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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

#81

Post by bilbo0s »

cycrutchfield wrote: post #65
ALittleLight wrote: post #62

Earlier quoted context omitted.

Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and com…

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first.

But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definitely includes sequestering final year med students and all residents at their respective homes. Apparently the idea is that as hospital staff go down, this pool of residents and med students can be drawn on.

I know she stays up nights worried sick that residents might go to a party, or invite their boyfriend over, or engage in some other risky behavior instead of stay home alone and safeguard their health. So I get the idea that they really don't have a backup to that plan. I suspect med students and residents are a pretty critical part of the plan for surge operations across the nation.

Just pointing that out because I think hospital administrators and medical directors are starting to plan on doing things they wouldn't normally do. Like pressing 4th year med students into service, or taking 68 year old women off of ventilators if a 33 year old woman presents with a need for it. It's not so much a question of what doctors want to do, as it is a question of doing what has to be done to get through this with the maximum number of recoveries.

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

#82

Post by verytrivial »

onetimemanytime wrote: post #55
cycrutchfield wrote: post #48

Earlier quoted context omitted.

About 4 years of medical school, and around 4 more years of residency training.

Most Covid patients die on respirators anyway, can a nurse do 90% of the job ("good enough") and ask a doc if the rest is needed? The other option is worse and I doubt USA can afford to have docs sitting for decades waiting for another Covid like scenario. Remember these ventilators will be produced and go in storage to wait...

The numbers from Wuhan were something like 30% fatalities for those moved to ventilation. That doesn't detract from your point but does support why the path "make a ton of ventilators" is being persued.

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

#83

Post by droithomme »

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…

Right, so it's a mistake to make ventilators, masks, PPE, all pointless in your opinion. Give up now we should.

The actual very interesting issue right now with ventilators is that there's companies in the US that make them and they say no one is ordering them. They cost around $25,000 each. Hospitals and states are sitting around waiting for the federal government to buy them and gift them to them, and whining that everything is the government's fault when that doesn't happen.

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

#85

Post by cycrutchfield »

corebit wrote: post #77
cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.

Ah yes, you surely know better than the trained professionals about how to best run an ICU.

Just because you can call yourself a software engineer with little more than a high school diploma doesn’t mean that the same rules apply for doctors.

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

#86

Post by ck2 »

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…

Another shortage is lack of ambulances to take you to the ventilators as demonstrated in NYC already as more and more drivers and personnel are already sick and not allowed to work

Once you are on a ventilator for covid19 you tend to monopolize it for 2+ weeks, hence the endless need for more machines

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

#87

Post by ohbleek »

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…

This conversation begins when the number of residencies increases. And that will not change until congress approves more funding for residencies. Until then, there will be no change.

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

#88

Post by lern_too_spel »

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…

Is there any evidence that access to medical professionals is a bottleneck? Even after all elective surgeries and routine doctor visits have been postponed? All the stories I've been seeing from other Western countries that have already reached peak capacity say that ventilators, not medical professionals are the real bottleneck.

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

#89

Post by epmaybe »

ohbleek wrote: post #87
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…

This conversation begins when the number of residencies increases. And that will not change until congress approves more funding for residencies. Until then, there will be no change.

That's a weak argument, in my opinion. I've commented on this in the past, but there's nothing physically stopping hospitals and other institutions with their own funding from opening of more spots. You can definitely get ACGME accreditation without CMS funding for your program, institutions just need to be willing to find other funding.

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

#90

Post by epmaybe »

ALittleLight wrote: post #74
cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

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…

Respiratory therapists exist
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