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The U.S. tried to build a new fleet of ventilators

nytimes.com

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Re: The U.S. tried to build a new fleet of ventilators

#91

Post by Kalium »

ALittleLight wrote: post #74
cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - tha…

I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort.

To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on.

Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment.

That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.

Re: The U.S. tried to build a new fleet of ventilators

#92

Post by jmole »

toomuchtodo wrote: post #9
lukevp wrote: post #7

what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft e…

There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.

There is evidence that positive pressure ventilation results in worse outcomes than the negative pressure iron-lung-style ventilators: https://www.atsjournals.org/doi/full/10.1164/rccm.200707-100...

Re: The U.S. tried to build a new fleet of ventilators

#93

Post by AdrianB1 »

blunte wrote: post #24
appleshore wrote: post #20

I always criticized the idea that “radical technology could exist but the competition buys it up” as a naive conspiracy theory. It’s pretty remarkable that the government paid for this but somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins, and void the contract.

> somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins Perfectly normal and common in the US low-regulation economic system. > and void the contract Most likely the government officials with the ability to allow this cancelation were bribed, or rather lobbied, to allow it.

It does not look like a regulation problem, but a contract breach: the buyer corporation should be held accountable to execute the contract as agreed, it bought the company with everything - assets and obligations.

Re: The U.S. tried to build a new fleet of ventilators

#94

Post by bamboozled »

ALittleLight wrote: post #74
cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - tha…

You’re comment reminds me of the reluctant success of sending teenagers on bomber raids in in WWII over Germany. As opposed to relying on only experienced airmen, which there went enough of.

Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chance.

It sounds like there is some fundamental idealogical opposition to this.

I have a friend who is going through her residency now, she has to deal with a lot of very unhealthy psychological and physical treatment (ridiculously long hours) to get through it. Sounds more like a hazing than a professional introduction.

Re: The U.S. tried to build a new fleet of ventilators

#95

Post by AdrianB1 »

mistermann wrote: post #28
appleshore wrote: post #20

I always criticized the idea that “radical technology could exist but the competition buys it up” as a naive conspiracy theory. It’s pretty remarkable that the government paid for this but somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins, and void the contract.

We believe many things to be true, that are not true. And not only do we believe them, we passionately defend them! I don't think many of us would recommend writing software on top of such uncertainty, yet we seem to think it's possible to do so with a society and economic system. Then we're surprised when it blows up in our faces every decade or so. The surprised Pikachu meme seems fitting. EDIT: To those who disagr…

Not voted in any way, but I cannot figure out what you tried to tell and how that would contribute to this discussion.

Re: The U.S. tried to build a new fleet of ventilators

#96

Post by Rebelgecko »

corebit wrote: post #77
cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.

I think it speaks more to the fact that medical school is mostly focused on book learning and residency is when doctors get most of their hands-on experience.

Re: The U.S. tried to build a new fleet of ventilators

#97

Post by SkyPuncher »

oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

> It’s much harder to ramp up production of medical professionals.

I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work.

Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. However, they all still have the baseline knowledge. They're able to assess patients, read charts, and report on vitals.

I just asked my wife (a psychiatry resident) if she could intubate/ventilate a patient. Here response was, "If I were the last person alive, I could intubate. You wouldn't want me to do it, but I could do it. I don't know how to run a vent, but I'm sure I could figure it out if I consulted with a doctor/therapist that does". I think most non-critical care doctors would express the same opinion.

What I'm getting at is we have a large amount of doctors that can act as multipliers for intensivists, hospitalist, ER docs, and pulmonologists. They are able to do much of the time consuming work while relying on specialists to guide overall care plan and intervene the on most challenging cases.

----

Given how medicine works, the chances of actually seeing this in action are low. But....it's an options.

Re: The U.S. tried to build a new fleet of ventilators

#98

Post by relativitypro »

This seems to be the cutting edge of capitalism, emboldened by legal force and lobbying.

Once you allow incumbents to rewrite the rules, they will do so to entrench and enrich themselves.

“Too big to fail” “Too big to jail” “Lower interest rates to fix covid-19”

Re: The U.S. tried to build a new fleet of ventilators

#99

Post by joe_the_user »

cycrutchfield wrote: post #65
ALittleLight wrote: post #62

Earlier quoted context omitted.

Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and com…

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

It seems like you've outlined a situation that could well be true. The US indeed has a training process that only generates useful competence with a full 8-12 year apprenticeship of hazing and theory.

Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited.

It seems like a world where the medical industry has piled goldstandard-or-nothing upon goldstandard-or-nothing approaches, to the point yeah, doctors really don't know how to produce useful people without those fricken' eight years or twelve years. Well friend, you should start thinking "outside the box" about how to make other people useful or many, many people will dies.

FYI: The US produces field medic with 16 week training period after basic training. That might who you want attending to you but things are going to be resembling a war zone really soon.

Re: The U.S. tried to build a new fleet of ventilators

#100

Post by roenxi »

cycrutchfield wrote: post #85
corebit wrote: post #77

Earlier quoted context omitted.

This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.

Ah yes, you surely know better than the trained professionals about how to best run an ICU. Just because you can call yourself a software engineer with little more than a high school diploma doesn’t mean that the same rules apply for doctors.

Doctors and nurses probably aren't trained how to run an ICU, they spend more than a decade learning about human bodies and they only have so much time. If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker.

Medicine has traditionally had a problem with a large number of very clever people who are sufficiently insulated from other communities that they are a bit behind the times. A good humourous example is the 1994 paper where a doctor will rediscover calculus.

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