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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

#131

Post by tylerhou »

tehjoker wrote: post #60
tylerhou wrote: post #24

Earlier quoted context omitted.

> 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.

Ventilators are highly complicated pieces of medical grade machinery that cost upwards of $50,000. They are not just regular old pumps with tubes attached. "Forced ventilation" does not properly describe the delicate nature of their operation.

If used properly by trained medical professionals, they are better than the alternative — no ventilation at all.

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

#132

Post by tylerhou »

baskire wrote: post #54
tylerhou wrote: post #24

Earlier quoted context omitted.

> 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, regar…

1. This is from April.

2. The cited study only measures outcomes and does not claim that ventilators worsen patient outcomes. Covid patients who are hospitalized have a higher rate of death [citation needed]. Does that mean hospitals kill Covid patients?

[1] https://jamanetwork.com/journals/jama/fullarticle/2765184

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

#133

Post by ixacto »

kepler1 wrote: post #74

The medical system is stretched to breaking. Vaccine distribution is completely disorganized, despite months of possible preparation time. A ridiculous patchwork of federal, state, county authorities can't get it together to enforce rules and can only ask for voluntary cooperation in a true crisis. I think we will look back on this as one of the great weaknesses of decentralized, democratic, random-walk governance, f…

More people will die from covid. But the principals of free speech and assembly should not be sacrificed for something that will be and mostly gone in 6-9months. Yes people have died and that is horrible, but a dictatorship like china is not the answer. Tbh I'm more afraid of the governments authoritarianism than covid.

*Disclaimer: yes I wear a mask indoors in public places and outdoors when not able to be 6 feet from everyone. No I don't wear a mask when walking alone outside, that is stupid and just shows how much our messaging on covid sucked even with the middle and upper classes.

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

#134

Post by tylerhou »

taxicabjesus wrote: post #65
tylerhou wrote: post #24

Earlier quoted context omitted.

> 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 realiz…

From your article:

> The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs.

> This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say.

A summary: we shouldn't ventilate everyone because ventilation has risks (like all medical treatments). Nowhere does the article claim that ventilation is a "death sentence" as you originally claimed.

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

#135

Post by VBprogrammer »

adrianN wrote: post #126
VBprogrammer wrote: post #120

Earlier quoted context omitted.

I know your comment is coming from the right place here but it reads to me like "how strong is the evidence that straight conversion doesn't work for homosexually?". I think these is some merit to the arguement that we should treat obese people (in the interest of full disclosure I'm usually in the overweight category by BMI) in the same way we treat smokers. Reduce temptation, avoid glamourising unhealthy foods, rem…

I'm also in favor of being excellent to each other. I think discussing this topic is quite difficult because there is no agreed upon definition of "fat shaming". I'm pretty sure that there are people who would count any measures to reduce obesity as fat shaming (i.e. "cancelling fat culture" or something ridiculous like that), and the discussion tends to get emotional very quickly. I think we have fairly strong evide…

I think we're largely in agreement. I think the definition of fat shaming I was working from was more on the "Omg, look at [insert c list female celebrity], she's (gained|lost) 10lbs!" end of the scale.

There is also a problem on the low side of body weight. A lot of the models we see are unhealthily thin and/or are photoshopped to look that way. While a lot of attention has been given to how this affects body image for people who end up with eating disorders like anorexia, I wouldn't be at all surprised to find that the same images contribute to people feeling like they will never look like that and going the opposite direction.

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

#136

Post by EliRivers »

Cthulhu_ wrote: post #92
labster wrote: post #59

Earlier quoted context omitted.

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.

You'd think they would test systems like that at maximum consumption. Mind you, electricity and water systems are also not designed for every outlet to be maxed out. Whomst among us hasn't caused a breaker to trip from having too much stuff on at the same time.

Without knowing at all what I'm talking about, wouldn't be surprised if they are beyond maximum rated consumption.

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

#137

Post by ibejoeb »

bradhe wrote: post #57
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.

For example, here are some excerpts from just one other LA Times article:

> Many hospitals also say they’re too full to accept any more patients or ambulances

> when paramedics are allowed to drop off patients at a hospital, the emergency room is often so crowded that there aren’t available staff members

> Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones

> canceling surgeries and erecting tents in their parking lots so they can triage the hordes

https://archive.is/VxZL9

If context matters, I'd expect an organization like the LA Times to be capable of addressing it. It's so frustrating to have to work backward just to find out if anything is remarkable. At this point, this kind of thing is seriously affecting the well-being of the audience.

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

#138

Post by EliRivers »

ixacto wrote: post #133
kepler1 wrote: post #74

The medical system is stretched to breaking. Vaccine distribution is completely disorganized, despite months of possible preparation time. A ridiculous patchwork of federal, state, county authorities can't get it together to enforce rules and can only ask for voluntary cooperation in a true crisis. I think we will look back on this as one of the great weaknesses of decentralized, democratic, random-walk governance, f…

More people will die from covid. But the principals of free speech and assembly should not be sacrificed for something that will be and mostly gone in 6-9months. Yes people have died and that is horrible, but a dictatorship like china is not the answer. Tbh I'm more afraid of the governments authoritarianism than covid. *Disclaimer: yes I wear a mask indoors in public places and outdoors when not able to be 6 feet fr…

But the principals of free speech and assembly should not be sacrificed for something that will be and mostly gone in 6-9months.

Why not? Ultimately, people are what matters. You know who can't exercise free speech and assembly? Dead people. Why is a 6 month hard lockdown worse than letting people keep walking around for 6 months? This sounds like a moral, absolutist statement you're making; like life is an art project, and the aim is to exercise some particular set of principles.

(Free speech? What's the threat to free speech here? Is it the people spreading bullshit and conspiracy about Covid that's getting people killed?)

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

#139

Post by schwartzworld »

jessriedel wrote: post #109

I'm disappointed that all the discussion seems to be operating at a non-quantitative level. ("If there's any chance, we have to try" against "If circulation can't be reestablished on scene, there's essentially no hope".) Presumably there are academic article that make an attempt at this.

People overestimate the efficacy of CPR because they see people in the movies come back to life after 4 chest compressions and a second of mouth-to-mouth. I wonder if that is the sort of thing driving the discussion

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

#140

Post by ReaganFJones »

VBprogrammer wrote: post #120
adrianN wrote: post #93

Earlier quoted context omitted.

How strong is the data that body shaming doesn't help people get in shape?

I know your comment is coming from the right place here but it reads to me like "how strong is the evidence that straight conversion doesn't work for homosexually?". I think these is some merit to the arguement that we should treat obese people (in the interest of full disclosure I'm usually in the overweight category by BMI) in the same way we treat smokers. Reduce temptation, avoid glamourising unhealthy foods, rem…

To a certain extent, there is substantial amount of "smoke shaming." A lot of the smoking mass media ads involved second hand smoke which was largely a shame campaign. By demonstrating the damage you cause others, you invoke shame in the action of smoking.
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