Coronavirus Discussion Thread

[FiremanMike]

No, we follow our basic training. We DO NOT enter an unsafe scene. Attending a COVID-19 pt without MEGG (mask, eye protection, gown, and gloves) is an UNSAFE scene. Universal Precautions work well but only at all when used universally.

Would you ever enter a burning structure without SCBA just because your department didn't have enough working ones on hand?

No SCBA = no entry ---------------------- no mask = unsafe scene

EMS's core safety concept is we do not ever enter an unsafe scene. To do so is critical fail and irresponsible.

A guideline we have learned from day one is "it's not our emergency." We ALWAYS put our safety first, followed by our partner's, and our patients'.

These life sustaining guidelines are just as true at a one patient call, a huge bus crash, or yes one heck of a nationwide pandemic.

Ok, then what's your solution for if/when we run out of PPE?

 

[NomadicMedic]

I'll just put this here:

This Page is No Longer Available

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).

www.cdc.gov

 

[RocketMedic]

I'll just put this here:

This Page is No Longer Available

This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”).

www.cdc.gov

Should probably mention that the CDC is subject to political pressure and that these guidelines are not necessarily unbiased.

 

[FiremanMike]

On this point my experience is entirely different from yours. When I started, we routinely restrained patients on our own (without law enforcement) unless they had firearms or knives). Now, we are required to "stage" (basically hide around the corner and await law enforcement) on many calls including preteen and early-teen suicide gestures by pills. What is the kid going to do, throw the pills at my partner and me? On a call a while back, my partner and I were required to remain staged for just shy of an hour while a man with a gunshot wound was prone on the dark blacktop on a sunny afternoon with the temperature at 105 degrees. We watched him try to crawl, then just move arms, finally seize, then never move again as he had died. Law enforcement told us the scene wasn't safe because they were searching for a suspect who, it turned out, did not exist as the deceased had shot himself then staggered into the street.

It is now accepted as proven that SARS-CoV-2 virus lives on some hard surfaces for 3 days or more and on porous materials for hours. When a single-use mask is over you mouth the outside catches droplets which carry virus. You gown performs the same function and gathers droplets and thus virus particles. The act of bagging, storing, unbagging, and reusing means that you are handling a contaminated item. Pathogens from the already used item transfer to your hands even if gloved. You then touch the inside part of that same mask and you have just placed virus inside the mask and ready to be sucked into your mouth with you inhale through the mask. You are contaminated. And that has nothing to do with whether the single-use mask is mechanically able to perform properly once its designed single use has taken place.

Contaminated, you go home each evening as the virus count increases and you pass the infection to your souse, kids, parents, and grandparents. The improper and unsafe reuse of a disposable medical supply has now compromised your loved ones. That my friend is why we ALWAYS use Universal Precautions and NEVER enter an unsafe scene. Our professional responsibility requires that we not contaminate others. Above all else, do no harm!

Just so I'm clear, in the beginning of your post you opine about the good old days when we wouldn't wait for cops and bitterly recalled watching a man die while the cops searched for a potential gunman..

Then in the end of your post and the general tone of your other posts on the topic of covid, you imply that you'll refuse to even be near covid patients if you don't have a fresh set of PPE..

Does that about sum it up?

 

[Summit]

Single-use medical equipment (and even more so, medical supplies) can, under federal law and regulations, only be reused if cleaned and repackaged by an entity holding federal license to manufacture equipment of that type. No EMS provider holds such a license. This reuse is not only unsafe and dumb, it is ILLEGAL.

No...
https://www.fda.gov/medical-devices...vation-strategies-letter-healthcare-providers
Not in desperate times

And these are desperate times (because of insufficient preparation)

And now we are in a viral war where we are going to be sent into battle with tattered boots and one pair of socks.

 

[Medic511]

Firstly if you are staged so close to a location that you are able to see someone crawling just in front of the residence, that defeats the purpose of being staged...

My partner and I staged where we were told to. In our opinion there never was any threat to us. Dispatch had been told, and she passed on to us when we requests available details, that the RP was a neighbor who had witnessed the patient shoot himself and stagger to the road. Law enforcement directed that "EMS stage at 123 Streetname" We did. We carried (as was required by that service with rural areas) a set of binoculars.

Regarding duty, we have no legal duty to follow unsafe directions. We have a moral obligation not to follow directions that unreasonably place others in danger. (Of course, "unreasonable" is subjective and perhaps it is that about which we do not agree.) The decision that I have to make is whether I will report to work if I know that I will be requested to reuse "single-use" supplies. That I will not do. So, my decision is complicated by the fact that some, as have you, will argue that I cannot decline only those calls that I feel are unsafe, that is those with possible COVID+ patients when I have inadequate PPE for such a call. So, you are arguing that I should simply quite my job. Well, if you feel that to be my correct decision, I should have quite on my first day at work about 20 years ago because I had been taught and I had decided that I would never knowingly enter an unsafe scene. Being merely human, of course, I could not tell until I was on scene whether the scene would be safe, as I had been taught that scene safety was a rational, fact-base decision and not a mantra to be chanted upon arrival.

Part of my frustration is that pandemics are know to occur. A federal government exercise last year sponsored by the current administration clearly identified an enormous shortage of medical supplies specifically including gowns and gloves. Not a single item was purchased that I know of to address the issue. Whose emergency do YOU think this is?

You can read about the details at this link:

Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded

 

[FiremanMike]

My partner and I staged where we were told to. In our opinion there never was any threat to us. Dispatch had been told, and she passed on to us when we requests available details, that the RP was a neighbor who had witnessed the patient shoot himself and stagger to the road. Law enforcement directed that "EMS stage at 123 Streetname" We did. We carried (as was required by that service with rural areas) a set of binoculars.

Regarding duty, we have no legal duty to follow unsafe directions. We have a moral obligation not to follow directions that unreasonably place others in danger. (Of course, "unreasonable" is subjective and perhaps it is that about which we do not agree.) The decision that I have to make is whether I will report to work if I know that I will be requested to reuse "single-use" supplies. That I will not do. So, my decision is complicated by the fact that some, as have you, will argue that I cannot decline only those calls that I feel are unsafe, that is those with possible COVID+ patients when I have inadequate PPE for such a call. So, you are arguing that I should simply quite my job. Well, if you feel that to be my correct decision, I should have quite on my first day at work about 20 years ago because I had been taught and I had decided that I would never knowingly enter an unsafe scene. Being merely human, of course, I could not tell until I was on scene whether the scene would be safe, as I had been taught that scene safety was a rational, fact-base decision and not a mantra to be chanted upon arrival.

Part of my frustration is that pandemics are know to occur. A federal government exercise last year sponsored by the current administration clearly identified an enormous shortage of medical supplies specifically including gowns and gloves. Not a single item was purchased that I know of to address the issue. Whose emergency do YOU think this is?

You can read about the details at this link:

Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded

Is it the federal government's responsibility to buy supplies for your agency? They don't buy anything for mine..

 

[Medic511]

Just so I'm clear, in the beginning of your post you opine about the good old days when we wouldn't wait for cops and bitterly recalled watching a man die while the cops searched for a potential gunman..

Then in the end of your post and the general tone of your other posts on the topic of covid, you imply that you'll refuse to even be near covid patients if you don't have a fresh set of PPE..

Does that about sum it up?

It makes the point that there is a disconnect somewhere along the line and that safety (a fundamental and good policy) can be interpreted and potentially bent so it barely resembles its original purpose. The staging-while-patient-died was not long a ago and the staging-for-teenybopper-'suicide' was a few month ago. So passage of time is not a likely explanation of the difference.

I may also have failed to make clear that, at the minute, it's more a matter of cost than availability. Example: chef's coats and aprons are currently available and can be easily washed and sanitized, then safely reused. The problem? Cost mostly and a true purist may argue that medical use of culinary gear is not allowed. But THAT is not the argument the 'outside the box bean counters' are reusing. The practical objection is cost. The impact my friend is on your health and your loved ones' health.

 

[FiremanMike]

It makes the point that there is a disconnect somewhere along the line and that safety (a fundamental and good policy) can be interpreted and potentially bent so it barely resembles its original purpose. The staging-while-patient-died was not long a ago and the staging-for-teenybopper-'suicide' was a few month ago. So passage of time is not a likely explanation of the difference.

I may also have failed to make clear that, at the minute, it's more a matter of cost than availability. Example: chef's coats and aprons are currently available and can be easily washed and sanitized, then safely reused. The problem? Cost mostly and a true purist may argue that medical use of culinary gear is not allowed. But THAT is not the argument the 'outside the box bean counters' are reusing. The practical objection is cost. The impact my friend is on your health and your loved ones' health.

Perhaps you are not involved in purchasing at your agency, but I am responsible for it at mine. I can assure you, the cost has not changed even slightly, availability is ZERO, and manufacturers aren't even giving a backorder date anymore..

 

[DesertMedic66]

You could also get full leather BDSM suits and then just wipe each other down with sani-wipes after each call and call it good.

 

[Peak]

You could also get full leather BDSM suits and then just wipe each other down with sani-wipes after each call and call it good.

Or we can do the rain/snow homeless special. Trash-bag top, personal belongings bags shoes.

 

[Medic511]

Is it the federal government's responsibility to buy supplies for your agency? They don't buy anything for mine..

Well, we can probably agree that it is NOT your responsibility or mine to buy our agency's/department's PPE but that it is their duty to do so. It would be our medical director's responsibility to be sure that the "available" resources and caches ARE adequate. It is the states responsibility to assure the the EMS and Health Service folks in their state are fullfilling their responsibilities in that regard and the the hospitals are fulfilling theirs. Hospital bean counters year back saw there were, in total, billions of dollars in supplies sitting around but that each month only a small fraction of those were used. So, hospitals started buying less and targeting to purchase each month just slightly what was used in similar prior periods. They saved big bucks and the CEO got handsome bonuses. BUT, and it's a big one, the rainy day (pandemic) caches were depleted almost out of existence. The entire US strategic stockpile of N95 masks in February was 13 million. (Please remember, we have 330 million or so people. Does that sound adequate to you?

For a detailed report of who learned what about the adequacy of our country's medical preparation for a pandemic, please take the time to actually the following news article and please don't judge it before you read it):

Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded

[I fixed bad link. Sorry!]
It just is not our place to endanger lives by spreading an infection as a result of working unsafe scenes with inadequate and improper gear. Above all else, it is our professional responsibility to do no harm. To me, that includes not doing things that we know to a certainty will pass on an infection. You will have to make your own decision of course. Committing suicide because of shame over being unable to accomplish an important task is common in some cultures but not in mine.

 

[DesertMedic66]

Or we can do the rain/snow homeless special. Trash-bag top, personal belongings bags shoes.

I look better in a skin tight BDSM suit than trash bags. Might as well feel fabulous while getting infected.

 

[Medic511]

Perhaps you are not involved in purchasing at your agency, but I am responsible for it at mine. I can assure you, the cost has not changed even slightly, availability is ZERO, and manufacturers aren't even giving a backorder date anymore..

Mike: With all due respect, you did not read what I wrote. I rather plainly said that there are OTHER products that will work but are more costly. If you are risking your people because you are not reading the information available to you, please maybe consider getting some sleep and taking a new run at finding something that works for your people. You will not be a hero if you stay within budget and loose staff or run up legal costs because you sent people to risky call with inadequate some talking point suggested. (The laguage being used across the coutry clearly has a common origin. )

 

[FiremanMike]

Mike: With all due respect, you did not read what I wrote. I rather plainly said that there are OTHER products that will work but are more costly. If you are risking your people because you are not reading the information available to you, please maybe consider getting some sleep and taking a new run at finding something that works for your people. You will not be a hero if you stay within budget and loose staff or run up legal costs because you sent people to risky call with inadequate some talking point suggested. (The laguage being used across the coutry clearly has a common origin. )

Ok, well your position is known. You’ll be calling off sick wishing things were different and most of the rest of us will be at work, making the best of this reality..

 

[ffemt8978]

I look better in a skin tight BDSM suit than trash bags. Might as well feel fabulous while getting infected.

Great...now in addition to a shortage of hand sanitizer, we're going to have a shortage of mind bleach.

 

[Seirende]

Great...now in addition to a shortage of hand sanitizer, we're going to have a shortage of mind bleach.

I went to a mind bleach site once and was quite disappointed to discover that the babes section was not full of smiling babies.

 

[RedBlanketRunner]

Is he trying to kill people? The heck with impeachment. How about 70 million counts of reckless endangerment?

March 21, 2020, 10:17

Donald J. Trump

✔ @realDonaldTrump

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....
....be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov

Dr. Edsel Salvana

✔ @EdselSalvana
Please don't take hydroxychloroquine (Plaquenil) plus Azithromycin for #COVID19 UNLESS your doctor prescribes it. Both drugs affect the QT interval of your heart and can lead to arrhythmias and sudden death, especially if you are taking other meds or have a heart condition.
(https://www.virology-education.com/edsel-salvana-md-dtmh-fpcp-fidsa/)

 

[SandpitMedic]

Is he trying to kill people? The heck with impeachment. How about 70 million counts of reckless endangerment?

March 21, 2020, 10:17

Donald J. Trump

✔ @realDonaldTrump

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....
....be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov

Dr. Edsel Salvana

✔ @EdselSalvana
Please don't take hydroxychloroquine (Plaquenil) plus Azithromycin for #COVID19 UNLESS your doctor prescribes it. Both drugs affect the QT interval of your heart and can lead to arrhythmias and sudden death, especially if you are taking other meds or have a heart condition.
(https://www.virology-education.com/edsel-salvana-md-dtmh-fpcp-fidsa/)

View attachment 4835

Ummm hey guy.... mr orange man bad guy....
Yes, um, do you think these drugs grow on trees? Perhaps you can make them with common household products under the sink? Is there an Azithromycin fairy- do I leave an NSAID and wake up with a Z-Pack?

YOU GET THEM WITH A PRESCRIPTION FROM A DOCTOR.... you don’t buy Hydroxychloroquine off the street, dude.

(I noticed you intentionally omitted the part of the context where the speakers also addressed this being a decision between a patient and their doctor... convienient for your agenda).

Cut out the political posts. We get it... you’re smarter than us all- and POTUS is antichrist. You’ve been heard, move along now.

 

[SandpitMedic]

Is he trying to kill people? The heck with impeachment. How about 70 million counts of reckless endangerment?

March 21, 2020, 10:17

Donald J. Trump

✔ @realDonaldTrump

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).....
....be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov

Dr. Edsel Salvana

✔ @EdselSalvana
Please don't take hydroxychloroquine (Plaquenil) plus Azithromycin for #COVID19 UNLESS your doctor prescribes it. Both drugs affect the QT interval of your heart and can lead to arrhythmias and sudden death, especially if you are taking other meds or have a heart condition.
(https://www.virology-education.com/edsel-salvana-md-dtmh-fpcp-fidsa/)

View attachment 4835

Also it’s really laughable that your source to bash the POTUS and how to treat/not treat COVID is from the NIGERIAN CDC! Hahaha.

Dude... stretching it thin to another level! I didn’t know that Nigeria was hiding the most brilliant doctors and scientists.