in their papers. On each page, and on the envelope, they were to make some visual mark, like a flower or shape, so that they could identify their package, but no one else would know whose package it was. The reason for this was, again, politics. In this manner, each individual alone would get his package back, hand-corrected and annotated by long time fundraisers for the Association. They would thus have heavy feedback, but no favoritism among the grading group, and no recrimination from their bosses, at least not from any information supplied by us.

The young student/staff members took it quite well after the shock of realizing they would have to do the equivalent of a large term paper in about 24 hours. However they managed to do it — working together with papers spread the length and width of their motel rooms — they completed this “death march”, and handed in their manila envelopes full of detailed planning for fundraising campaigns in this “mock” city in their state Affiliate.

The real groaners were the fundraisers who used to sit around the bar and tell fundraising stories into the night until trainees were able to slip away. That was the formal “training” in the old days.

Instead, with several of these plans in each of their hands, I asked the fundraisers to go line by line and critique each thought, and say what could make it better. Some of them wrote many sentences per page until they realized they would be up all night as well as those students who had just been through the 24 hour “death march” (for which I became famous and despised by all). I had to keep all the graders happy and awake, bringing in beer and pizza at first. However, as the early morning hours grew in number, I was bringing in coffee and napping pillows.

The students would be in the main conference room to receive their papers back at 9am that Friday morning and receive a general critique by the fundraiser/graders. No one know who had written what or who had graded what, but of course each student knew his or her performance in great detail. The students who had partied all night and the fundraisers who had graded all night were red eyed and a bit shakey but overall, surprised at what they could accomplish.

After giving about six of these classes the first year, to thirty students in each class, the national fundraising went up 30%. The Association was sold on my training, and at that point I asked the Board for money to make a CPR simulator to standardize procedures and allow the outreach of a course that had been plague by the logistics of time and place and the availability of instructors.

CPR courses used a manikin for practice, and my vision was to computerize it. Many physician volunteers had helped in this process, but several of the Board members vocipherously balked when I said I would need $100,000 to do it.

“How do we know it will work?” They asked.

I gave them a lot of studies on flight simulators because there were no directly relevant results anywhere else. I even mentioned that the fundraising training was a sort of simulation that had worked. That was not the ironclad assurance they wanted. However, they knew they must try to solve the problem of giving mass instruction of CPR, and they very much wanted to show that they were doing something.

“Yes, but how do we know it will really work?”

“Because I say it will.”

That was apparently the right answer because, I’m sure partly because of the fundraising success, they wanted someone they could trust who would commit to a solution completely. Luckily my previous job was with Texas Instruments, where I learned how they Design to Cost. The world was about to see both a computerized CPR learning system, and one of the first important demonstrations of the new videodisc technology. It would also make me slightly famous.

Copyright 2017 David Hon – All rights reserved