The U.S. tried to build a new fleet of ventilators • Hacker News Board

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

#241

Post by mistermann » Mon, Mar 30, 2020, 5:27 AM UTC

greedo wrote: post #182

bamboozled wrote: post #94

Earlier quoted context omitted.

You’re comment reminds me of the reluctant success of sending teenagers on bomber raids in in WWII over Germany. As opposed to relying on only experienced airmen, which there went enough of. Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chanc…

It's not the age of the pilot or doctor, but the experience. In WW2, some pilots were considered combat capable after 150 hours of flight time, basically 6 months. They died. Eventually the flight programs ended up taking 1.5-2 years on average to crank out a new pilot. A pilot that also died quickly. Now in war, you have to throw bodies at a problem, and if the bodies end up 6 ft under, that's war. But generally bad…

Technically, it is the skill level. Indeed there is a very strong causal relationship between skill and experience, but we have no data in the realm being discussed so it may be helpful if we were to explicitly realize we are speculating, as I'd think this may improve the quality of our thinking and decision making.

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

#242

Post by omar_a1 » Mon, Mar 30, 2020, 5:32 AM UTC

marnett wrote: post #236

omar_a1 wrote: post #221

Earlier quoted context omitted.

I fail to see how explaining that, "Yes, you need to know medicine to practice medicine, or people will die" is considered being contrarian. Would you rather just revel in ignorance? So here's my idea: stop treating invasive medical procedures as something that can be trivially learned in a short amount of time. In short, drop the God complex. You're out of your depth here. The need for action doesn't mean acting foo…

> The need for action doesn't mean acting foolish. Irrational behavior in the name of "just doing something" will needlessly deplete more resources. I am genuinely interested in what your suggestion would be though. This is me asking. What would you do to address in the hypothetical I proposed?

For one, if I were hypothetically responsible for addressing this crisis, I would be talking to the nurses and doctors to figure out what level of training is actually necessary to operate these ventilators. I'd also ask what else they actually need: if we get them ventilators but nothing else they're short on, we're still in trouble. In other words, I would recognize that I'm out of my league here and ask the actual professionals on the front lines of this crisis.

As I mentioned above, cross-training medical professionals in adjacent fields sounds more practical. Allowing nurses to do more of what the doctors typically do is another. Even just offloading some of the administrative paperwork for clinicians to admin staff might make a significant dent. Relaxing any bottle-neck non-essential bureaucratic requirements slowing down access to treatment or acquisition of new equipment and supplies.

Having said that, I also recognize that the ideas I just came up with in the last 30 seconds are just that: ideas off the top of my head, coming from someone with no actual experience in healthcare management.

Basically, my first priority would be to make an informed decision, and that starts with figuring out what I don't know, and filling in those gaps. Rather than uncritically insisting, quite emphatically, that medicine can be solved with a 30-day boot camp. Because, hey, if it worked for tech then it must work for medicine!

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

#243

Post by mistermann » Mon, Mar 30, 2020, 5:36 AM UTC

14 wrote: post #107

ALittleLight wrote: post #74

Earlier quoted context omitted.

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - tha…

I have been nursing for years and the battle of skills has never stopped. Only doctors can do A B or C. Then at some point the registered nurses start doing it and then eventually the licensed practical nurses get to do it. The shift in skill set is always happening and often fought from the top ie doctors fighting to keep the skill to theirselves. You are absolutely right there are plenty of people who could efficie…

Thanks for adding your expertise to the discussion.

It's quite interesting to hear the opinion of someone who has both education and hands on experience directly in the field, and then compare that opinion to the opinions of those who have neither.

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

#244

Post by ryanmccullagh » Mon, Mar 30, 2020, 5:36 AM UTC

naringas wrote: post #75

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. and the fact that we think about "ramping up production" of "medical personel" leads the way to terrible industry-like education systems which emphasize cost-efficiency rather than quality education.

Maybe we need a Doctor bootcamp?

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

#245

Post by ido » Mon, Mar 30, 2020, 5:36 AM UTC

thepangolino wrote: post #185

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…

I don’t think there’s going to be a mindset change in the population. The absolute worst estimates are between 0.5 and 1 percent of the population dying.

1% of the world's population is almost 800m people. That's >10x the death-toll of WW2 (which took 6 years to achieve).

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

#246

Post by mistermann » Mon, Mar 30, 2020, 5:39 AM UTC

cycrutchfield wrote: post #108

joe_the_user wrote: post #99

Earlier quoted context omitted.

It seems like you've outlined a situation that could well be true. The US indeed has a training process that only generates useful competence with a full 8-12 year apprenticeship of hazing and theory. Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited. It…

Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.

Imagine thinking that claim was actually contained within that comment.

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

#247

Post by mistermann » Mon, Mar 30, 2020, 5:45 AM UTC

cycrutchfield wrote: post #115

roenxi wrote: post #100

Earlier quoted context omitted.

Doctors and nurses probably aren't trained how to run an ICU, they spend more than a decade learning about human bodies and they only have so much time. If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Medicine has traditionally had a problem with a large number of very clever people who are…

> If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.

A scarily high percentage of comments in this thread are people making presumptions, and asserting them as if they are fact. Some of those comments were written by you.

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

#248

Post by mistermann » Mon, Mar 30, 2020, 5:50 AM UTC

omar_a1 wrote: post #146

cycrutchfield wrote: post #115

Earlier quoted context omitted.

> If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.

Obviously because being an ICU doctor isn't something hard like writing code. Fewer buttons on a ventilator! /s But seriously, the amount of people on here trivializing modern medicine isn't helping matters. Granted, neither is business-as-usual, but a 30-day "ventilator boot camp" for untrained professionals is going to kill far more people than it helps. And a poor allocation of resources during a time of scarcity.

The number of people on here perceiving or claiming that people are trivializing modern medicine, when their actual words say nothing of the kind, may also be unhelpful.

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

#249

Post by mistermann » Mon, Mar 30, 2020, 5:53 AM UTC

omar_a1 wrote: post #198

ALittleLight wrote: post #195

Earlier quoted context omitted.

Again, nobody is saying that ventilator boot camp graduates should replace doctors. If there is a concern that there will be more people who need ventilators than we have medical professionals to operate ventilators - then the answer is that we need to quickly increase numbers of ventilator-operators - even if they are substandard. Perhaps you think our capacity won't be overwhelmed. Then it would make perfect sense…

No, it's that I'm aware that "ventilator bootcamps" would be a resounding failure that would kill more people than it saves. Going from zero to medical professional - not a doctor, just someone who can perform invasive medical procedures without killing a large number of people - isn't 30 days of work. Ignoring that reality will recklessly endanger people's lives. If we're talking veterinarians, dentists, nurses, res…

Are you aware of the degree to which your interpretation of his words is inconsistent with his actual words?

It is significant.

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

#250

Post by joe_the_user » Mon, Mar 30, 2020, 5:55 AM UTC

jacquesm wrote: post #233

joe_the_user wrote: post #225

Earlier quoted context omitted.

Life is not a movie, some stuff is just hard ... I think this sort of language is why a lot of non-professionals are sort-of balking. Life currently is like a movie. A zombie or some similar disaster movie, a situation where things are changing fast, where the normal plans are expected to fail. ...and requires a long time of training before we'll let you go 'solo'. One mistake and someone ends up dead, there are no d…

> Life currently is like a movie. A zombie or some similar disaster movie, a situation where things are changing fast, where the normal plans are expected to fail. No, because after a movie you get to go home, no matter how terrible it was. And in real life you don't get to go home. So you will have to trust in the people that have spent their lives preparing for stuff like this while we, the software smartasses were…

The ICU staff is working double shifts and around the clock in plenty of places. They too get ill, plenty of them have already died. It's a bit late to stick your oar in now and make it your mission, I totally sympathize with the intentions but this isn't your fight other than to stay put, tell other people to stay put and accept that this story will not have a Hollywood ending for many people.

This language of addressing each posters as if they personally had this intention is pretty bizarre. It's very much the language of "proper authorities are taking care of that." I don't personally have any intention of jumping but I'm part of a community and part of a situation where the proper authorities aren't taking care things.