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LA: Ambulance crews to not transport patients with little chance of survival

latimes.com

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Re: LA: Ambulance crews to not transport patients with little chance of survival

#21

Post by burnthrow »

sneak wrote: post #16
harikb wrote: post #14

> Patients who are not to be transported to hospitals include those whose hearts have stopped and, despite efforts at resuscitation, have no signs of breathing, movement, a pulse or blood pressure and would be declared dead at the scene.

Who else does it include? This statement sounds like weasel words to calm people down about what is plainly an unacceptable situation.

That's all it includes. For your convenience here is a direct link to the agency memo, from the linked article.

http://file.lacounty.gov/SDSInter/dhs/1100458_Directive_6rev...

As for "unacceptable situation", here's a bit more color from actual local EMS: https://old.reddit.com/r/LosAngeles/comments/kqlgqz/ambulanc...

> As a former paramedic now assigned to media relations, the first thing I taught my kids about the news? Never react to the headline. While COVID-19 has shaped many pre-hospital care policies, protocols and procedures across California (and beyond) over the past year - including in Los Angeles County, rest assured that the concept of "No ROSC = No Transport" is not in any way new to our region, or most others.

> Brian Humphrey Firefighter/Specialist Public Service Officer Los Angeles Fire Department

(Above reference would be a separate comment, but this lovely thread sent serial downvoters to my history and I am timed out!)

Re: LA: Ambulance crews to not transport patients with little chance of survival

#22

Post by highmastdon »

remote_phone wrote: post #13

Regardless of politics, I think places like LA need to institute a full lockdown. No one leaves their house except to go to the grocery store and pharmacy. No one leaves more than 2 miles away from their residence. It should be enforced by the military. Essentially martial law. It’s not something I suggest lightly. But 6-8 weeks of complete lockdown and pay people to stay home. It’s the only way that California is go…

There’s enough evidence for medication and preventive supplements (Ivermectin, Vitamin D) that lockdowns aren’t necessary anymore. Other treatments have looked promising when applied early in the disease instead of after hospitalisation. According to combined research (c19study.com) over 800,000 lives could’ve been saved when treated earlier

Re: LA: Ambulance crews to not transport patients with little chance of survival

#23

Post by brodie »

throw473388 wrote: post #19
nnx wrote: post #5

Why are some proven simple yet _useful_ preventative measures not taken? Like, promoting self blood oxygen monitoring with those (cheap!) finger oxymeter devices for all at-risk persons... This would avoid lots of late emergency calls in critical condition due to silent hypoxia that developed in them for days/weeks...

Please, next time you will tell people to exercise and not to be morbidly obese. BTW read the article, it talks about already dead people with no pulse.

On a more serious, thought out note: It is kind of interesting seeing the rise of home pulse oximeter products (due to the pandemic).

Re: LA: Ambulance crews to not transport patients with little chance of survival

#24

Post by tylerhou »

taxicabjesus wrote: post #10
nnx wrote: post #5

Why are some proven simple yet _useful_ preventative measures not taken? Like, promoting self blood oxygen monitoring with those (cheap!) finger oxymeter devices for all at-risk persons... This would avoid lots of late emergency calls in critical condition due to silent hypoxia that developed in them for days/weeks...

The commonly-used treatments for hypoxia are incredibly damaging. In the beginning "ventilation" was the go-to treatment to pump oxygen into patients' lungs. Doctors eventually realized invasive ventilation was a death sentence. Now they're trying to just use lots of oxygen, but that doesn't work either. A lot of people had COVID-19 before tests were available. What happened to make the disease so much more deadly? I…

> Doctors eventually realized invasive ventilation was a death sentence.

Do you have a source that ventilation itself worsens outcomes, and isn't just correlated with already poor-performing patients?

Re: LA: Ambulance crews to not transport patients with little chance of survival

#25

Post by MattGaiser »

jchonphoenix wrote: post #20
danhak wrote: post #12

Earlier quoted context omitted.

There are many factors at play, but in L.A. I don't believe premature reopening is one of them. Bars, indoor dining and gyms have been shut down for pretty much the whole pandemic. Outdoor dining was banned (again) about a month ago. My take is that L.A.'s issues have more to do with housing density, high number of people living with roommates and high number of multigenerational households. Also perhaps some some ch…

I'll point you to Hong Kong, Singapore, Shanghai, and Tokyo as counterexamples. All of those cities are 3-7x denser than LA, more populous, and culturally multigenerational. I think it's quite clear to anyone who's been paying attention at this point that behavior has more to do with containment than anything else. The US and perhaps LA in particular for some reason or another is unwilling or unable to implement the…

Indeed. LA is not that densely populated by any global standard.

Re: LA: Ambulance crews to not transport patients with little chance of survival

#26

Post by andi999 »

harikb wrote: post #14

> Patients who are not to be transported to hospitals include those whose hearts have stopped and, despite efforts at resuscitation, have no signs of breathing, movement, a pulse or blood pressure and would be declared dead at the scene.

Wait, so normally such patients are transported? For what? Billing purposes?

Re: LA: Ambulance crews to not transport patients with little chance of survival

#27

Post by jsnell »

taxicabjesus wrote: post #10
nnx wrote: post #5

Why are some proven simple yet _useful_ preventative measures not taken? Like, promoting self blood oxygen monitoring with those (cheap!) finger oxymeter devices for all at-risk persons... This would avoid lots of late emergency calls in critical condition due to silent hypoxia that developed in them for days/weeks...

The commonly-used treatments for hypoxia are incredibly damaging. In the beginning "ventilation" was the go-to treatment to pump oxygen into patients' lungs. Doctors eventually realized invasive ventilation was a death sentence. Now they're trying to just use lots of oxygen, but that doesn't work either. A lot of people had COVID-19 before tests were available. What happened to make the disease so much more deadly? I…

A lot of people did not have Covid before the tests were available. You know how we can tell? Because we did not have a lot of people hospitalised or even die with an undiagnosed mystery pneumonia. (There are other ways we can then cross validate that.)

You have somehow internalised a gross mistruth as a fact, have realized it is inconsistent with reality, and are now trying to patch up the inconsistencies by positing that the virus became more deadly. That way lie conspiracy theories.

Re: LA: Ambulance crews to not transport patients with little chance of survival

#28

Post by flunhat »

trhway wrote: post #11
crx07 wrote: post #4

Earlier quoted context omitted.

What are they supposed to do? Sometimes dealing with reality involves some pretty uncomfortable choices to make, even when that essentially makes you the bad guy. The real issue here is that the economy was prematurely reopened before it was safe -- we have far more than enough money as a nation to have prevented this scenario from happening and chose a path of destruction out of sheer avarice instead.

>we have far more than enough money as a nation to for example open more beds in preparation for the second wave (which was obvious to come). Instead hospitals were laying off people in the summer.

I suspect the limiting factor is personnel, not beds (i.e. trained staff to manage covid patients), which can't be increased on short notice. But still -- we have incompetent state & federal leadership that basically knew what would happen yet still didn't do enough to prepare.

> Instead hospitals were laying off people in the summer.

Yup. One of the dark ironies of this whole mess has been that hospitals have been letting go of staff because they had to suspend (very profitable) elective surgeries to treat (not so profitable) covid patients. Think hip surgeries being postponed and bleeding hospitals dry as a result.

Re: LA: Ambulance crews to not transport patients with little chance of survival

#29

Post by crx07 »

trhway wrote: post #11
crx07 wrote: post #4

Earlier quoted context omitted.

What are they supposed to do? Sometimes dealing with reality involves some pretty uncomfortable choices to make, even when that essentially makes you the bad guy. The real issue here is that the economy was prematurely reopened before it was safe -- we have far more than enough money as a nation to have prevented this scenario from happening and chose a path of destruction out of sheer avarice instead.

>we have far more than enough money as a nation to for example open more beds in preparation for the second wave (which was obvious to come). Instead hospitals were laying off people in the summer.

There are multiple points of failure. Pretending everything was A-OK is the largest one, failing to identify the virus's presence in the country for months was another, denying and downplaying the usefulness of masks was another, underfunding hospitals was another, failing to secure PPE was another, making it painfully difficult to get tested was another. There's a lot of blame to go around on this one. But reopening the economy was the biggest mistake.

Re: LA: Ambulance crews to not transport patients with little chance of survival

#30

Post by adrianN »

highmastdon wrote: post #22
remote_phone wrote: post #13

Regardless of politics, I think places like LA need to institute a full lockdown. No one leaves their house except to go to the grocery store and pharmacy. No one leaves more than 2 miles away from their residence. It should be enforced by the military. Essentially martial law. It’s not something I suggest lightly. But 6-8 weeks of complete lockdown and pay people to stay home. It’s the only way that California is go…

There’s enough evidence for medication and preventive supplements (Ivermectin, Vitamin D) that lockdowns aren’t necessary anymore. Other treatments have looked promising when applied early in the disease instead of after hospitalisation. According to combined research (c19study.com) over 800,000 lives could’ve been saved when treated earlier

If there were such evidence I doubt that so many countries would fuck over their economy with lockdowns, so I have strong doubts about your claim.
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