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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

#261

Post by barry-cotter »

cycrutchfield wrote: post #48
romanows wrote: post #41

Earlier quoted context omitted.

I wonder how long it would take to teach someone to be more help than harm? After 30 intensive days of training, what would candidates lack?

About 4 years of medical school, and around 4 more years of residency training.

> About 4 years of medical school, and around 4 more years of residency training.

This is not universal in the US. You can do Bac + Med School in six years even there[1]. That’s the standard route outside the US’ former colonies and those countries with colonial cringe. Medical school in the UK and Ireland varies from five to six years with undergraduate entry. Graduate entry is four years like in the US, but pre-med doesn’t exist; you can start med school with a degree in dance[2]. Even in the US you can do med school in three years[3]

[1] https://www.forbes.com/sites/noodleeducation/2018/06/18/3-bs...

[2] https://www.ul.ie/gems/programmes/bmbs-programme

[3] https://med.nyu.edu/education/md-degree/accelerated-three-ye...

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

#262

Post by jacquesm »

Nambia wrote: post #23
toomuchtodo wrote: post #9

Earlier quoted context omitted.

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.

Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?

Yes, it's pretty narrow. I've had double pneumonia somewhere in my 20's. Just playing a reed instrument (sax) was over-pressuring my lungs to the point that it led to more damage over time. And that's only a tiny little bit of pressure.

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

#263

Post by barry-cotter »

Kalium wrote: post #91
ALittleLight wrote: post #74

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…

> 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 will happen soon or not at all. The AMA and its equivalents worldwide have a very consistent attitude to anyone, anywhere being allowed to do anything a doctor can do. It should not be allowed. Psychologists should not be allowed prescribe; nurse practitioners should not be allowed practice independently under any circumstances, etc.

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

#264

Post by barry-cotter »

onetimemanytime wrote: post #126
verytrivial wrote: post #82

Earlier quoted context omitted.

The numbers from Wuhan were something like 30% fatalities for those moved to ventilation. That doesn't detract from your point but does support why the path "make a ton of ventilators" is being persued.

Technically I should provide a citation and searched, but couldn't find it. I'm almost certain that I've read that wayyy more than 50% (prob 70% die) once placed on ventilator. Maybe because those ending there are already with one foot+ on the grave. The ventilator can save,say 30%, and also make us feel good "we did all we could," after all, we will all reach that point one day ;)

Most people who get put on a ventilator die under the best of circumstances.

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

#265

Post by omar_a1 »

mistermann wrote: post #251
omar_a1 wrote: post #207

Earlier quoted context omitted.

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 are accusing him of saying things that he has clearly not said. And then on top of it, accuse him of having a problem with his imagination. At the very least, this behavior seems disrespectful. I encourage you to print off, on paper, your portions of this thread, and then draw lines between your claims of what he said, and the corresponding words he wrote. Then, compare the contents of the pairs. After doing this…

They asked for evidence. I did as much, explaining a very, very basic concept in medicine, "sterile technique," and how even that can take years to get right. And was told, in response, that I'm just imagining reasons to object. Evidentally, keeping tools sterile in medicine is something I just conjured up!

Perhaps you should take your own advice, rather than responding with personal vitriol directed at the users countering your point.

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

#266

Post by cycrutchfield »

barry-cotter wrote: post #263
Kalium wrote: post #91

Earlier quoted context omitted.

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…

> 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 will happen soon or not at all. The AMA and its equivalents worldwide have a very consistent attitude to anyo…

Pretty reasonable if you ask me. History is littered with quacks and snake oil salesmen. There is a reason why becoming a physician is such an arduous and selective process.

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

#267

Post by cycrutchfield »

mistermann wrote: post #246
cycrutchfield wrote: post #108

Earlier quoted context omitted.

Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.

Imagine thinking that claim was actually contained within that comment.

> 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.

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

#268

Post by [deleted] »

joe_the_user wrote: post #120
cycrutchfield wrote: post #108

Earlier quoted context omitted.

Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.

In a huge medical emergency, when people essentially desperately pleading for a ramp-up of the effectiveness of medical personnel, it's kind of mind-boggling that the only answer you're giving is sneering at how little the layman knows (and yeah, that seems like a standard answer doctor in the US are going give). And, yeah, maybe I know little of what exactly ICU processes are but it seems indeed implausible that the…

[deleted]

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

#269

Post by cycrutchfield »

zaroth wrote: post #216
bilbo0s wrote: post #81

Earlier quoted context omitted.

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.

Reminds me of some of the horror stories from the peak of the outbreak in Wuhan. Doctors and nurses treating patients without any PPE because, well, there wasn’t any left, and they had all tested positive anyway.

I don’t know what the fatality rates were for those healthcare workers at those facilities, but it would be good to know for future reference.

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

#270

Post by [deleted] »

mistermann wrote: post #247
cycrutchfield wrote: post #115

Earlier quoted context omitted.

> 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. Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.

A scarily high percentage of comments in this thread are people making presumptions, and asserting them as if they are fact . Some of those comments were written by you.

[deleted]
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