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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

#291

Post by mistermann »

bilbo0s wrote: post #81
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?

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…

> The original idea of 30 days training is an end of the world worst case scenario.

The person was asking a question, not proposing a plan of only training people for thirty days.

This thread is a like a giant version of that telephone game that we used to play in school, except in that game you didn't have the advantage of reading the exact words that the person said, as we can in this thread.

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

#292

Post by omar_a1 »

mistermann wrote: post #286
omar_a1 wrote: post #285

Earlier quoted context omitted.

No.

No, as in you are unable to provide evidence, or no as in your are unwilling ?

As in: No, I'm not about to read your lengthy line-by-line literary critique of your stunning assertions that I'm making up every single rebuttal and that I seem to have imagined this entire conversation.

It's like poorly-executed gaslighting, as if you weren't aware that I can scroll up and see the post that I was replying to. I'm able to verify that, yes, it plainly states the thing that you have spent several bewildering pages insisting it did not state. If you missed it, I suggest you reread the above discussion, rather than me quoting the all of the above posts back at you, as it's become abundantly clear that doing so would be a waste of time.

But I will commend you on your dedication to being wholly disagreeable, while adeptly managing to disengage with any of the actual discussion.

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

#294

Post by dsfyu404ed »

joe_the_user wrote: post #111
SkyPuncher wrote: post #97

Earlier quoted context omitted.

> 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. Ho…

The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war. Right now, the death rate still isn't higher than a flu epidemic but just the number of known infections promises a lot worse and the potential doublings after that are terrifying. It seems like there's an endless dialogue of: A: H…

The problem is that X includes a nonzero risk to human life/limb that is the responsibility of the person doing X. If you are in charge of a hospital and just let Y people die because there's not enough qualified doctors to run ventilators then you can easily wash your hands of it as though it's not your fault. If you let less-qualified people run ventilators and Y/10 die from human error but you prevent 8Y/10 people from dying then all the families of the Y/10 that died from error are going to hold you responsible even though you minimized the number of overall deaths.

We have spent decades holding people systemically dis-incentivizing people from doing positive things in bad situations by assigning responsibility in this perverse "who was the last one to touch it" manner. Society has made its bed and now it gets to lay in it. Nobody is gonna be the one that bucks the trend and reduces and sort of real or perceived safety standard in order to increase volume of care until the situation becomes so obviously bad that not doing so is indefensible.

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

#295

Post by thu2111 »

jacquesm wrote: post #209
SkyPuncher wrote: post #178

Earlier quoted context omitted.

> Just like you don't want a front-ender doing back-end or systems This is not the argument I'm making though. That implies the front dev has no oversight. I'm making the argument that a frontend development can successfully complete features with the guidance/oversight of a backend dev. The results might not be ideal, but it can provide an acceptable outcome. ---- > You need the experience and you need the detailed…

There are exactly 6 known instances of talk down landings that I'm aware of. All concerned general aviation and in one of them the person had prior flight experience. Several of those ended in a crash. A general aviation plane is in no way comparable to a large airliner, and no instance of such a landing has ever been recorded, nor has it been attempted. Life is not a movie, some stuff is just hard and requires a lon…

no instance of such a landing has ever been recorded, nor has it been attempted

It has in a simulator.

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

#296

Post by thu2111 »

saurik wrote: post #103
SkyPuncher wrote: post #97

Earlier quoted context omitted.

> 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. Ho…

I now don't remember where I saw this, nor can I find it... but I swear I had seen something in the past week or two comparing how much retraining different medical professions needed to quickly get useful for staffing ventilator technology, and veterinarians came out on top; so like, people are (unless I dreamth this?!) looking into reusing people.

You didn't dream it, it was in Forbes.

The US did a disaster prep simulation for virulent flu, that involved a shortage of ventilator scenarios. They took people with something approximating medical backgrounds, including nurses, other kinds of docs and vetinarians, and gave them training in how to use a ventilator. After two days they were given a test and the vets had the best score.

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

#297

Post by romanows »

mistermann wrote: post #291
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…

> The original idea of 30 days training is an end of the world worst case scenario. The person was asking a question, not proposing a plan of only training people for thirty days. This thread is a like a giant version of that telephone game that we used to play in school, except in that game you didn't have the advantage of reading the exact words that the person said, as we can in this thread.

Thanks for your comments in this thread. Some people seem to have an axe to grind concerning the hubris of software hackers and are pushing that debate rather than addressing the question.

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

#298

Post by alexandercrohde »

lucretian wrote: post #176
cm2187 wrote: 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.

it's not good. in on study, 24/26 of pts with non-invasive mech ventilation and 31/32 of pts with invasive ventilation died. https://www.thelancet.com/journals/lancet/article/PIIS0140-6... note that the study demographics were skewed to the more vulnerable cohorts (avg age = 56, range = 46-67, 62% male, 48% with a comorbidity).

Wow... I had no idea it was so low.

Since you seem to be knowledgeable, if ventilating isn't a big-impact intervention, what's the point of flattening the curve? Is there some other intervention that hospital is doing that actually makes a more meaningful difference that can't be done at home?

Or is it maybe just psychological?

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

#299

Post by SkyPuncher »

tcbawo wrote: post #238
SkyPuncher wrote: post #97

Earlier quoted context omitted.

> 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. Ho…

There is an ophthalmologist/comedian on Twitter @dglaucomflecken with an entertaining, somewhat tongue in cheek feed with similar sentiments ( https://twitter.com/DGlaucomflecken/status/12389545581407723... )

Thank you. That made my wife's morning.

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

#300

Post by SkyPuncher »

mistermann wrote: post #228
SkyPuncher wrote: post #97

Earlier quoted context omitted.

> 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. Ho…

Do you have any idea how long it took your wife to learn to achieve the level of skill she is at? Let's say this was WW3, and we somehow lost 75% of these specialized personnel, what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level?

There's a lot to this question.

> what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level?

It really depends and I'm speaking out of my comfort zone here.

Becoming a doctor takes a really long time because it includes a LOT of background and general medicine knowledge. Doctors know a lot about medicine outside their speciality.

Med school is 4 years (2 years of bookwork focus and 2 years of clinical focus) and builds on undergrad significantly. Residency is 3+ years. I'd say the majority of people with STEM backgrounds could have function acceptably as a general doctor with 2 to 5 years of postgrad training. Surgeons are built much more on experience so that's very hard to fast track.

In my opinion, the real measure is the ability to handle edge cases/unusual cases. Specialized/limited scope workers, especially those with the direct support of an experienced individual, could pick up tasks much, much more easily as long as an expert is there to take over the challenging cases.

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