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LA Paramedics Told Not To Transport Some Patients With Low Chance Of Survival:
The Los Angeles County Emergency Medical Services Agency issued a directive Monday that ambulance crews should only administer bottled oxygen to patients whose oxygen saturation levels fall below 90%.
In a separate memo from the county's EMS Agency, paramedic crews have been told not to transfer patients who experience cardiac arrest unless spontaneous circulation can be restored on the scene.
Both measures announced Monday, which were issued by the agency's medical director, Dr. Marianne Gausche-Hill, were taken in an attempt to get ahead of an expected surge to come following the winter holidays.
Many hospitals in the region "have reached a point of crisis and are having to make very tough decisions about patient care," Dr. Christina Ghaly, the LA County director of health services said at a briefing Monday.
[...] "We do not believe that we are yet seeing the cases that stemmed from the Christmas holiday," Ghaly added. "This, sadly, and the cases from the recent New Year's holiday, is still before us, and hospitals across the region are doing everything they can to prepare."
Los Angeles County hospitals are so inundated, officials said they're just trying to provide the best care they can for the people who need it.
The memo sent out on December 28 by the medical director of L.A. County's Emergency Medical Services agency, Dr. Marianne Gausche-Hill, addressed how first responders should treat stroke and heart attack patients, saying a patient should be treated at the scene first and have a pulse during resuscitation before transporting them to the hospital.
[...] The medical director of L.A. County's Emergency Services Agency, Dr. Marianne Gausche-Hill, assured CBS2 that officials continue to do all they can to save patients' lives at the scene and the hospital, as they always have.
"We are not abandoning resuscitation," Gausche-Hill said. "We are absolutely doing best practice resuscitation and that is do it in the field, do it right away... What we're asking is that — which is slightly different than before — is that we are emphasizing the fact that transporting these patients arrested leads to very poor outcomes.
(Score: 5, Insightful) by Grishnakh on Tuesday January 05 2021, @08:57PM (24 children)
Can someone explain to me why, after flattening the curve and buying time for *ten months*, nobody thought to use that time to expand hospitals, hire more hospital staff, mass-manufacture ventilators and oxygen tanks, and have 10x the capacity they'd need in the worst case?
Because we're not China, that's why.
1. Expand hospitals: where do you think the money for this is going to come from? Hospitals in this country are not owned by the State, they're all privately-owned (usually by healthcare corporations like Kaiser, HCA, and also by various religious corporations). The only exceptions are military and VA hospitals. If you want the government to build new hospitals, then we need a complete revamp of the healthcare system in this country so that we have government-owned hospitals for non-military people.
2. Hire more hospital staff: Where exactly do you think these staff are going to come from? Cuba? You can't just grab some person off the street and stick them in a 3-month training program and suddenly have a new ICU doctor or nurse. It takes *years* to get through both MD and RN programs. Even an LPN certification takes 2 years.
3. Ventilators and oxygen tanks: Ventilators aren't much good if you don't have an ICU to use them in, which takes us back to point #1. The ventilators don't seem to be that much of a problem anyway, it's everything else. If you've burned out all your doctors and nurses, who's going to operate the ventilators?
All those months of relative calm, wasted. They could have tripled hospital capacity in that time.
Again, how, exactly? This is not China: we can't just build state-owned hospitals in 10 days here. This is also not the UK with a nationalized health system. You (Americans) didn't want "socialized medicine", you've voted against it every opportunity you got, so this is what you get. Suck it up and stop whining.
(Score: 0) by Anonymous Coward on Tuesday January 05 2021, @09:14PM (6 children)
In the spring, President Trump provided Navy hospital ships to NYC and LA. There was no need for them it turned out as almost nobody used their services. If LA truly needs a hospital ship now, it can be sent back.
https://www.google.com/amp/s/www.businessinsider.com/us-navy-hospital-ship-usns-mercy-stops-receiving-patients-2020-5%3famp [google.com]
I also don't know why you praise a communist one-party state as such a model to be followed compared to America. I sure don't hope you have swallowed their own reporting of COVID figures or their flawless response to it. That's pure state propaganda from the country that wants you to forget they started the worldwide coronavirus spread.
(Score: 2) by HiThere on Tuesday January 05 2021, @09:26PM (5 children)
You don't seem to understand WHY there was no need for the hospital ship. It wasn't equipped to deal with the problem. It still isn't. Hospital ships are mainly for dealing with physically injured, with few facilities for anything else. And if one COVID case got on board the entire thing would need to be evacuated. It's the wrong answer to this problem. Emergency hospitals of the kind the British are calling Nightingale would be more appropriate, and can be thrown together quickly. But where do you get the people to staff them? The supplies?
Admittedly rationing oxygen seems to say "poor planning", as I've seen a medical oxygen generator that can be plugged into the wall and condense it out of the air, but there are likely problems involved that I don't understand even enough to consider. (E.g. perhaps that "oxygen generator" didn't produce oxygen of the required purity...whatever that might mean.)
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 1, Insightful) by Anonymous Coward on Tuesday January 05 2021, @10:23PM (1 child)
It's available for substitution, if nothing else. COVID? Hospital. Car crash? Hospital ship. COVID? Hospital. Stab wound from gang violence? Hospital ship. COVID? Hospital. .... you starting to see how this works?
If they needed more medical staff, more orderlies, more hands-on grunts who will do what they're told and know how to clean a room? The Navy would be happy to provide them by the hundred, and instruct them in key roles.
But nooooo ...
(Score: 2) by Grishnakh on Wednesday January 06 2021, @05:46PM
If they needed more medical staff, more orderlies, more hands-on grunts
That's not the problem. They need more doctors and nurses. And while the military has a small supply of those (who are mostly already busy with their normal work), it's certainly not enough to deal with the shortages nationwide. You can't just grab some guy off the street and make him a doctor or nurse; it takes *years* of education and training.
(Score: 4, Informative) by RS3 on Tuesday January 05 2021, @10:27PM (2 children)
The oxygen "generators" (in spite of their name, they don't generate, they separate) come in several output flow ranges, and from what I've seen (spending huge time in hospitals with my dying parents), the standard ones that plug into standard wall outlet power can't quite produce enough oxygen for the highest requirement patients.
That said, if you're out of O2, or don't have enough and need to ration it, you could use some from the wall O2 outlet they have in hospitals (or a tank), and add the oxygen "generator" output to get the needed flow.
I'm not sure of the purity, but the medical requirements are, and the specs say, they're in the 90-95% range, so it's pretty good.
IIRC, the bigger (and much noisier) units make 10 LPM. That's liters per minute for all of you outside of the US who would be in disbelief that the US uses metric units (when we feel like it! :) There are smaller units that do like 3 LPM, and 5 LPM.
To put it all in perspective, if you've ever seen someone carting around an oxygen tank, say 0.6 M x 10 CM diameter, at 10 LPM that tank will empty in well under an hour. More like minutes.
The larger green tanks you may see being used for welding, for example, are typically 80 cubic foot capacity, so roughly 2,300 liters. So at 10 LPM, you'd have ~3.8 hours of oxygen. So you can see it can be a lot of oxygen and tank carting, and the critically ill patients need more than 10 LPM.
(Score: 3, Informative) by RS3 on Wednesday January 06 2021, @12:38AM (1 child)
Correction: "generator" should say "concentrator", as in oxygen concentrator, which is a good description of what they do, and here's more for nerds like me: https://en.wikipedia.org/wiki/Oxygen_concentrator [wikipedia.org]
(Score: 0) by Anonymous Coward on Thursday January 07 2021, @12:21PM
Oooh - thanks for the correction and the link.
(Score: 1) by fustakrakich on Tuesday January 05 2021, @10:45PM (14 children)
Money is a bullshit issue. The fed is giving Wall Street almost a trillion a month. Just divert that river, and we'll have thousands of very nice hospitals with well paid employees, and beluga caviar on the finest china.
La politica e i criminali sono la stessa cosa..
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @02:14AM (1 child)
Citation please.
I'm betting this is exactly like the other time you opened your mouth about finance and showed that you thought the treasury market was wall street, when in reality it was you being too stupid to understand that buying back treasury's was simply the government repaying part of the debt that was coming due.
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @02:21AM
Believe what you wish. If you're making money from it, more power to ya! Go ahead, I say, join the circus and make a bundle, just know when to cash out and convert to another currency.
Whatever, all your cash shortages are due to this one thing. I would expect you to be in denial as long as you're not hurting personally.
(Score: 2) by Username on Wednesday January 06 2021, @02:59AM (1 child)
That's not how subsidising works. If we do divert it, they will just beg for more since they know they will get it. You will get even more photos of lines and ques with people begging for care while doctors still dine on caviar.
(Score: 1) by fustakrakich on Wednesday January 06 2021, @04:15AM
There's enough money there (they stopped counting) to quarantine and treat the entire population in their own private suites, with monitors for off track betting, and caviar for all!
La politica e i criminali sono la stessa cosa..
(Score: 2) by Grishnakh on Wednesday January 06 2021, @05:43PM (9 children)
Ok, then how exactly do you think more hospitals will get built with federal money?
In case you forgot, they've tried this several times with broadband: give lots of money to the cablecos, with the promise that it'll result in lots of broadband expansion, and what happens? The ISPs just pocket the cash and don't build anything.
You can't have the government just giving money to companies with the vague promise that something useful will happen with it. It never works. If you want actual results, you need ironclad contracts, which is how "government contractors" work. But that's a whole industry of companies that specialize in contracting with the government (companies like Lockheed-Martin, for instance, plus many many others around the Beltway). There's no precedent for such a thing with healthcare corporations that are not already contractors.
Finally, where are you going to find all these "well paid employees"? You think you're just going to hire qualified doctors and nurses off the street? I don't care how much money you throw at the problem; you can't just will qualified employees into existence. You sound like someone who thinks you can gestate a baby in 1 month by putting 9 women to work on the problem.
(Score: 1) by fustakrakich on Wednesday January 06 2021, @05:55PM (8 children)
Government oversight is our responsibility. It's up to us to employ competent people and to discharge the incompetent with the opportunity we are granted every two years. If we can't be bothered, the bullshit will continue.
La politica e i criminali sono la stessa cosa..
(Score: 2) by Grishnakh on Thursday January 07 2021, @02:07AM (7 children)
Yes, every nation gets the government it deserves.
But I don't see how that has anything to do with this discussion. You still haven't addressed my point about the lack of qualified staff. No, you can't make doctors in 3 months. I don't care how competent a government is; it's not possible to create highly trained people overnight, no matter how much money you have.
(Score: 1) by fustakrakich on Thursday January 07 2021, @02:40AM (6 children)
We are supposed to seek out and appoint people to make those arrangements, make the government serve, use that money for massive training efforts and other infrastructure, so what if you don't have them immediately, they are there for the future. Chronic shortages of anything is a crime. It should not happen in a prosperous society. So now, let's correct the problem, by redirecting all that fed money to where it is needed. Giving it to Wall Street only buys hookers and coke.
La politica e i criminali sono la stessa cosa..
(Score: 2) by Grishnakh on Thursday January 07 2021, @06:23AM (5 children)
Again, I really don't care how much money you throw at it, you simply cannot train people to be doctors and nurses in a few months. It takes years. It's just like making a baby: even if you take all the money of Bill Gates, Warren Buffet, and Jeff Bezos combined, it will still take 9 months, no matter what. Sure, you could train some people to be nurses' aides, but that's only going to go so far: you have to have real doctors and nurses, and they can only service so many patients at a time, even with some extra less-trained help.
And finally, it's not the government's job to train doctors. We have a system of mostly privately-owned healthcare companies, and various universities and medical schools that have limited enrollment, so we can only make so many new doctors and nurses at a time, and it just isn't something the federal government has any control over. This isn't Cuba, nor is it the UK, or even Canada. What you're advocating is for this country to become more like one of those countries, and Americans do not want that (even if it would work much better, since we have by far the highest cost for care in the world (including as a percentage of GDP), but not great care for most of the population). Even in the middle of a terrible pandemic, Americans have clearly spoken at the voting booth that they do not want "socialism" (while Biden won the Presidential election, the Democrats (who aren't even socialist except for a few) **lost** seats in the House). There's just not anywhere near enough political will in this country to make the kind of changes you're advocating.
(Score: 1) by fustakrakich on Thursday January 07 2021, @07:04AM (4 children)
Exactly, and that is why we have shortages and rationing. A mere observation. There is no mystery.
La politica e i criminali sono la stessa cosa..
(Score: 2) by Grishnakh on Thursday January 07 2021, @04:20PM (3 children)
We're getting the government that we voted for, and that we deserve.
(Score: 1) by fustakrakich on Thursday January 07 2021, @05:26PM (2 children)
That's all I ever said. But in answer to your original question, if you're looking for the money, you know where it is, and they are printing it like there's an infinite supply. So, people just have to vote on where it goes. And they just voted to send more trillions to Wall Street instead of disaster relief. The money issue is as plain as day, plenty there, just being misspent on hookers and coke.
La politica e i criminali sono la stessa cosa..
(Score: 2) by Grishnakh on Thursday January 07 2021, @07:41PM (1 child)
Yes, but that's the way this country rolls. We don't want "socialism", so instead of having a well-managed healthcare system like those in UK or Germany (which can be more centralized like the UK's, or more public/private partnership like Germany), where we really could build more hospitals and push more education/training programs to increase the number of healthcare professionals (which would still take a lot of time, but at least it'd prepare us for the next pandemic), we rely on "The Holy Invisible Hand" to run things and then throw money at Wall Street when things aren't working.
I just don't see any way of fixing this when half our country is violently (and I mean that word literally, based on what we saw yesterday) opposed to anything that could be called "socialism", but is perfectly happy to hand out money to Wall Street.
(Score: 1) by fustakrakich on Thursday January 07 2021, @08:03PM
And that is the problem, not the money, we just create barriers to access.
La politica e i criminali sono la stessa cosa..
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @12:23AM
Wrong.
https://www.nychealthandhospitals.org/ [nychealthandhospitals.org]
Publicly owned.
https://omh.ny.gov/ [ny.gov]
Runs hospital like systems.
University Hospital Systems.
https://www.numc.edu/ [numc.edu]
County Owned and Staffed.
(Score: 1) by khallow on Wednesday January 06 2021, @09:30PM
If you're speaking of the US, there are plenty of state-owned hospitals too. And being private or public doesn't magically prepare you for things you don't bother to prepare for. Trillions of public funds have been burned over the past 9 or so months. That seems a good place to start to look for that money.
Good idea actually. Yes, grab people off the street (or in other words, accept volunteers), train them for three months, and get something far better than nothing.
Yet another reason to get that additional staff that you say is impossible to get.
Actually, the US already did that [usatoday.com].
And if you have ten months to prepare, well, you might not need ten day builds.