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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

#51

Post by GavinMcG »

warent wrote: post #42
andi999 wrote: post #26

Earlier quoted context omitted.

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

I've been thru EMT training. It boils down to EMTs not having formal medical education necessary to make a call as significant as pronouncing someone deceased. It's a blanket rule, so even in extreme circumstances like if you find someone beheaded, you just log it as a severe injury and transport the body to the hospital where a doctor pronounces them dead.

That's not broadly true. Anyone has sufficient medical training to declare a beheaded person deceased.

States have more and less sane approaches to this. Obviously, many things are not as clear-cut as beheading. But there are states that allow EMTs to make a field declaration, depending on specific guidelines, and possibly with the requirement of contacting a doctor to describe the situation and get their permission to terminate resuscitation efforts.

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

#52

Post by detaro »

gizmo686 wrote: post #43
andi999 wrote: post #26

Earlier quoted context omitted.

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

Way outside my expertise, but you still need to remove the corpse, and the ambulance is already there. Plus, it is not really a good look for paramedics to be leaving a dead person.

EMTs are specifically supposed to not move bodies unless there is an urgent reason to do so, but leave them on the scene for coroner etc to handle.

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

#54

Post by baskire »

tylerhou wrote: post #24
taxicabjesus wrote: post #10

Earlier quoted context omitted.

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?

Here’s a good summary of some findings.

“ Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation, the Northwell Health COVID-19 Research Consortium reported.”

“ Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.”

https://www.webmd.com/lung/news/20200422/most-covid-19-patie...

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

#55

Post by wukerplank »

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?

So, leave the body by the curb?

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

#56

Post by danaliv »

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…

At some point, “this is a free country” became “I don’t have to apply impulse control under any circumstances.”

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

#57

Post by bradhe »

songgao wrote: post #41

This might be an unpopular opinion but this is a pretty awful headline and it makes it look way worse than what the EMS documents actually say. There’s a bold text [1] “shall not be transported if return of spontaneous circulation is not achieved in the field”. There’s a pretty big difference between abandoning patients with little chance of survival in general, and giving up after failure to achieve ROSC. Perhaps at…

> But a headline designed to make incorrect impression just doesn’t help.

Yet this is basically all we get. Because it makes people click. It’s so hard to tell what’s real and what’s exaggerated these days. And if you try to make the case that something is exaggerated, you come off as a right wing nut job.

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

#58

Post by stordoff »

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...

FWIW, silent hypoxia can onset quite quickly. I was monitoring my oxygen levels following a positive test, and my O2 sats dropped from 95+ to 78 in about 12 hours (I'd more or less stopped monitoring it as I generally seemed to be recovering, hence the long gap between values).

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

#59

Post by labster »

wbl wrote: post #47
songgao wrote: post #41

This might be an unpopular opinion but this is a pretty awful headline and it makes it look way worse than what the EMS documents actually say. There’s a bold text [1] “shall not be transported if return of spontaneous circulation is not achieved in the field”. There’s a pretty big difference between abandoning patients with little chance of survival in general, and giving up after failure to achieve ROSC. Perhaps at…

When have they ever run out of oxygen before?

Hospitals are running out of oxygen in a way: so much is going through the pipes that the upper floors have low pressure, and the oxygen pipes occasionally freeze from adiabatic expansion. In LA.

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

#60

Post by tehjoker »

tylerhou wrote: post #24
taxicabjesus wrote: post #10

Earlier quoted context omitted.

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?

The problem was that for a healthy person, ventilation just moves your lung physiologically, but for very sick patients parts of their lungs are like inflamed tissue paper so the forced inflation could cause problems.
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