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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

#61

Post by GavinMcG »

CyanLite4 wrote: post #32
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.

Can you describe how? Advanced Cardiac Life Support protocols (ACLS) are fairly standard in both pre-hospital and hospital settings. Specifically because it's critical, paramedics are trained in ACLS.

EMT-Bs aren't, but the BLS ambulances they staff shouldn't generally be assigned as the only responding unit for cardiac arrests, anyway. And given that, it's not clear why you think there will "absolutely" be excess mortality.

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

#62

Post by ImaCake »

nharada wrote: post #37
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 ev…

You are right to be skeptical but it looks damn good. There is a clinical trial under way now with n=800.

https://clinicaltrials.gov/ct2/show/NCT04668950

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

#63

Post by MattGaiser »

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?

My understanding is that some hospitals have a central oxygen system, no different from how we are all connected to the water system and water comes out of the tap.

If too many taps were open, nobody would get enough water. Well, too many oxygen taps are open.

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

#64

Post by stordoff »

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…

> Now they're trying to just use lots of oxygen, but that doesn't work either.

Do you have a citation? I was hospitalised with Covid-19, and that was my primary treatment (100% oxygen CPAP was required to keep my O2 sats above 90% - high flow nasal oxygen would cause it to dip below 90).

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

#65

Post by taxicabjesus »

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?

Lots of sources. This one is from April 23, 2020:

Special Report: As virus advances, doctors rethink rush to ventilate - https://www.reuters.com/article/us-health-coronavirus-ventil...

This is not even a good source, just something that I linked to in a previous comment here.

Remember how the governments were rushing Ventilator production, then those efforts got memory-holed? This was because the professionals realized they shouldn't try to ventilate every COVID-19 patient in their hospital.

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

#66

Post by GavinMcG »

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…

In emergency medicine, you've got patients who are dead, and patients who are dead dead.

Patients who are just dead might still be brought back. This isn't about them. Patients who are dead dead because they haven't responded to resuscitation efforts aren't going to be taken to the hospital, is all. And in a lot of places that's already the norm.

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

#67

Post by stevegalla »

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…

I suspect those 4 cities are doing more than just wearing masks. I’m having a hard time tracking down the interviews (I think it was Dr. Jim Yong Kim who said this), but there are two types of transmission between households and within households. Mask wearing, social distancing, quarantining, contact tracing, and some other measures can help to reduce between house transmission. However, you need to stop the within house transmission, too. To stop within house transmission, people are removed from their home and isolated in medical facilities in some parts of Asia.

Stopping between house and within house transmission is what I suspect those 4 cities you mentioned are doing. North America is more focused on stopping between house transmission.

Anecdotally, I know some cities in South Korea have quarantined people by placing them in an isolation room (4 people per room spread 6 feet out each wearing a mask 24/7) until they test as being COVID free. This was around 20-30 days from what I understand.

In Canada, if you quarantine, it’s 14 days in your own home. Mostly this is on the honor system. If you live in a condo / townhouse / strata or your neighbors know you’re quarantining, they can report you for violations. When quarantining, you’re restricted to a single room if you live with others, but there is still risk of passing it on to others. Anecdotally, I know of a case in Canada where an individual quarantining in their room has managed to pass COVID to 3 others who live in the house. These people were wearing masks around the house when not in their own room. If this original person was isolated in a hospital, the spread would stop at one. Since they weren’t, it ended up infecting the entire house.

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

#68

Post by [deleted] »

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…

[deleted]

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

#69

Post by gizmo686 »

baskire wrote: post #48
throw473388 wrote: post #19

Earlier quoted context omitted.

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.

I’m curious if covid will finally change the liberal belief that being morbidly obese is ok and shouldn’t be viewed similar to smoking. Our food policies have failed us. Like honestly allowing a single serving of food/drink to have multiple “servings” on their labels is crazy. A single hot-bun is 1 serving not 2.5

It is not the mainstream liberal position that obesity is not a health issue.

Michele Obama is still one of the most popular figures in American politics; and her signature issue was fighting childhood obesity.

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

#70

Post by andi999 »

tdeck wrote: post #38
andi999 wrote: post #26

Earlier quoted context omitted.

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.

Maybe insurance covers the call then. Here if it is DOA medical insurance won't pay.
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