> 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?
LA: Ambulance crews to not transport patients with little chance of survival
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Re: LA: Ambulance crews to not transport patients with little chance of survival
#82Euthanasia ?
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.
The three places that I know of that have gotten cases to zero are China, New Zealand, and Australia, and they all used lockdowns that were far stricter than in the U.S.
The problem is that a soft lockdown doesn't bring R low enough to eradicate the virus quickly, and people won't stomach it dragging on for months. I also don't believe that it can be done on the honor system. There must be police writing tickets or worse for violations, or there is a segment of the population that will ignore whatever measures that are enacted. Unfortunately sometimes these are even identifiable groups of people that all socialize together in violation of health orders, so the virus will spread within these communities regardless of whatever the governor puts on a piece of paper and makes a speech about.
Re: LA: Ambulance crews to not transport patients with little chance of survival
#83The link below is an example of EMS protocols that would cover this. Here's a snippet.
"Discontinuation of Prehospital Resuscitation"
1. Discontinuation of CPR and ALS intervention may be implemented prior to contact with Medical Control if ALL of the following criteria have been met: Patient must be 18 years of age or older, or family of a minor is agreeable after consultation with the APP or District Chief. Adequate CPR has been administered. Airway has been successfully managed with verification of device placement. Acceptable management techniques include orotracheal intubation, nasotracheal intubation, Blind Insertion Airway Device (BIAD) placement, or cricothyrotomy. IV or IO access has been achieved. Rhythm appropriate medications and defibrillation have been administered according to protocol. Persistent asystole or agonal rhythm is present and no reversible causes are identified after a minimum of 25 minutes of resuscitation. Failure to establish sustained palpable pulses or to establish persistent/recurring ventricular fibrillation/tachycardia or lack of any continued neurological activity such as eye opening or motor responses All EMS paramedic personnel involved in the patient’s care agree that discontinuation of the resuscitation is appropriate 2. If all of the above criteria are not met and discontinuation of pre-hospital resuscitation is possibly indicated or desired, contact Medical Control. 3. The Deceased Subjects Policy should be followed.
http://www.wakegov.com/ems/medical/Documents/WCEMSS%20Standa...
Re: LA: Ambulance crews to not transport patients with little chance of survival
#84Earlier 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 just moved to LA from New York State in December, and it seems to me that the number one problem here is noncompliance. So many people are just out and about like nothing unusual is going on. People aren’t wearing masks, or they are but not covering their nose. The number of house parties I’ve seen in the past month is shocking—and no one at these events has worn a mask. Outdoor places like beaches and trails are p…
Agreed. I see far too many people out without masks. It's scary.
Re: LA: Ambulance crews to not transport patients with little chance of survival
#85Earlier quoted context omitted.
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.
Don't they need to be brought to the hospital for organ donation though ?
I don't think most countries have laws like that though.
Re: LA: Ambulance crews to not transport patients with little chance of survival
#86While 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
#87Earlier quoted context omitted.
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…
With the number of now empty hotel rooms we have, this could easily have been provided on a voluntary/strongly encouraged basis. Instead what we got in SF for example was hotel rooms for the homeless (that hypothetically could have COVID) and no hotel rooms for people that actually tested positive for COVID.
Re: LA: Ambulance crews to not transport patients with little chance of survival
#88Earlier quoted context omitted.
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.
Turkey has been treating people with HCQ from May onwards, despite outcomes of the now-retracted(!) study once published in The Lancet, and they have a very low death rate. 256/1M Population. (See: https://www.middleeasteye.net/news/hydroxychloroquine-corona... ) Their death rate has been on a steady 1% throughout the pandemic where for example Germany is on about 3%. Of course this needs to be corrected for age etc…
Re: LA: Ambulance crews to not transport patients with little chance of survival
#89Regardless 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…
Do you think it is all politics? Because we like communism? Or rather it is because we don't have a choice.
Re: LA: Ambulance crews to not transport patients with little chance of survival
#90Earlier 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…
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 positin…
They would have diagnozed pneumonia. Like, pneumonia is not mystery whether you know it is caused by covid or not. And it is diagnkzable.