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The U.S. tried to build a new fleet of ventilators

nytimes.com

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Re: The U.S. tried to build a new fleet of ventilators

#161

Post by canada_dry »

DanBC wrote: post #57
lukevp wrote: post #7

what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft e…

Partly this is a problem with jargon. When healthcare professionals talk about "beds" or "ventilators" they mean "the bed and all the staff needed for the patient in that bed", or "the ventilator and all the staff needed to put a patient on, and take a patient off, the ventilator". Ventilators turn out the be pretty complicated. Here's a useful thread: https://twitter.com/aroradrn/status/1243091107149418496 And anoth…

> caused by machines having different layouts

This is going to be a huge issue with the onslaught of different manufacturers.

I liken it somewhat similar to helping troubleshoot router/switch issues... yes at a high level they're all the same but, at the same time, each one has it quirks and peculiarities and even use slightly different nomenclature that make it a non-trivial exercise.

Re: The U.S. tried to build a new fleet of ventilators

#162

Post by cadlin »

SkyPuncher wrote: post #97
oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. Ho…

Doctors that don't know how to properly operate a vent are currently a problem in the US. Not blaming them, as there doesn't seem to be any real alternative.

Here's an /r/medicine discussion of it.

https://www.reddit.com/r/medicine/comments/fr0x3m/how_do_you...

Re: The U.S. tried to build a new fleet of ventilators

#163

Post by [deleted] »

Mediterraneo10 wrote: post #142
joe_the_user wrote: post #111

Earlier quoted context omitted.

The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war. Right now, the death rate still isn't higher than a flu epidemic but just the number of known infections promises a lot worse and the potential doublings after that are terrifying. It seems like there's an endless dialogue of: A: H…

"The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war." The millions of people who would die in a worst-case scenario are mainly demographics that society is already used to neglecting: the elderly, the terminally ill, those with lifelong chronic illnesses where any infection could be…

[deleted]

Re: The U.S. tried to build a new fleet of ventilators

#164

Post by jacquesm »

strken wrote: post #156
jacquesm wrote: post #144

Earlier quoted context omitted.

Typical for tech oriented people to look at it this way. Patients with the same condition are still meatware and each has the capacity to develop their own variation on a large number of themes all of which require adaptations in treatment regime and sometimes very rapid intervention lest you lose a patient. Your assumption doesn't hold.

It's not a choice between a doctor and a layman, though. It's a choice between a volunteer who's only trained in the very basics and watched a couple of intubations, and nobody at all. How much training does someone need before they become a clear net positive for the patient?

A couple of years should do it. A volunteer would not just be a 'net negative' but would leave a lot of dead people. Why is it so hard to see that the people that operate this stuff are not just button pushers but specialists that have been schooled over years to take care of people?

The ICU staff would not even allow the doctors to mess with their setup because it is critical and it is their responsibility until some either dies or is discharged from the ICU and allowed to move back to a normal ward.

Think 'airline pilot' not 'assembly line worker'.

Re: The U.S. tried to build a new fleet of ventilators

#165

Post by jacquesm »

Mediterraneo10 wrote: post #142
joe_the_user wrote: post #111

Earlier quoted context omitted.

The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war. Right now, the death rate still isn't higher than a flu epidemic but just the number of known infections promises a lot worse and the potential doublings after that are terrifying. It seems like there's an endless dialogue of: A: H…

"The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war." The millions of people who would die in a worst-case scenario are mainly demographics that society is already used to neglecting: the elderly, the terminally ill, those with lifelong chronic illnesses where any infection could be…

The switch to war footing is already happening in the places hardest hit, for others it may be days or weeks away.

Re: The U.S. tried to build a new fleet of ventilators

#166

Post by wiseleo »

dang wrote: post #13

We changed the URL from https://dnyuz.com/2020/03/29/the-u-s-tried-to-build-a-new-fl... to that of the article that it fully ripped off (and banned that site).

Consider this https://www.msn.com/en-us/news/us/the-us-tried-to-build-a-ne... (this actually is licensed :))

Re: The U.S. tried to build a new fleet of ventilators

#167

Post by jacquesm »

yibg wrote: post #127
oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

I’m not a medical professional so hopefully someone more knowledgeable and confirm or counter. From what I’m reading the treatment of COVID19 seems to require a pretty narrow set of practices. Mostly around monitoring, administering of medication, ventilation / oxygen and general bedside care. If this is true can we not cross train adjacent areas like EMT, army medics etc fairly quickly to provide care? They don’t ev…

So, just to reset your mental image of what a typical ventilator ICU setup looks like (don't click if you're squeamish):

https://pbs.twimg.com/media/EUNYuOuU4AApgBX?format=jpg&name=...

Still want to gamble on that 'narrow set of practices'?

Re: The U.S. tried to build a new fleet of ventilators

#168

Post by DanBC »

tmpz22 wrote: post #63
noelsusman wrote: post #60

Earlier quoted context omitted.

You answered your own question in the last sentence.

Is it though? Can't you train people on the basics of a single device as a sort of Tier-1 support with the ability to escalate to Tier-2 immediately? Governor Cuomo said in at least one briefing that they were considering training national guard troops to do exactly that.

People who are experts in using one class of ventilators (ICU) are already being trained in using a different class of ventilator (anaesthetics), and they're somewhat concerned about this because of the differences in the machines. https://twitter.com/aroradrn/status/1244134454001635329?s=20

Your idea is to take a bunch of people who are not experts in ventilating, who have minimal experience with ICU vents, and give them a training course on ICU and anaesthetic vents and hope that they remember the difference and can work out the different panels, while exhausted, while in full PPE.

This is happening, but it's scary.

Your wider point - can we reskill a huge amount of the existing workforce to do a different job - is a good point, but that's already happening. Lots of people are doing jobs that they were not trained to do and they're doing those jobs with minimal re-training. This may help some patients, and it may cause harm to others.

Re: The U.S. tried to build a new fleet of ventilators

#169

Post by pdonis »

zozbot234 wrote: post #64
worik wrote: post #26

Earlier quoted context omitted.

I completely disagree. If the government had done it in house they could have succeeded. The problem here was the profit motive. Cheep ventilators endanger profits. It is a side effect of free markets (I like free markets) that big firms get bigger, get more market power, kill off competition then price gouge. Health is a bad bad place to have free markets as the incentives are almost all wrong (exceptions: E.g. runn…

There's no "free market" in healthcare; it's one of the most heavily regulated sectors in the economy. It's a known side-effect of regulation that big and politically-connected firms are advantaged over smaller and leaner ones, market power tends to increase in lockstep with the regulatory burden, and a lot of price gouging becomes feasible that wouldn't occur in a more contestable environment.

Not only is health care regulated, it isn't even a market in the correct sense, because the people actually getting the health care services--patients--don't even know how much the services themselves cost. Which means that nobody is in a position to judge whether the services are worth what they cost. This isn't a market at all, it's a recipe for disaster. Which of course is exactly what we have.

Re: The U.S. tried to build a new fleet of ventilators

#170

Post by pdonis »

m0xte wrote: post #56
pdonis wrote: post #39

Earlier quoted context omitted.

> The issue in some sense isn't government, it's the corruption of government Ok, so how do we keep the government from being corrupted? Nobody has yet solved that problem, and people have been trying for centuries. > Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking. The money supply is not the same as the economy. Government spending as a percentage of GDP, w…

Well the first thing you do is ban professional politicians and lobbying.

As I commented upthread, your solution is to just change the entire system of government. Sure, that should be simple. Not.
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