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Medical care, under dire circumstances

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  • liam
    replied
    Re: Medical care, under dire circumstances

    Another consideration is that delivery is not the only 'just in time' aspect of the supply line. With computerized record keeping and modern communications manufacturers anticipate orders by historical patterns and do not keep huge inventories of stock on hand on speculation.

    If everyone interested in ventilators were magically suddenly standing in the lobby of the manufacturers with wheelbarrows full of cash it would still be well into the pandemic before every order was filled and waiting for someone well enough to deliver it. This applies to all other expensive equipment as well.

    The outcome of this event will not hang on manufacturing such as we saw in the US in WW2. The timeline is too compressed. It appears we will go between phases of a single long wave without breathers in between waves. If so there will be no catching up. The psychological adjustment time for facing a new danger may be more drawn out for professionals, authorities and the public since we are not in the practice from wartime (1918). The general shift from self to government dependance with the expectation that they must do something may lead the government to interfere with the free market manufacturing and allocation as with vaccines. This would add a further layer of complexities.

    On the bright side, many doctors will be spared many decisions about who gets scarce resources because there will be fewer resources to decide about.
    Liam

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  • Rocky
    replied
    Re: Medical care, under dire circumstances

    one other critical point to remember is the nurses from ground zero here in Arizona said a Majority of the complications from swine flu come from dehydration...

    are 30-40 IV Drips available to go with each ventilator? Will someone be sitting in the back room filling them from the tap?

    In Paraguay, 1 out of 10 confirmed cases so far have ended up in death...

    has anyone looked to see what is missing in their treatment that has caused a higher fatality rate?

    (I just noticed rhizalabs totals on the map aren't subtracting from confirmed on the deaths, it is adding....)

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  • peter m
    replied
    Re: Medical care, under dire circumstances

    The provision for more ventilators and ICU beds to deal with a massive fall ouitbreak will be haphazardous and slipshod, as the Fed and other gov entities, like all of us, do not know exactly how bad this sw flu will get. They can base their planning(the worst case scenario) on the 1918-1919 pandemic and plan for est 2.1 million US deaths, based on the recorded deaths back then - 700.000 US deaths. US poplulation was 105 million back then, now is has almost tripled so the pandemic fatalities will likewise triple(700,000 x 3 = 2.1 miilion) . If u factor in that we have far greater technogical skills and superior medical knowhow to deal with this Pandemic then we can drop down the total fatalities to between 500,000 and 1 miilion. That would be the adjusted worst- case scenario, which would be catastrophic if Us has severe shortage in hospital emergency medical devices, and critical shortages of trained ER techs and nurses to run them.

    We will need to train large nos. of new nurses now. This winter likely 10% of available nurses will themselves be ill and incapaciated from the coming fall wave,or tsunami.

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  • peter m
    replied
    Re: Medical care, under dire circumstances

    I wonder how many respirators are even available and where they are built. Will they be held for use in the country where they are manufactured?
    Normally we outsource productiion/ manufacturing of industrial goods to areas of cheaper labor to countries such as china. This has been how US companies have operated last 20-30 years, shifting all manufacturing to China and other far eastern coountries.. I don' think that Vents and ICU beds production will be outsourced but the feds need to put together a crash production program very quick. A public/ private partnership, and they need to do it quick. Convert a former shuttered GM plant into a medical products manufacturing plant.

    Time is running short, the fall outbreak is 2-3 months away.

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  • german-docter
    replied
    Re: Medical care, under dire circumstances

    Originally posted by tropical View Post
    #18:
    "To allocate ventilators, beds and intensive-care equipment doctors would have to 'score' patients on their health and prognosis as well as seriousness of their conditions.

    Those who failed to respond to treatment would be subject to 'reverse triage' - in which they were taken off ventilators and left in NHS 'dying rooms' with only painkillers to ease their suffering.

    Patients with underlying illness such as advanced cancer or the last stage of heart, lung or liver failure - and those unlikely to survive even if they were given treatment - would not be given an intensive-care bed."


    God and ...

    Doctors would NOT have!

    This is an twisted brainwashing advice from weak health chains, who have no willingness to drag more money for lifeboat issues!

    Doctors would have to push the system to get all the needed equipment and staff - not the oposite.

    Nobody subscribe special rights to the system to eutanased him by doctors triages instead of giving treatments, because of economic based wrong previous advising decisions, and without to gave to the citizens the possibility of sufinance by additional money tickets the production of additional ventilators, and staff engaging, now when it is plenty of time to ensuring that needs!

    Doctors would NOT have!

    Yes, that's it.
    tropical, thank you for your wake up call !

    Leave a comment:


  • tropical
    replied
    Re: Medical care, under dire circumstances

    #18:
    "To allocate ventilators, beds and intensive-care equipment doctors would have to 'score' patients on their health and prognosis as well as seriousness of their conditions.

    Those who failed to respond to treatment would be subject to 'reverse triage' - in which they were taken off ventilators and left in NHS 'dying rooms' with only painkillers to ease their suffering.

    Patients with underlying illness such as advanced cancer or the last stage of heart, lung or liver failure - and those unlikely to survive even if they were given treatment - would not be given an intensive-care bed."


    God and ...

    Doctors would NOT have!

    This is an twisted brainwashing advice from weak health chains, who have no willingness to drag more money for lifeboat issues!

    Doctors would have to push the system to get all the needed equipment and staff - not the oposite.

    Nobody subscribe special rights to the system to eutanased him by doctors triages instead of giving treatments, because of economic based wrong previous advising decisions, and without to gave to the citizens the possibility of sufinance by additional money tickets the production of additional ventilators, and staff engaging, now when it is plenty of time to ensuring that needs!

    Leave a comment:


  • Evelyn
    replied
    Re: Medical care, under dire circumstances

    A general comment: the ventilators themselves are useless without highly trained personnel to run them. The availability of respiratory therapists will be another limiting factor. Alas.

    Leave a comment:


  • AlaskaDenise
    replied
    Re: Medical care, under dire circumstances

    [QUOTE=peter m;272671..........That was 3 years ago, The states fiscal picture has gone 500% opposite dirertion .......... There is no ability for the state to provdide ample funds for pandemic flu perparation even if it wanted to. The state is flat broke. Only the fed and Obama can come in and provide needed emergency funds, which they are doing. Call it a stimulus injection for emergency nationwide medical funding. Only Fed can print out dollars via the printing presses, and sell treasuries to foreign investors to raise funds for US coffers. Ths money will be doled out but it wil be provided somewhat slowly, as other states compete for the same emergency medical funds. The state's credit rating is shot to hell and CA cannot borrow for Emergency medical needs except at usurus rates. It is a near-bankrupt entity who abused its' CCard to the max during the good times 3 years ago, and now finds itself with a near bankrupt and empty coffer
    .
    How is the state to get funds for 10,000-20,000 needed vents at $2000 apiece, pass a bond measure? It used up its credit and borrowing lines long ago and cannot make up for it with increased revenue as the CA citizenlry is on the verge of revolt with the already crushing state taxes.[/QUOTE]

    We can assume they made the expenditures in that old article, so at least that much has been added, but yes California is hurting. I recently spent some time with California relatives who work as a corrections officer and a teacher. I got an earful.

    I would agree that the federal government needs to step into areas unable to care for themselves - California, Detroit, etc.

    I wonder how many respirators are even available and where they are built. Will they be held for use in the country where they are manufactured?

    .

    Leave a comment:


  • peter m
    replied
    Re: Medical care, under dire circumstances

    according to these statistics, figuring that 1 out of every 124 people are going to die from not having enough ventilators,
    this is an estimate of what to expect in the top Metro regions in the US

    these numbers were from a 2000 census, just glancing at the population of a few Metros I know, they are way off... San Diego over 6M Phoenix over 7M etc

    2 Los Angeles--Riverside--Orange County, CA CMSA 16,373,645 132,046
    Actually that is the correct estimate of the polulation of the three mentioned Scal counties for 2009, give or take a million or so. So we will have 132,046 deaths without sufficent ventilators. 1 out of 124 case end up fatalities. not good.
    OC is the richest county by average income per capita so it will likely meet it needs in supplies before all the other Scal countes. LA county will not fair so well unless the ample supporters of Obama in this county can manage to politize the swine flu pandemic and LA can siphon off the limited Obama med emergency stimulus funds from other regions. LA county already receives a dispoportionate share of stimulus monies for affordable housing, road building, worker retraining programs, medi-cal shoring, ect. It has powerful Obama supporters especially the unions & teachers who are a powerful force in La as in Ca, and they will be heard in Wshington.

    Never underestimate the power of politics in the shifting and allocation of funds in meeting emergency needs.

    Leave a comment:


  • peter m
    replied
    Re: Medical care, under dire circumstances

    Originally posted by AlaskaDenise View Post
    This issue was being discussed on FT back in 2006. At that same time states were making vent purchases for pandemic preparedness (hopefully). Mellie was very much on top of this issue. Here are some old threads and extracts:



    post #1:




    post #2:






    post#1:



    Looking back at discussions and news articles from 2006 makes me appreciate all the H5N1 prep work that was done by various agencies. It may not be everything we want, but where would we be without it?

    .
    "The governor is proposing a new $400-million disaster-preparedness effort that would include about $50 million to buy face masks for medical workers, $100 million to buy ventilators, and $164 million for other medical supplies in the event of an outbreak of avian flu." California Health and Human Services Secretary

    That was 3 years ago, The states fiscal picture has gone 500% opposite dirertion since then and CA just passed a budget to close a 26 billion budget deficent by deep cuts in all sorts of social safety net programs including health care cuts to the needy. There is no ability for the state to provdide ample funds for pandemic flu perparation even if it wanted to. The state is flat broke. Only the fed and Obama can come in and provide needed emergency funds, which they are doing. Call it a stimulus injection for emergency nationwide medical funding. Only Fed can print out dollars via the printing presses, and sell treasuries to foreign investors to raise funds for US coffers. Ths money will be doled out but it wil be provided somewhat slowly, as other states compete for the same emergency medical funds. The state's credit rating is shot to hell and CA cannot borrow for Emergency medical needs except at usurus rates. It is a near-bankrupt entity who abused its' CCard to the max during the good times 3 years ago, and now finds itself with a near bankrupt and empty coffer
    .
    How is the state to get funds for 10,000-20,000 needed vents at $2000 apiece, pass a bond measure? It used up its credit and borrowing lines long ago and cannot make up for it with increased revenue as the CA citizenlry is on the verge of revolt with the already crushing state taxes.

    Leave a comment:


  • Rocky
    replied
    Re: Medical care, under dire circumstances

    Originally posted by AlaskaDenise View Post
    I believe there are disposable mouth pieces that must be used - are there enough of those in stock?
    .
    Well at that point the Doc might already know you have the same cold as the last guy or gal, what are you more worried about, germs or breathing?

    If you were 200 feet under the surface of the ocean and the guy beside you was dying and didn't need the rest of his air tank and yours was empty...

    Would you try to make it to the surface to change mouth pieces knowing you would die, or wipe it off and pop it in your mouth?

    Leave a comment:


  • Niko
    replied
    Re: Medical care, under dire circumstances

    Doctors face 'playing God' over who lives or dies if swine flu overwhelms NHS... as fans start wearing masks to football matches


    By Beezy Marsh and David Derbyshire
    Last updated at 1:25 AM on 28th July 2009

    Thousands of patients could be denied NHS treatment and left to die under 'worst-case' emergency plans for a swine-flu epidemic.
    The blueprint would force doctors to 'play God' and prioritise intensive-care treatment for those most likely to benefit - ruling out patients with problems such as advanced cancer.
    The 'scoring' system would be introduced if half the population became infected with flu.

    Football fans at Wembley stadium wear anti-flu masks before Friday's game between Celtic and Egyptian champions Al Ahly

    More than 100,000 cases were diagnosed last week alone in the UK. Although the disease has claimed 30 lives, many sufferers have experienced little more than a bad cold, raised temperature and cough.
    However health experts are concerned that the H1N1 virus could mutate into something more severe.

    The scale of their concern is highlighted in the Department of Health's report: Pandemic Flu - Managing Demand and Capacity in Health Care Organisations.

    Detailing plans to ration hospital treatment, the report warns that if half the population were infected, 6,600 patients per week would be competing for just under 4,000 intensive-care beds.
    Around 85 per cent of those beds could already be full with day-to-day emergencies.

    To allocate ventilators, beds and intensive-care equipment doctors would have to 'score' patients on their health and prognosis as well as seriousness of their conditions.

    Those who failed to respond to treatment would be subject to 'reverse triage' - in which they were taken off ventilators and left in NHS 'dying rooms' with only painkillers to ease their suffering.

    Patients with underlying illness such as advanced cancer or the last stage of heart, lung or liver failure - and those unlikely to survive even if they were given treatment - would not be given an intensive-care bed.


    A passerby casts an anxious glance at a group of students posing with anti-flu masks outside a London underground station

    Leading doctors stressed, however, that the plans were unlikely to see the light of day and that swine flu remains a mild disease for most of those infected.

    The report was published at the start of the swine-flu crisis in April, along with advice from the British Medical Association and the Intensive Care Society.
    Dr Carl Waldmann, president of the Intensive Care Society, said: 'Even if we doubled intensive-care capacity, with a pandemic hitting at the level outlined in this report, we would run out of beds.
    'No one wants to think about this, and thankfully we are still a long way off this situation, but the ethics of it has been a big deal for doctors.'

    Dr Tony Calland, chairman of the BMA's ethics committee, added: 'I seriously doubt we will get anywhere near a 50 per cent clinical attack rate, but if 25 per cent of the population were infected that could cause major problems for the health service.
    'The Department of Health is right to address this in the report and the NHS must face the issue, but many doctors would doubtlessly feel extremely uncomfortable if they found themselves having to face these kind of decisions.'
    A Health Department spokesman said: 'We can't be certain how the current pandemic will develop, but we have to prepare for the reasonable worst case. Our planning assumptions are cautious scenarios, and not predictions.'

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  • AlaskaDenise
    replied
    Re: Medical care, under dire circumstances

    What is the average time a respiratory is used on each patient? I assume they're not single use. I believe there are disposable mouth pieces that must be used - are there enough of those in stock?

    BTW - one of the old 2006 links I posted gave the dollars spent by each state. They didn't always specify respirators, but we could assume some $$ were going that direction.

    .

    Leave a comment:


  • colormyquilt
    replied
    Re: Medical care, under dire circumstances

    Thanks, Rocky. Should have read your earlier post closer.

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  • Rocky
    replied
    Re: Medical care, under dire circumstances

    Minnesota has 700 ventilators and are buying 300 more?

    population - 5,132,799 * 35% = 1.8 Million infected... If only one out of a hundred need ventilators at a time, they will need 18,000

    isn't anyone scratching their head and wondering who was getting prepared for this?

    If that is a state that was thinking ahead, what about the ones who weren't?

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