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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: 2) by Thexalon on Tuesday January 05 2021, @10:55PM (1 child)
If you, 10 months ago, took *everybody* with a 4-year degree and started training them to be nurses, do you know how many extra nurses you'd have right now? Zero. Because it takes longer than 10 months to train a nurse. And even moreso for doctors. You can go a bit faster when it comes to aides and techs with specific jobs, but it still takes time. Oh, and the people who are going to have to do the training work are the same experienced staff that you need to work double-shifts to treat patients.
They've already done the relatively easy things they could do:
1. They've offered big bucks to qualified-but-otherwise-employed people (e.g. RNs who normally staff a nursing home or dialysis clinic) to work temporary contracts in hard-hit areas.
2. They've offered big bucks to retired nurses and doctors to come back to help out.
And no, they can't solve the staffing shortage by hiring foreigners, either, because foreign doctors / nurses are needed in their own countries.
Workers don't just spawn the way clicking the "Medic" button in Starcraft works.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 2) by pdfernhout on Wednesday January 06 2021, @03:24AM
Example: https://www.indeed.com/career-advice/finding-a-job/how-long-to-become-lpn [indeed.com]
"Practical nursing certification programs usually last about one to two years, depending on whether you attend full- or part-time."
There are also Registered Nurses who get more training, but perhaps some of that is probably redundant for people with already, say, a BA in biology, and so perhaps less training would be required in an emergency situation.
https://www.nursinglicensure.org/articles/lpn-versus-rn/ [nursinglicensure.org]
"RN and LPN: two different sets of initials on different name badges – and often two very different roles. Registered nurses (RN) have, at the minimum, a two-year degree or three-year diploma. Many have baccalaureate degrees. RNs have an expanded set of duties and are more frequently employed in hospital settings. They, RNs, are generally expected to do more critical thinking on the job. Find a Registered Nursing program in your state. Licensed practical nurses (LPN) have about a year of nursing education, often culminating in a certificate. A minority complete longer programs and walk away with a degree – often an Associate of Applied Science (AAS). The role of an LPN is, as the name suggests, practical. LPNs are expected to report even minor changes in patient care to a registered nurse or other medical professional. As for what they actually do on the job, often it’s a lot!"
And see also: https://www.military.com/special-operations/army-special-forces-training.html [military.com]
"18D - SF Medical Sergeant – 46 weeks. The 18D education is arguably the best combat medic training in the world and creates experts in medical, surgical, dental, veterinary, and pharmaceutical subjects. This course is called the Special Forces Medical Sergeants Course (SFMS) which consists of the 24 week Special Operations Combat Medic Course (SOCM) as well as an additional 22 week training cycle to complete the 18D training pipeline. Complete with trauma care, physiology, anatomy, and advanced paramedic training."
While it may take a lifetime to learn any profession well, whether nursing, doctoring, or programming -- you can often learn the basics in a short time and then bootstrap from there in a supportive environment (yes, likely with some disasters along the way, to be weighed against the disasters from inadequate staffing in time of need).
Or there is the cheapo Dilbert "Google Health Plan" ( https://dilbert.com/strip/2007-02-18 [dilbert.com] ) at-home learning program for people like my family who did not have health insurance for many years (ironically due to moving to a non-age-adjusted high-health-insurance-cost state two decades ago to help elderly parents covered by four different health insurances).
On the plus side, not having health insurance for so many years is part of why I learned so much about staying healthy. :-)
Beyond Google and Catbert's help, here are some useful "Where There is No Doctor/Dentist" guides from Hesperian for people living in either underdeveloped and overdeveloped health care systems:
https://store.hesperian.org/prod/Where_There_Is_No_Doctor.html [hesperian.org]
https://store.hesperian.org/prod/Where_There_Is_No_Dentist.html [hesperian.org]
Some other educational references on that about eating better and having a healthy microbiome:
https://www.healthpromoting.com/the-pleasure-trap [healthpromoting.com]
https://www.amazon.com/Fasting-Eating-Health-Medical-Conquering/dp/031218719X [amazon.com]
https://www.amazon.com/Whole-Foods-Diet-Lifesaving-Longevity/dp/1478944919 [amazon.com]
https://www.amazon.com/dp/B00Q33FYY0/ [amazon.com]
https://en.wikipedia.org/wiki/Fat,_Sick_and_Nearly_Dead [wikipedia.org]
Or in general, get outdoor exercise, sunlight/D3, good sleep, social interactions, whole foods, and relaxing experiences every day:
https://tlc.ku.edu/ [ku.edu]
"We were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life. (Stephen Ilardi, PhD)"
Of course, now that we have comprehensive health insurance (>US$20K per year), doctors push stuff on my family like drinking polyethylene glycol to wipe out beneficial gut bacteria (for routine colonoscopy), irradiating body tissue to "prevent" cancer (for mammography), and a lifetime of prescription psychotropics (for headaches mainly due to unlabelled sulfites in food which Al Gore tried unsuccessfully to ban decades ago) -- all standard medical interventions that contribute to IBS, cancer, mental illness, and other ill health that highly-paid medical practitioners can then profitably treat. See also books by a cofounder of the Cochrane collaboration: https://en.wikipedia.org/wiki/Peter_C._G%C3%B8tzsche [wikipedia.org]
A historical footnote on how US medical care got so screwed up -- where for generations essentially no one but a rich white man with a university degree could be a physician, and health care was only concerned with applying specific treatments to individuals identified as sick:
https://en.wikipedia.org/wiki/Flexner_Report [wikipedia.org]
"Flexner sought to reduce the number of medical schools in the US. A majority of American institutions granting MD or DO degrees as of the date of the Report (1910) closed within two to three decades. (In Canada, only the medical school at Western University was deemed inadequate, but none was closed or merged subsequent to the Report.) In 1904, there were 160 MD-granting institutions with more than 28,000 students. By 1920, there were only 85 MD-granting institutions, educating only 13,800 students. By 1935, there were only 66 medical schools operating in the US. ... Flexner advocated closing all but two of the historically black medical schools. His opinions were followed and only Howard and Meharry were left open, while five other schools were closed. His perspective was that black doctors should only treat black patients and should serve roles subservient to white physicians. The closure of these schools and the fact that black students were not admitted to many medical schools in the US for 50 years after Flexner has contributed to the low numbers of American born physicians of color and the ramifications are still felt more than a century later. ... The vision for medical education described in the Flexner Report narrowed medical schools’ interests to disease, and not on the system of health care or society’s health beyond disease. Preventive medicine and population health were not considered a responsibility of physicians, bifurcating “health” into two separate fields: scientific medicine and public health. ..."
Maybe sometimes the only way to win the medical game is not to play? From:
https://www.drfuhrman.com/elearning/blog/183/coronavirus-and-the-flu-five-ways-to-protect-yourself [drfuhrman.com]
"They say that the best defense is a good offense – and when it comes to protecting yourself from the coronavirus and the flu, that’s never been more true. There’s a lot of advice floating around on the internet – some of it good, much of it ridiculous. In this short video, I discuss how to keep yourself and your family safe – and why eating a high-nutrient Nutritarian diet is really the best way to boost your immunity and keep yourself safe from disease."
The biggest challenge of the 21st century: the irony of technologies of abundance used by scarcity-minded people.