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Two Letters Re: Triage in Emergency Mass Critical Care (EMCC) Events
Dear Jim,
This letter is in response to NC Bluedog's very informative article that appeared
today. Here in rural Wisconsin, we have the same problems as he noted--shortage
of high-technology life-saving devices. This is due to the overall situation
that our medical care industry is dollar-driven. He have a small hospital,
and two more within a 15 minute dash via ambulance. Each hospital has at least
a four-bed Intensive Care Unit (ICU) with a ventilator per bed, and at least two extra ventilators
that can be used outside of their ICUs. Beyond that, there are none available.
Extra units would have to be imported from major hospitals within the state.
To get these units would take time, along with the funding to lease them--providing
the disaster is confined to my area. The hospitals in my area are not sufficiently
wealthy to do this in a mass emergency event.
So, in a TEOTWAWKI situation, what can you or I do? There is a solution. Each
EMT and Paramedic have in their Rescue bags, a set of airways and a bag-valve
mask. Some even have a device called a "Pulse Oximeter." This unit
measures the amount of oxygen in the blood. When an airway, bag mask, and Pulse
Oximeter are used in conjunction with each other, you have a primitive ventilator.
There are more devices that are available to the EMT/Paramedic, but all require
more advanced training in their use. I won't go that way here. However, to
use these devices requires training, and I suggest that you enroll in the proper
program to use them correctly. The only down-side to ventilating a patient
in this manner is very time-consuming and labor-intensive. If you must do this
for any length of time, I suggest you have several individuals willing to take
over and give the proper ventilations to the patient. This method is used in
our hospitals as a back-up should there be a ventilator failure.
How much does this cost? The basic set of six airways will run approximately
less than $5, and bag-valve-mask starts at approximately $10 and goes
up, and the killer is the Pulse Oximeter. I've seen them advertised starting
at $300 and continue on up through the roof. If you are a family, and
have the need for such a unit, (an asthmatic child, etc.) talk to your insurance
company and see what can be done. If you are a member of a group, talk it over
and have each member donate toward the cost. Then get proper training. These
units together are not hard to use or understand. Think about this when you
have your next group meeting. All of these devices can be purchased Over The Counter (OTC) from
the better Medical/EMT supply companies.
I hope this small solution will answer a lingering question that any of you
have concerning the availability of ventilators in an emergency. Start thinking
about, and plan for, the addition of airway management tools to your medical
preps. Doing so now will give you an edge up when the day comes. - DS in Wisconsin
Jim:
The other dirty secret that isn't described is that at some point, you
will run into staffing issues. I'm an Intensive Care nurse at a big teaching
hospital,
and I find the challenge of a complex patient: managing ventilators and "dancing
on the vasopressors" is second nature and even quite fun.
NC Bluedog makes a good point that the hospitals are chronically short of staff
an money, but let's play with the idea further. We'll grant that we've been
able to find intrepid and dutiful nurses and physicians who will work for free
and will work more than a hundred hours a week. And the Ventilator Fairy drops
all of the vents (and warmers, IV pumps, heart monitors, Swan-Ganz monitors,
etc, etc, etc...) that we need. Even with the Hollywood Scenario, at some point
there will not be staff. Certainly in an outbreak, but I wonder about it often
during especially bad flu and pneumonia seasons. There will be no staff because
they're all out sick themselves (the stress and long hours having weakened
their immune system in the face of super bugs, or just the "run-of-the-mill
the native drug-resistant ones we have in the hospitals now), or because they've
got a sick family member to care for. Or they have their own kids to look after-
recall earlier this year when Singapore (or was it Hong Kong?) closed the schools
for two weeks to prevent the spread of an especially bad infection. Someone's
going
to have to stay home with all those quarantined kids. I can't put them in day
care while I head to the hospital after all.
And at some point the devotion to duty will start to fail. Even with the threat
of lost licenses (State Boards of Nursing frown on folks who walk away from
their patients or who don't show up when needed), folks will feel the need
to be home with their kith and kin.
And that's when we reach Kunstler's "World Made by Hand" - Regards,
Michael G.
