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

nytimes.com

211–220 of 355 posts

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

#211
post #201

Earlier quoted context omitted.

I've sure you've already considered this, but wouldn't any kind of training program of the sort you describe risk diverting resources from current operations?

It's possible. That's something that would have to be weighed against how bad we expect shortages to be and how much we expect amateur ventilator-operators to help. Given that we likely have more spare doctor cycles now than we will in the future, we should utilize them now. We can also do things like hire doctors from countries not as badly stressed to come teach the classes.

There are clearly a lot of contrarians in this thread, perhaps that is because the premise of a flooded healthcare system is still too impossible for some to envision.

And of course there are many levels to addressing bottlenecks. For example, operators wouldn’t have to be amateurs at first, they could be any of the non-essential medical professionals who are not able operate business as usual due to the virus. Could a podiatrist or urologist operate a ventilator given enough training?

In general we are brainstorming proactive measures. I think, at least in the US, we continue to have a reactive as opposed to a proactive strategy because of our decentralized government structure as well as the delicate balance between effective mitigation and maintaining social order. While we should be leveraging the current shelter in place strategy to build as much healthcare infrastructure as possible (both physical and technical, as per the thread) to handle slowly returning society to normal operations, we probably are not moving fast enough. In several weeks, as the unemployment and anxiety builds, so too will unrest. And I guess then it will really be a test of a nation’s people.

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

#212

Earlier quoted context omitted.

> Yes, people in this thread are letting the perfect be the enemy of the good No, it's because medicine has a very low fault tolerance, and requires a large body of technical knowledge to even understand what needs to happen for your patient. Having a team of incompetent clinicians perform complicated medical procedures "good" as a layperson still results in disproportionate people dying, that would have survived und…

> [...] would have survived under a competent practitioner. Bringing us back to the topic of this thread, a potential lack of competent practitioners if the pandemic worsens, and what the best solution to address this would be, such as a COVID-specific ventilator training.

Because the difference between letting someone die under inappropriately-applied ventilation versus just letting someone die is the occupation of a perfectly good ventilator. One that could be used to actually save someone. If you're in the business of killing patients, a gun would be more economical than a ventilator.

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

#213
post #145

Does anyone know the survival probability of a covid-19 patient once he requires the assistance of a ventilator? I have heard people mention it is fairly low but haven’t seen any figure on that.

Italy Cremona https://www.youtube.com/watch?v=rfkbv_WQtn0 Italy Bergamo https://www.youtube.com/watch?v=_suhYeWEcJg

Two hospitals, not a single patient survived ventilation/ecmo to date (last week).

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

#214
post #91

Earlier quoted context omitted.

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 f…

> 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.

This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are.

If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...?

We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”

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

#215
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…

My wife is a doctor (I am not). I've been following COVID closely and discussing with her/peers. I'm not an expert (but feel I have an above average understanding, thanks to my wife) > I see a lot of DIY posts that are probably not 100% the same thing but are they even close? I have yet to see (though I haven't looked extensively) a DIY ventilator that has the fine tune control many doctors are suggesting are require…

There is nothing complicated about air pressure/volume control loop. If $5 arduino can control a V8 engine (Speeduino) it can control a small air pump.

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

#216
post #81

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?

Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first. But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definit…

Curious what your SO thinks of this...

If a health care worker has a positive test and no or mild symptoms, seems to me they could sleep alongside COVID patients and continue to treat just fine? Save a lot on PPE while you’re at it.

A lot of workers would prefer that, rather then being quarantined at home where they will infect their families.

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

#217
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.

How could we archive that? its not like almost disposably cheap actuators moving with 0.1mm precision guaranteed for >10K hours MTBF was a solved problem over 30 years ago (floppy drive). /s

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

#218

Earlier quoted context omitted.

Earlier in this thread it's stipulated that the bottleneck is not the number of ventilators but the trained people to operate them. As such, training more operators is an obvious solution, and allowing the new operators to be substandard will mean we can get more operators faster. This pretty much dissolves your only real objection, that we'd be keeping a ventilator occupied that would otherwise be in use. Nope. The…

I'm sorry, I still haven't seen your empirical research and relevant credentials. So, to be clear, you can blindly assert that sending incompetent pseudo-medics to perform invasive procedures will be beneficial, and assert that claim with absolute certainty and zero evidence. But when I explain that, no, medicine is more complicated than you think, and back that up with concrete examples of how that is factually accu…

You seem like you're not making real arguments, so I'll leave the conversation at this.

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

#219

Earlier quoted context omitted.

Earlier in this thread it's stipulated that the bottleneck is not the number of ventilators but the trained people to operate them. As such, training more operators is an obvious solution, and allowing the new operators to be substandard will mean we can get more operators faster. This pretty much dissolves your only real objection, that we'd be keeping a ventilator occupied that would otherwise be in use. Nope. The…

I'm sorry, I still haven't seen your empirical research and relevant credentials. So, to be clear, you can blindly assert that sending incompetent pseudo-medics to perform invasive procedures will be beneficial, and assert that claim with absolute certainty and zero evidence. But when I explain that, no, medicine is more complicated than you think, and back that up with concrete examples of how that is factually accu…

As the contrarian, can you at least enlighten us to what, in your opinion, would be the best strategy to proactively address potential bottlenecks? I think we can all agree, career shaming aside, that medical professionals and engineers of all varieties actively participate in mindsets geared towards problem solving.

So in a hypothetical situation, where existing permanent healthcare infrastructure is at capacity, field hospitals are setup and existing medical professional staff need to be divided amongst the existing and newly supplemented infrastructure, what is your suggestion to save the most lives?

This exercise of sharing ideas, informing, critiquing is what this forum is for. Disagree and casting shame for a lack of first-hand professional experience is not educational and it’s not what this forum embodies.

I want to be as informed as possible so I can call BS when politicians say “nothing at all could have been done.”

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

#220
post #87

Earlier quoted context omitted.

This conversation begins when the number of residencies increases. And that will not change until congress approves more funding for residencies. Until then, there will be no change.

Is it Congress making this decision, or the lobbyists for the AMA?

They don't want to let their prestigious profession become what it essentially is—a body mechanic.
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