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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: 0) by Anonymous Coward on Tuesday January 05 2021, @09:34PM (2 children)
Tough decisions about patient care. Like who can pay for it and who can't. Thank god there's a pandemic to help clear that up.
(Score: 0) by Anonymous Coward on Tuesday January 05 2021, @11:33PM
Don't forget skin color. In today's world, skin color is the most important consideration for distributing health care services.
(Score: 2) by ChrisMaple on Wednesday January 06 2021, @06:03AM
In the U.S., by law hospitals must provide emergency care for anyone who shows up, and that's what happens. The extraordinarily wealthy can get specialized care, but nobody is denied lifesaving efforts even if they can't pay a penny.
(Score: 1, Insightful) by Anonymous Coward on Tuesday January 05 2021, @09:42PM (9 children)
Finally! They've publicly recolonized just how pointless some medical interventions can be. Any EMT will tell you that mouth to mouth and heart pumping almost never works out out. Despite how it's portrayed on TV shows, It's nothing more than an show for friends and family so they can feel better about doing something. Any doctor will also tell you that if you end up on ventilator, you're going to die. There's saving lives and then there's just theater to pretend we're saving lives. As a society we need to try harder to recognize the difference and make better use of the time we have.
(Score: 0) by Anonymous Coward on Tuesday January 05 2021, @10:10PM
Bullshit. Real data from here tells you 1/4 - 1/3 death rate for ventilators. It used to be 25% but now it's creeping up in last few months as hospitals are stretched and idiots are ignoring restrictions. Here, even in English for you,
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Jan_2021/2021-01-05-en.pdf?__blob=publicationFile [www.rki.de]
(Score: 0) by Anonymous Coward on Tuesday January 05 2021, @10:14PM (4 children)
"Any EMT will tell you that mouth to mouth and heart pumping almost never works out out. Despite how it's portrayed on TV shows, It's nothing more than an show for friends and family so they can feel better about doing something."
Painfully wrong. It keeps oxygenating the blood to give the patient time until they can defib, intubate, whatever. It is a stop gap measure, and yes sadly most people still die because CPR isn't magic.
"Any doctor will also tell you that if you end up on ventilator, you're going to die."
Sweaty balls on a camel you are nuts. Oh look, survival rate in the 70% range for COVID.
https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patients-on-ventilators-usually-survive [npr.org]
Maybe we should repeal 230 even with the dystopian information censorship it will create. Then we can prosecute people like yourself that spread dangerous misinformation, or at least shut down any unapproved platforms. Wheee dystopia, the only way to deal with the evil, stupid, or evilly stupid people like yourself that won't do the most basic fact checking.
(Score: 2, Informative) by Anonymous Coward on Tuesday January 05 2021, @11:06PM (2 children)
“The majority of patients and non-medical personnel have very unrealistic expectations about the success of CPR as well as the quality of life after patients are revived,”
https://fr.reuters.com/article/us-health-cpr-expectations/cpr-survival-rates-are-lower-than-most-people-think-idUSKCN1G72SW [reuters.com]
CPR survival rates are less than 10% for out of hospital events, less than 20% for in-hospital events. And survival doesn't even begin to touch on the long term neurological damage. In some cases "survival" is barely better than death.
https://www.medscape.com/answers/1344081-122892/what-are-the-survival-rates-for-patients-with-cardiac-arrest-treated-with-cardiopulmonary-resuscitation-cpr [medscape.com]
Covid-19 patients on ventilators usually survive? Survive what? Getting off ventiatlors? Or recovering and leaving hospital? That's some good cherry picking going on there. Everything is true if you conveniently ignore ugly truths.
Survival rates of ventilation were studied at 66.6% which sounds pretty good. Until you read deeper. That's just the survival to "getting off the ventilator". Then it drops to 61.1% leaving ICU alive (after being taken off a ventilator), down to 49.1% leaving the hospital alive and finally only %30 1 year after leaving the hospital. So sure, odds are pretty good you'll survive the ventilator. Pretty much 2/3 good. Pop your champagne and have a toast. Unless you flip the coin wrong and die before leaving the hospital, or take the Vegas odds on surviving the first year after. The bottom line is mechanical ventilation f*cks you up and most likely will kill you. If not immediately, not too much longer later due to complications.
https://pubmed.ncbi.nlm.nih.gov/8404197 [nih.gov]
I would dig up some equally disturbing covid-19 ventilator stats, but to be honest there's a million media stories and research papers about covid-19 ventilator "facts" out there that all claim to be telling the truth and vary wildly different proportions. Pick your bias.
(Score: 0) by Anonymous Coward on Tuesday January 05 2021, @11:12PM (1 child)
Nice links and data.
Care to show it to the author of:
??? Pretty please?
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @05:17AM
omg, haha. I am the author
(Score: 5, Interesting) by Tork on Wednesday January 06 2021, @01:31AM
Correct.
But even if you weren't I wanted to mention that when you take a CPR class what they emphasize most, even above the actual breathing and compressions, is that you summon help, get those EMTs en route to you right away. By the time you've started CPR you've already kicked things into motion that have a huge say in the survival of the person you're assisting. The reason for this is when someone falls ill it's typical for an American to pretend not to notice or just play dumb. When someone shouts "Help this person!" that's when they'll leap to action.. and that's precisely what CPR courses teach you to do... take charge cos nothing will happen until someone does. EMT arrival time is a much larger factor in the victims' survival than say skill at giving compressions.
The expectation of a miracle really isn't all that unrealistic when framed in a practical context. The real problem here is yet another anonymous dipshit thinking the accuracy of their data source has any relation at all to the validity of whatever agenda they're trying to push. It's like railing against gun control saying "You actually can't die from a bullet in your body!" because sometimes when treating a gunshot wound they don't actually remove it.
🏳️🌈 Proud Ally 🏳️🌈
(Score: 3, Insightful) by sjames on Tuesday January 05 2021, @10:59PM (1 child)
Emphasis mine. It's a low cost (anywhere but the U.S.) intervention. It doesn't pay off often, but when it does, it's a really big payoff.
(Score: 0) by Anonymous Coward on Tuesday January 05 2021, @11:14PM
But how will the EMTs or good samaritans ever get those precious few hours of their life back? Talk about a waste of time statistically amirite?
Huh, just re-read what I wrote. No, I am not right.
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @04:34AM
Just engaging in mouth to mouth and chest compressions doesn't typically work, but it's not intended to. It's intended to be a stop gap measure before other methods can be used. And here in King County, WA, where the Medic One program started, we have some of the highest survival rates for heart attacks anywhere because you can't swing a dead cat without hitting somebody that knows CPR. On top of that, we can get actual medical doctors on scene with medications and equipment in a matter of minutes. But, the CPR is really just about keeping the blood oxygenated and somewhat flowing while the medics drive to the scene.
This is one of the reasons why you're allowed to give up after a half hour when you're in the back country. If it hasn't resulted in the patient breathing and having a beating heart at that point, nothing will. In the city, you'd just keep at it until help either arrives or you physically can't do it any longer.
(Score: 3, Touché) by sjames on Tuesday January 05 2021, @11:04PM (14 children)
We were told that you only get death panels and shortages from socialized medicine!
(Score: 0, Insightful) by Anonymous Coward on Tuesday January 05 2021, @11:21PM
Turns out the death panels were right behind us the whole time!
Seems to be a law of nature
Gaslight
Obstruct
Project
(Score: 4, Interesting) by helel on Wednesday January 06 2021, @12:10AM (11 children)
It's all about the sorting algorithm used. Under a socialized system you'll have panels that, at least in theory, prioritize patients by need, likelihood of success, and years of life that can be saved. This means that a poor child might receive a kidney before a rich businessman or a working class adult might receive limited cancer treatment before an elderly trust-fund baby.
Conservatives aren't against rationing treatments, food, or anything else. They just prefer that the algorithm used to do so look at how much money someone has ahead of any other factors. That way the businessman (job-creator?) gets the kidney and the poor child dies and that the geriatric who never worked a day in their life continues their entitled existence an extra half-dozen years while the (wo)man who can barely afford to take time off to get the diagnosis loses out on decades they would otherwise spend supporting their family.
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @12:57AM (10 children)
I am fascinated by this supposed link between a preference for incremental changes in government rather than radical, and a desire to ration access to health care by funding sources.
This is the first I've ever heard of such a link. Would you care to explain your analysis?
Oh, and if by "conservative" you really meant "hypothetical randian extremist strawman" that could be worth pointing out as well.
(Score: 2) by helel on Wednesday January 06 2021, @01:20AM (6 children)
To be fair, by "conservative" I mean anyone who favors a market-based approach to health care. Treatment for those that can afford it.
Please, feel free to share the factors you feel should be used when determining who receives first access to limited supplies, and any factors (such as being unable to pay) that should disqualify them before consideration.
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @01:59AM (5 children)
How about medical opinion? Regular triage processes?
As for market-based, I'm not aware of many people outside the anarchist fringe who disapprove of a social safety net. It seems to be a pretty strong point of consensus, actually. Even night watchman state libertarians tend to speak in favour of functions with strong externalities such as national defense, logistics and public health.
So basically, you're barking at anarchists up a tree.
You bark hard, my friend. Bark at those anarchists.
(Score: 2) by helel on Wednesday January 06 2021, @02:13AM (3 children)
Thats... Uhh... Do you know what triage is?
And if I understand correctly you don't see that ability to pay should play any role in deciding who gets care and who does not? Random houseless individual comes in off the street should have the same access to care that Bill Gates or the president of the United States does?
I admire your idealism.
(Score: 1) by khallow on Wednesday January 06 2021, @05:03AM (2 children)
Eventually, ability to pay matters because no matter how deep-pocketed the society is, you can demand more health care than it can afford to pay.
(Score: 2) by helel on Wednesday January 06 2021, @12:48PM (1 child)
The AC suggested that only medical expertise should play a role in distributing medical care. Yes, some treatments may be limited due to costs or supply constraints and in those cases medical opinion would see no difference between a houseless individual and the richest person in the country. Whoever has greater need, greater odds of success, and more years of life to gain gets it and no amount of money should change the decision, according to the AC.
I can only imagine how upset the AC is with the current state of affairs where insulin, a drug we can easily produce enough of for everyone that needs it, is rationed by monetary income such that people routinely die for its lack [snopes.com].
(Score: 1) by khallow on Wednesday January 06 2021, @09:20PM
And the rich person, should they exhaust the above cost/supply constraints, is simply going to go out of that system to get the medical care they want. As I noted before, money will make a difference.
They're also rationed by artificial supply constraints which the bleeding hearts such as Mr. AC have had a hand in creating. After all, we can't have the Alec Smiths of the world killed by substandard/unregulated insulin.
(Score: 2) by sjames on Wednesday January 06 2021, @03:25AM
If only. The GOP regularly attempts to sabotage then cancel anything resembling the social safety net.
(Score: 2) by sjames on Wednesday January 06 2021, @01:54AM (2 children)
The link is clear. The current mercenary style medicine DOES ration care based on ability to pay. That is somewhat tempered by things like medicare and medicaid.
The conservative as champion of incremental change is long dead. They now propose radical changes towards privatization while opposing incremental moves towards a social safety net. They tend to want to go "back" to some fictional never-was state and no proposal is too radical if it does that.
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @02:01AM (1 child)
It sounds as if you're not talking about conservatives, but about radical reactionaries.
Radical: wanting to make big, sweeping changes.
Reactionaries: wanting to go back to some past state (real or imagined).
If you're going to insist on using the terms of political science/political economics, how about using them to describe what the connotation of the words addresses? Maybe even for a trial period of a month or three?
(Score: 2) by sjames on Wednesday January 06 2021, @02:58AM
I am talking about the current GOP which calls itself "conservative" for hysterical raisins.
I use that term because that is the term used on the news, in political commentary, and by the GOP itself.
(Score: 1) by khallow on Wednesday January 06 2021, @04:59AM
You want a death panel? I give you the "Los Angeles County Emergency Medical Services Agency".
(Score: 3, Touché) by Azuma Hazuki on Wednesday January 06 2021, @12:45AM (5 children)
They said if I voted for Clinton we'd see rationed care, shortages of supplies, and death panels. I did vote for Clinton (albeit holding my nose the entire time) and...well, just look. :|
I am "that girl" your mother warned you about...
(Score: -1, Troll) by Anonymous Coward on Wednesday January 06 2021, @01:06AM (3 children)
Yeah, Commiefornia is a weird place. :|
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @01:40AM (2 children)
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @02:55AM (1 child)
https://nypost.com/2020/11/18/photos-show-california-gov-newsom-at-maskless-party/ [nypost.com]
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @03:03AM
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @03:05AM
quick make a tik tok video about it.
(Score: 0) by Anonymous Coward on Wednesday January 06 2021, @08:05PM
citizens only for hospitals, ambulances, oxygen. let the mestizo invaders die in their welfare-subsidized homes!