LA: Ambulance crews to not transport patients with little chance of survival • Hacker News Board

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

#31

Post by geewee » Tue, Jan 05, 2021, 7:23 AM UTC

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

You realize this is crazy-talk right? No country has avoided a pretty wild amount of casualties without locking down. If the evidence was so strong, you'd think at least one of them would have succeeded with this strategy.

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

#32

Post by CyanLite4 » Tue, Jan 05, 2021, 7:23 AM UTC

burnthrow wrote: post #9

While the headline makes it sound like Grandma isn't getting a ride because she's frail, "little chance of survival" is more specific: > 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.

It’s protocol to NOT allow EMTs to declare someone dead. An EMT (with a few hours of community college training, mind you) are not trained for advanced resuscitation that only doctors can perform. This absolutely will lead to excess mortality.

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

#33

Post by bozhark » Tue, Jan 05, 2021, 7:25 AM UTC

andi999 wrote: post #26

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?

Because people can be revived

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

#34

Post by danielovichdk » Tue, Jan 05, 2021, 7:25 AM UTC

Firstly the country has not really been serious about the pandemic it seems. On a political scale that is. And since each state can take their own actions it's really difficult to understand why this has not been done before.

On the other hand, the weak are the ones that die first. It's the law of nature.

So when doctors look at a patient it's of course their job to validate whether or not it's time and money well spent to save a life. How did you think it worked, honestly?

Many years ago a story of similar character ran across Denmark, where doctors were being exposed due to the fact that they had to make a life (but how much longer!) or death decision for a variety of patients. And of course they have to imo.

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

#35

Post by trhway » Tue, Jan 05, 2021, 7:25 AM UTC

flunhat wrote: post #28

trhway wrote: post #11

Earlier quoted context omitted.

>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 l…

>can't be increased on short notice.

i think the 3-6 months that we had would have been enough to train any MD to care for a covid patient, at least for majority of cases and under supervision of existing high specialist. My understanding is that non-covid personnel had their workload significantly decreased, so they could have been trained for covid for the second wave.

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

#36

Post by kenhwang » Tue, Jan 05, 2021, 7:26 AM UTC

andi999 wrote: post #26

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?

Normally such patients aren't either. This is media sensationalism. Someone got alarmed by the wording of the reminder/clarification of the policy as-it-was. Pronounced dead at the scene and should not be transported for failure to achieve ROSC has been LA policy since the 1980s[1]. Just about everything about the memo is the same policy as before, just in less confusing wording.

[1] https://file.lacounty.gov/SDSInter/dhs/206332_Ref.No.814,Det...

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

#37

Post by nharada » Tue, Jan 05, 2021, 7:26 AM UTC

baggy_trough wrote: post #6

https://www.quora.com/What-is-the-current-treatment-for-Covi...

I'm a little skeptical of the claims made in that post

> If everyone in the world just did one thing differently, talking to their doctor about whether they should start fluvoxamine or ivermectin after they learned they were COVID positive, our hospitals and ICUs would be nearly empty today and there would be very few “long haulers.”

Yes, there was a preliminary communication released recently in JAMA showing some evidence that Fluvoxamine treatment has clinical promise. You can read it here: https://jamanetwork.com/journals/jama/article-abstract/27731...

The results: "In this randomized trial that included 152 adult outpatients with confirmed COVID-19 and symptom onset within 7 days, clinical deterioration occurred in 0 patients treated with fluvoxamine vs 6 (8.3%) patients treated with placebo over 15 days, a difference that was statistically significant."

Not bad results, but seems like a big jump to suggest that all doctors change their treatment procedures based on this study. I'm interested to see larger studies, especially with longer follow-up durations.

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

#38

Post by tdeck » Tue, Jan 05, 2021, 7:26 AM UTC

andi999 wrote: post #26

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?

A former EMT I know told me their policy was always to transport DOA patients and to tell the caller that the person died on the way to the hospital, even if they were already dead. I'm not sure if it's the same everywhere but the idea was that it's kinder to whoever found the person.

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

#39

Post by remote_phone » Tue, Jan 05, 2021, 7:26 AM UTC

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

There’s nothing except lockdowns that will stop what is happening in LA right now. It will be quick and effective and we really don’t have any other tool. We still don’t have a prophylaxis or treatment. People are going to die that shouldn’t be dying and I’m not just talking about COVID patients. When hospitals are full, people die.

Ivermectin is not a supplement. It’s an expensive anti-scabies drug. I’ve read it’s supposedly somewhat effective but I haven’t seen anyone implement it in treatment yet at least in the US. I’m familiar with the IMASK+ protocol. I believe they are using that in Peru but it doesn’t appear to have been making any changes in the death rate.

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

#40

Post by flunhat » Tue, Jan 05, 2021, 7:27 AM UTC

andi999 wrote: post #26

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?

Someone else commented this on the thread, but my understanding is that some non-zero percentage (maybe even non-trivial percentage) of people without, say, a pulse can be revived only at a hospital but not by an EMT (because of equipment or skills, I guess?). This decision forecloses that possibility completely.