Are you familiar with the Glasgow Coma Scale or GCS? It is an index of neurological conscious level. How awake are you? It first appeared in a landmark paper by Jennett and Teasdale, neurosurgeons in Glasgow’s then Southern General Hospital – now Queen Elizabeth University Hospital – in 1974. At the morning ward round, the consultant would ask the nursing sister how awake a head-injured patient was, and the sister would reply, a little more – or a little less – awake than yesterday, or just the same. It was evident that some more objective means of assessment was needed, and the Southern General came up with the GCS.
It looks at three modalities. It assesses a patient’s eye opening ability, speech, and movement, as follows:
Spontaneously open (Score 4 points)
Open to command (3)
Open to a painful stimulus (2)
Localises a painful stimulus (5)
Withdraws from a painful stimulus (4)
Flexes to a painful stimulus (3)
Extends to a painful stimulus (2)
No movement (1)
You can see that if you score full marks, that is, if you are wide awake with eyes open, speaking and moving normally, you have a GCS of 15 (4 + 5 + 6). On the other hand, if you are profoundly comatose, with eyes closed, silent as the tomb, and completely immobile, you score a 3 (1 + 1 + 1). You can’t score less than 3. You get a 3 for turning up.
My theme today is not really the GCS, but I can’t resist a pedagogical impulse and must clarify a few points. If the patient’s eyes are closed, the doctor says, “Open your eyes, please, if you can.” If the patient cannot, the doctor exerts a painful stimulus upon the patient, in a controlled and non-injurious manner, such as exerting some pressure with a blunt instrument, like the side of a pencil, on the flat of a fingernail.
With regard to speech, there is certainly some subjective overlap in the spectrum from confusion to incoherence to incomprehensibility, but in reality most physicianly assessments of these states reach broad agreement. Confused speech is usually syntactically more or less correct, whereas incoherent speech is sometimes described as a “word salad”, and incomprehensible speech more resembles a grunt.
With regard to movement, the doctor exerts pressure on, say, the right index fingernail, and the index finger is removed (score 5), or the whole right arm is removed (4), or the patient adopts a highly abnormal reflex posture in which the arms flex across the torso (3), or adopts another highly abnormal reflex posture in which the arms extend beside the torso (2), or there is no reaction (1).
Back in the 70s, you might say the GCS went viral. It certainly went global. In particular, it was found to be of enormous use in the pre-hospital and acute emergency setting, with respect to the care of patients who presented with diminished consciousness from both medical and surgical causes. It remains in use today.
With COP26, now that Glasgow is back on the map, I see an opportunity for another Glasgow-inspired index. How successful will COP26 be? Very successful, moderately successful, so-so, somewhat counterproductive, or an absolute disaster? Again, we need something a little more analytical, so I propose the GBS or Glasgow Blah Scale, which will be an index of the presence or absence of humbug. I am grateful to Ms Thunberg for the use of the word “blah”. I have a notion that her characterisation of the deliberations, to date, of word leaders with respect to global warming, “Blah Blah Blah” will immortalise her. It is self-evident that the extent to which COP26 falls short of target will be camouflaged in “blah”, or “fudge”. I have modelled the GBS on the GCS. The GBS may be used to reflect both the overall success of the meeting, and the power of each individual attendee’s contribution. Here I apply the GBS to the latter, that is, the individual attendant, be he for example Prime Minister Johnson, Prime Minister Morrison, or Chairman Xi. The three modalities in this case are presence or attendance at Glasgow (cf eyes), the comprehensibility of the communiqué (cf speech), and the extent to which the communiqué is realised by subsequent action (cf movement). As follows:
Token appearance (delegate drops by) (3)
Sends a deputy (2)
All ambitious targets ratified (5)
Confusion in some areas (4)
All ratified resolutions implemented (6)
Some isolated targets missed (5)
Oil exploration subsidised (4)
Coal industry revived (3)
Mining for minerals in Antarctica commenced (2)
No agreement reached in Glasgow, but COP27 put in the diary (1).
It occurs to me that the Glasgow Blah Scale might be modified to refer to any committee meeting we each may have the misfortune to attend. Who has not attended a meeting, be it in the Palace of Westminster, in the work place, or at the local golf club, which has been abandoned with precious little achieved? GBS 3. I hope this will not pertain to Glasgow. There is a letter in The Herald today from a professor in Anchorage Alaska, urging Glasgow to close all means of exit from the city, (airport, roads, river etc) until a legally binding agreement has been reached, among other things, to reduce global carbon emissions by at least 50% by 2030, and to fully fund a $100 billion/year Green Climate Fund.
The idea of detaining all the world leaders down by the Broomielaw, until they have laboriously worked their way from GBS 3 to GBS 15, is beguiling. Watch this space.