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Two Letters Re: Triage in Emergency Mass Critical Care (EMCC) Events
Jim:
Two minor notes:regarding the letter from DS in Wisconsin:
Pulse Oximeters are cheaper now than ever. Some drug companies give them
away as promo's. You can find them online starting well under $100, some
nearer
to $50. These are battery operated self-contained finger clamp units, but
I've seen nurses at more than one hospital using them to take vitals.
Secondly, while it is possible to ventilate a patient by hand for long
term, it is not very practical. You'd need a staff of dedicated people
that are willing
to perform a laborious and painful task for hours on end, rest a bit, and
then go in for another shift, and to keep this up for days or longer. If
you don't
think it is painful, then practice by squeezing one of your dog's larger
squeaky toys non-stop for, say, 3 hours. Do it in one place, without moving
the toy,
and while you are standing up. Don't stop for more than 30 seconds or your
squeaky toy will die. You will need to keep this up for the entire duration
that the patient needs ventilation, or the patient will expire. While you
might be able to pull this off for one family member during a crisis, to
plan on
using this method for treating mass casualties in an outbreak is more than
a little bit optimistic.- Patrick M.
Jim,
In response to the e-mail from DS in Wisconsin: There’s no way anyone
can BVM (bag-valve-mask) aka ventilate a patient over an extended period of
time,
it’s
strictly for transporting patients (usually under half an hour). There are
several “disaster” ventilators
available that rely on purely mechanical ventilation and will function over
a longer period of time (think bird flu). Do a web search on “surevent” for
an example. Individual pricing for these “disaster” vents is usually
under $100. For patients who can breath on their own, do a web search on “bubble
CPAP”, a device that can be manufactured at home. In all cases you will
need a source of air and/or oxygen that has absolutely no oil
residue (remember how a diesel engine works?)—use commercial medical
grade compressed gases/compressors only.
As a clinical engineer, I often wonder where people get their ideas. Pulse
oximetry (SpO2) is not a reliable indicator of oxygen perfusion, although from
an equipment standpoint, it is the cheapest indicator. If you have critical
needs, or money to burn, end tidal CO2 (etCO2) is the way to go.
