COVID-19

[Jim123]

I think the hospital administrators probably understand it better than journalists, let alone the general public.

Funny though, it's not a mind-bending concept. I mean workforce specialization is pretty universal in the adult world.

Or maybe the general public does understand it, if you take thirty seconds to explain it to them, and a lot of the journalists are smarter than I give them credit for, but "boring news" doesn't sell- controversy does.

 

[Gatordev]

Then why don't those workers go to the affected areas where I see nurses crying on TV about how horrible it is. Why aren't those hospitals, lacking lessor and elective surgeries filling up with COVID related cases, or even filling with the heart attacks, strokes, burns, gunshot wounds etc transferred from the over run COVID epicenter hospitals. Have all the accident, cancer, maternity cases requiring hospitalization at the "epicenter" hospitals so over run just drying up? Why are they not filling other hospitals?

Varied scarcity is certainly part of it, but one major reason they're not doing what you're saying is because a large number of hospitals in this country can't support or care for those higher demand patients. It has been absolutely eye-opening seeing how bad the surrounding hospitals outside of the city centers are and how quickly they get overloaded with just one complicated patient. And even in city centers, not all hospitals (including trauma centers) are equal. There's one well known Level 2 Trauma Center that is notorious for accepting patients from the rural areas, bill them, then bounce them to the main hospital a day later where they should have gone in the first place. The care there is also notorious.

Something else to consider is there are a lot of people in that hospital who can't legally work on individuals coming in, and probably shouldn't because of lack of familiarity. Peds is a big one, as non-Peds docs aren't very good with kids and a lot of Peds ARNPs can't legally care for adults...and may not be able to from a knowledge standpoint.

 

[taxi1]

Ding ding ding!!! We have a winner.

They're using all kinds of doctors to monitor the patients. I know they are at our hospital.

Hospitals redeploy specialists to COVID-19 front lines

Specialists like anesthesiologists, orthopedic surgeons and cardiologists, who don't typically treat infectious disease patients, are heeding calls from overwhelmed hospitals to help treat the rising number of COVID-19 patients.

www.modernhealthcare.com

 

[picklesuit]

I think it falls more under “every Marine is a rifleman” doctrine. Every doctor had a basic level of medical knowledge that can be applied, with proper supervision, to the problem.

 

[ABMD]

Another thing no one is talking about - healthcare professionals are not a homogeneous blob. Many specialize in a field. The plastic surgeon and nurses operating to save a burn victim are not the same people as the obgyn and nurses doing an emergency c-section, and none of the above are the people who would provide week long icu care to COVID-19 patients.

Truth. My wife is an OR nurse. She does OR nurse things, she doesn't do rounds, she doesn't speak with patients (who are conscious) and doesn't do "normal" nurse things, she is specialized in what she does. She even said, if they asked her to assist in another part of the hospital it would take days or longer to train her or others from her dept to learn what would be required of them. She also confirms, at least at her hospital, they aren't doing any elective surgeries and PPE inventory is low.

 

[Pags]

It also seems like a lot of specialists are contracted to hospitals via parent companies. Even if the hospital and the specialist were onboard with doing generalist work it could require contract work with contracting company, etc. None of these issues are insurmountable but it's certainly a more complex problem than "just have the plastic surgeons start intubating people."

Also, even if people are in an area that hasn't been hit saying they should go where there are problems isn't easy as they may have family obligations where they are and can't just run across the country to say nothing of who's going to pay for the travel costs.

 

[wink]

I think it falls more under “every Marine is a rifleman” doctrine. Every doctor had a basic level of medical knowledge that can be applied, with proper supervision, to the problem.

This is what I was thinking. If it is truly a crisis, people dying because of over worked personnel, you do what you can. Any nurse can make rounds and check vitals once someone is stable. If you clean and sanitize rooms in one hospital you can in another. You can prepare instrument trays and stock anywhere. In an emergency I am sure there are uses for most idle personnel. Is this an emergency or not.

I am also getting tired of referances to war zones or mass casualty events. COVID patients do not arrive in waves. They do not require the same sort of triage. Hours of surgery by entire teams is not required to repair trauma to the body. COVID patients are almost always able to speak and participate in their care on arrival and initial diagnosis. Props to all the health care folks, especially the low wage orderlies and custodial people. All of their jobs are harder just because of the PPE requirements. Let alone risk. But let's be honest. Most of the care given COVID patients is shift work like any other day in the ICU. And psychologically, I can't imagine it is like seeing a dozen twentysomethings bleeding out in the ER, losing a 5 year old drowning victim after an hour fight, or watching a couple premature babies die in a single shift.

 

[ABMD]

It also seems like a lot of specialists are contracted to hospitals via parent companies. Even if the hospital and the specialist were onboard with doing generalist work it could require contract work with contracting company, etc. None of these issues are insurmountable but it's certainly a more complex problem than "just have the plastic surgeons start intubating people."

Also, even if people are in an area that hasn't been hit saying they should go where there are problems isn't easy as they may have family obligations where they are and can't just run across the country to say nothing of who's going to pay for the travel costs.

Yup, my wife said nurses are being offered up to $10k/week (3 week minimum) to go to NYC. I think the offer is so high for that reason.

 

[taxi1]

And psychologically, I can't imagine it is like seeing a dozen twentysomethings bleeding out in the ER, losing a 5 year old drowning victim after an hour fight, or watching a couple premature babies die in a single shift.

About 15% of the total patients are health care workers, with a lot of them getting very sick. Seems the initial viral load makes a difference in the race between the virus and your immune response, so they often get really sick.

I have engineers working for me dedicated to making PPE. Now they're doing a custom intubation shield (like a box over the patient) that keeps all the coughed up virus-laden goop from flying around. The doctors we are supporting at Hershey are pushing us hard to get them built before the anticipated surge next week.

There are now deaths with health care workers too, from cleaning folks to ER docs. There will be more. Hopefully we'll rally up and build a memorial for those who lost their lives in this.

Worth a google on "covid19 doctor experience". Illuminating.

 

[wink]

About 15% of the total patients are health care workers, with a lot of them getting very sick. Seems the initial viral load makes a difference in the race between the virus and your immune response, so they often get really sick.

I have engineers working for me dedicated to making PPE. Now they're doing a custom intubation shield (like a box over the patient) that keeps all the coughed up virus-laden goop from flying around. The doctors we are supporting at Hershey are pushing us hard to get them built before the anticipated surge next week.

There are now deaths with health care workers too, from cleaning folks to ER docs. There will be more. Hopefully we'll rally up and build a memorial for those who lost their lives in this.

Worth a google on "covid19 doctor experience". Illuminating.

My son is an engineer with one of the big oil services companies. He runs an additive manufacturing ( 3D printing ) shop. His machines are running 24/7 making PPE equipment. Lots of hospitals in Houston.

 

[TimeBomb]

Combat casualty care/mass casualty care and our current crisis are two sides of the same coin. Both test the medical system, but in different ways. Equating the two situations isn't correct, but they have significant overlap.

Seeing young people die from combat trauma, MVA, or drowning is quite different than this experience. Yeah, they both really suck, but psychologically, the two experiences don't push the same buttons. There is a substantial amount of distress generated in knowing that every COVID-19 patient you care for can kill you, especially when you're using your only N-95 mask for the third straight day.

Caring for COVID-19 patients is a multidisciplinary effort as well, just not surgical, but medical. You need cardiology to manage the myocarditis, nephrology to manage the renal failure, pulmonary/critical care to run the vents and ARDS treatment, ID to honcho the latest bright, shiny treatment, and internal medicine to make sure all the other coexisting conditions dont fall off the radar. The big centers seeing lots of COVID-19 patients are managing their cases in this manner.

We haven't had to triage COVID-19 cases as one would in a mass casualty scenario...yet. It may come to that at some point or in some locations. I believe that will depend on how many people come in with severe COVID-19 infection, and how fast they get better or die.

V/R

 

[Gatordev]

Every doctor had a basic level of medical knowledge that can be applied, with proper supervision, to the problem.

You'd be surprised. And where/who is the supervision? Again, it is absolutely crazy where the level, or lack thereof, of care that's out there. The other day during an interfacility transfer, my guys had to spend 45+ minutes starting from scratch with a patient after the mess that a hospital had created after admission. Lines weren't even going in the right direction. So much for the Golden Hour.

Most of the care given COVID patients is shift work like any other day in the ICU.

Wink, I get your overall point, but I don't think you have a full grasp of the reality of how the medical system works. "Any other day in the ICU" is leaps and bounds above what a typical floor nurse does. Peds adds another level of complication. Add in Extenders (ARNPs/PAs) and it gets more segmented.

Or to put it in a more accessible way... My wife cares for Peds Cardiovascular ICU patients as an ARNP. It's not uncommon she's responsible for 12 babies/infants with seriously bad heard conditions and no doctor physically in the unit (and sometimes another Cardiologist in the PICU won't even come over to help if she calls). But she'd be the first to tell you that you wouldn't want her to be your primary person if you came in with a DVT because she doesn't really know what to do with you as an adult.

 

[Swanee]

I think it falls more under “every Marine is a rifleman” doctrine. Every doctor had a basic level of medical knowledge that can be applied, with proper supervision, to the problem.

Eh. Not so much.

This is like telling a jet pilot to fly a helo in combat on their first (or 3rd) time in the helicopter.

Surgeons cut, radiologists read scans (some do interventional procedures), pathologists spend their time looking in a microscope, medical examiners deal with dead people, psychiatrists talk and observe moods.

There is a HUGE reason why you have to redo your residency if you switch specialties.

 

[wink]

Eh. Not so much.

This is like telling a jet pilot to fly a helo in combat on their first (or 3rd) time in the helicopter.

Surgeons cut, radiologists read scans (some do interventional procedures), pathologists spend their time looking in a microscope, medical examiners deal with dead people, psychiatrists talk and observe moods.

There is a HUGE reason why you have to redo your residency if you switch specialties.

Sure. And most all this folks are required right now even in their speciality. And if they happen to be shuffling by when my loved one is gasping for breath, blue in the face and burning up I'd rather have anyone of them over no one at all just because they didn't have the right PQS signed off. In flight on an airliner we have all sorts of medical professionals volunteer when needed and they save lives.

 

[HAL Pilot]