The virus. PPE. Part 1

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Donnie said:
LOL, yeah we're being protective, we're just insecure and pretending things are more complicated than they really are to retain some sense of status.
:rolleyes::rolleyes::rolleyes:

Intensive care nursing and as a medicine continually develops and has done for decades, but it develops incrementally, there's no massive strides and changes to practice to be seen.
OK, now in a time of crisis, which it very much is (or more accurately is continuing towards) there will be changes when it comes to the rationing of ventilators and it really will be rationing, a process to stop many getting as far as needing or being put on a vent.

For example where normally there would be little restriction on who gets it, now many will be denied itu and instead automatically be put on an end of life pathway, but thats ok because its a crisis.

Properly caring for intensive care patients is not something a nurse can be trained to do in a matter of weeks, anything less than properly trained staff is not caring for them, it's not treating them, it's hoping nothing will go wrong and trusting in blind luck.
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1) No-one is saying you're pretending it's more complicated or you're insecure etc - but it's rather odd that you should bring it up.
2) We know rationing and 3 wise men will come in, so a different approach, maybe something outlandish would make a difference but I appreciate "do no harm" is your guiding principle and as I said litigation is stifling.
3)Where did I say get someone in off the streets to run ICU/HDU and trust to blind luck.

My family have had to use the NHS over the last 10 years quite a bit and I have nothing but the highest praise for the life saving care they received.

Answer this by all means if you wish but we're never going to agree so I'm out of this one with you, hope that doesn't come across as petulant or aggressive as it's not meant that way just that we've reached the end of this road I feel.
 
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Marc said:
Yes, really. What you quoted doesn't say that people from other areas can't come up with solutions, just that, when someone with knowledge and experience in that particular field says that YOUR solution won't work, it's pointless to keep pushing the same solution
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Or maybe that person in that field just lacks the vision to make or allow change. We are in unprecedented times, new thinking and processes are required.
 
Donnie said:
Unfortunately not and the your very words "if symptoms go outside certain parameters" show your lack of knowledge on how ventilators fit in the care of a ventilated patient as ventilators don't show symptoms for a start.
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I know ventilators don’t record symptoms, my point was I do know how to take a temperature, blood pressure, pulse etc with other equipment, although my certificates have long expired. I was simply making the point that others may assist the higher trained regular staff with “set” routines in the unusual situation of many patients with the same condition.

(I was one of the original community first responders when St John Ambulance piloted it around 2003, but wouldn’t pretend to know more than any medical professional)
 
nilagin said:
And knowing how to be a ventilator operator doesn't mean you have to be an ICU nurse. If the manufacturers are providing the training, do you think it will be ICU nurses providing the training?
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I have no idea about that in particular but that is roughly what manufacturers/reseller do, ie employ nurses/doctors as representatives (not called salesmen usually :)) to demonstrate how wonderful and magical their equipment/drug is otherwise any professional’s bullshït detector would kick in :).

Edit to circumvent TP software’s prissy bullshït detector :).
 
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sphexx said:
Great advances are rare because novel ideas are more likely to kill the patient than cure them (as I think Christian Barnard’s did initially?) — it’s rather like mutations, a tiny number are good but most are harmful/fatal :(.
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I doubt today he could survive the litigation that would surely come his way, you're correct some of his patients didn't live very long after transplant, so I doubt we'll see such transformative procedures ever again.
 
sphexx said:
I read your links but my point is that, once again, as Paul @Donnie says, the numbers are as vague as farts (I always though farts were quite emphatic but I bow to his specialist knowledge) . This is sad because I’m really sure there’s no real difference in our views on this particular matter just a failure of dialogue. :(.
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It's only vague in the fact that the logistics aren't detailed. Details we don't really need to know. Let's just say they had said 8k ventilators will be delivered this Thursday at 2pm. Now unless you are the one they are delivering to, the finer details mean diddly squat to anyone reading a newspaper or internet site story.
 
nilagin said:
It doesn't have to be vehicular, the process can be applied to anything. A few years ago I was working with an engine calibration engineer, he left to work in his local hospital to take care of their equipment.
Look at my links earlier listing all the car companies and formula one teams being enlisted to manufacture ventilators, whether it is reverse engineer existing ventilators or design new ones.
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Yeah, but he didn't leave to carry out surgery or care for seriously ill patients.
 
Donnie said:
LOL, yeah we're being protective, we're just insecure and pretending things are more complicated than they really are to retain some sense of status.
:rolleyes::rolleyes::rolleyes:

Intensive care nursing and as a medicine continually develops and has done for decades, but it develops incrementally, there's no massive strides and changes to practice to be seen.
OK, now in a time of crisis, which it very much is (or more accurately is continuing towards) there will be changes when it comes to the rationing of ventilators and it really will be rationing, a process to stop many getting as far as needing or being put on a vent.

For example where normally there would be little restriction on who gets it, now many will be denied itu and instead automatically be put on an end of life pathway, but thats ok because its a crisis.

Properly caring for intensive care patients is not something a nurse can be trained to do in a matter of weeks, anything less than properly trained staff is not caring for them, it's not treating them, it's hoping nothing will go wrong and trusting in blind luck.
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But that isn't to say non ICU staff can't be trained to assist with certain functions.
In the Sky news video of the hospital in Italy, they were rotating the patients to help them breathe, you don't need to be an ICU trained nurse to do that.
 
nilagin said:
Or maybe that person in that field just lacks the vision to make or allow change. We are in unprecedented times, new thinking and processes are required.
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Astrophysicist gets magnets stuck up nose while inventing coronavirus device

'Australian Dr Daniel Reardon ended up in hospital after inserting magnets in his nostrils while building a necklace that warns you when you touch your face'

https://www.theguardian.com/austral...ck-up-nose-while-inventing-coronavirus-device
 
nilagin said:
But that isn't to say non ICU staff can't be trained to assist with certain functions.
In the Sky news video of the hospital in Italy, they were rotating the patients to help them breathe, you don't need to be an ICU trained nurse to do that.
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But thats not what you were advocating intially, you were talking about training people to use ventilators in a matter of days. As for the sky video, i have not seen it so have no reference to know what "rotating the patients to help them breathe" means?
 
Marc said:
Again, no-one is saying there can't or don't need to be changes, they're just pointing out why YOUR solution wouldn't work. What part of that are you not getting?
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No, he is just basing it on current practices.
It's no different to the car companies bringing in their higher production processes to the ventilator manufacturers to change production from 100's a month to 1000's.

Donnie won't have come up with the work processes, he is just following them. It doesn't mean someone else can't find alternative processes or work practices to become more efficient and effective.
 
gman said:
Now that so many are in "lock down" and we are all frantically washing our hands, it would be interesting to see if there is a reduction in other bacteria and viral infections when compared against trends for the same period in past years?
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The sales of moisturiser must be going through the roof... All this extra hand washing and use of the gel has done quite a bit of damage to the skin on the back of my hands, especially on the knuckles.
 
Retune said:
Astrophysicist gets magnets stuck up nose while inventing coronavirus device

'Australian Dr Daniel Reardon ended up in hospital after inserting magnets in his nostrils while building a necklace that warns you when you touch your face'

https://www.theguardian.com/austral...ck-up-nose-while-inventing-coronavirus-device
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I saw a much easier solution on facebook. Just add Tabasco sauce to your soap and or sanitizer. You'll soon learn to keep your hands away from your face.
 
nilagin said:
Donnie won't have come up with the work processes, he is just following them. It doesn't mean someone else can't find alternative processes or work practices to become more efficient and effective.
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sigh, again that shows naivety on how nhs teams work, we are not just told what to do and then obey. The whole system of clinical governance within the nhs promotes all voices in the team being equal and valid and instills challenge in the system. Everyone is involved in these processes otherwise there is no ownership.

Ive already stated what the alternatives processes and work practices are but you choose to ignore them in favour of you being right
 
Donnie said:
But thats not what you were advocating intially, you were talking about training people to use ventilators in a matter of days. As for the sky video, i have not seen it so have no reference to know what "rotating the patients to help them breathe" means?
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It doesn't matter how long it will take to train. It's not like this is going to go away fast. We have trained ICU nurses now that can operate them, in 2-3 months time we could have a lot more nurses trained in just that one function.
 
Donnie said:
sigh, again that shows naivety on how nhs teams work, we are not just told what to do and then obey. The whole system of clinical governance within the nhs promotes all voices in the team being equal and valid and instills challenge in the system. Everyone is involved in these processes otherwise there is no ownership.

Ive already stated what the alternatives processes and work practices are but you choose to ignore them in favour of you being right
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At the moment the s*** hasn't really hit the fan, you're just getting the prelude. Your work practices are going to have to change and progress quickly, there won't be time to sit around consulting the collective.
 
nilagin said:
At the moment the s*** hasn't really hit the fan, you're just getting the prelude. Your work practices are going to have to change and progress quickly, there won't be time to sit around consulting the collective.
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That wont change, group responsibility means less chance of an individual copping the blame.
 
nilagin said:
It doesn't matter how long it will take to train. It's not like this is going to go away fast. We have trained ICU nurses now that can operate them, in 2-3 months time we could have a lot more nurses trained in just that one function.
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I really dont know how many times i have to repeat that its not just about training a person to use a ventilator, you cannot isolate the ventilator from the actual care, interpretation, diagnostics, treatment and evaluation of the patient attached, it is not that simple. I just dont know how to communicate that better than I have.

nilagin said:
At the moment the s*** hasn't really hit the fan, you're just getting the prelude. Your work practices are going to have to change and progress quickly, there won't be time to sit around consulting the collective.
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Oh I know full well the s***s nowhere near hit the fan, do you think that nhs staff dont know that this is simply a prelude? Our work practices as a whole have changed immensely in the last 10 days alone and it literally continues on a more than daily basis and all this in an nhs that already had 100,000 vacancies before it all started.
Why the f*** you think nhs staff "sit around consulting the collective" is anyone's guess but it again shows a real lack of understanding of what is actually going on.

MatBin said:
That wont change, group responsibility means less chance of an individual copping the blame.
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And in the future when it's all being dissected this is how Boris et al will fudge the unecessary deaths that should never have happened.
 
MatBin said:
That wont change, group responsibility means less chance of an individual copping the blame.
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That's not what I meant, I am talking about drafting in extra nurses just to perform certain functions as it will be quicker to do that than train them to perform all functions.
 
Breast, cervical and bowel screening is being suspended in Scotland to allow the NHS to cope with coronavirus.

What will be the cost of this, we know that catching cancer early saves many lives, I know we can’t have everything, but should corona be more important than that?
 
MatBin said:
So is the theory going down the line of those that have had more flu vaccines are more at risk? Those that have had actual flu multiple times are more at risk? Perhaps colds too?
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No, I don’t read that into it,Matt. It wasn’t about the risk of getting the virus but having got it how severe it was. Bear in mind that doctor stated at the start of his answer that they don’t know .

Just had a thought. I hope you can access this podcast/catch-up so you can hear the doctor speaking in answer to Nicky C's questioon. It's close to the end of 5 Live Breakfast show and just before the 9.00am phone-in It starts at 2.50/2.51 and if you hear a man called Bob ( a caller) asking for advice then the Dr tells Bob to keep an eye on his temperature etc and the call ends here and that's when Nicky C asks the doctor that question. You may have to sign up to the BBC to hear it, though.

https://www.bbc.co.uk/sounds/play/m000gwfl
 
sphexx said:
I really hope this is not true as it will be twisted by the anti-vaxxers ;(.
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Richard..I've just posted the link for Matt to listen to the exchange between Nicky Campbell and the doctor. I've just listened to it again and he's talking about the antibodies generated after each dose of 'flu ,he doesn't mention vaccines but I take your point. Those people are dangerous. Children have contracted mealses,to give one example because of those anti-vaccine idiots. .
 
nilagin said:
Or maybe that person in that field just lacks the vision to make or allow change. We are in unprecedented times, new thinking and processes are required.
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Hugely different fields. You try something new and it doesn't work, an engine goes bang - big deal. If a change is made to some medical things and it doesn't work, what goes bang is a human life.
 
Retune said:
Coronaviruses aren't related to influenza viruses, so there's no reason to believe that flu vaccinations would have any impact on the severity of COVID-19. In fact, it's a very good idea to have a flu shot, because you don't want to end up in hospital with flu right now, and because people who have both flu and COVID-19 at the same time apparently do worse.

But humans are commonly infected by other coronaviruses, very distantly related to the virus that causes COVID-19. Four of the many viruses that cause common cold symptoms are coronaviruses. We have probably all been infected by them, and there is no vaccine for any of them. The idea would be that previous infections by these viruses somehow make us more vulnerable to infection by the new coronavirus. Something similar ('antibody dependent enhancement') is seen in dengue virus infections. But the idea it might apply to human coronaviruses is pure speculation at this point. Some people are making almost the opposite argument - that children who are probably being infected by coronaviruses more often than adults are (perhaps for the first time) may have some protection against the new virus. But there may well be simpler explanations for the more severe disease seen in older people. The immune system (especially 'innate immunity' to things the immune system has never encountered before) declines with age. Older people are also more likely to have one or more of the 'existing conditions' that we know make people more vulnerable.

Why some younger people without apparent existing conditions do poorly is not known. Some of them probably have undocumented existing conditions. There may be genetic differences that determine vulnerability to the virus, as there are with some other viruses (e.g., some people are resistant to HIV infection because they have a different form of the 'receptor' protein the virus latches on to). Perhaps environmental factors play a role, or smoking history, or co-infection with other pathogens. We just don't know. It's probably nothing to do with the specific viruses they are infected by. Although these viruses do accumulate mutations over time, so far nobody has found any change that is likely to make the new virus more virulent. A widely reported publication that claimed there are 'S type' and 'L type' strains that differ in virulence has not convinced other virologists.
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Many thanks. Really appreciate the comprehensive reply. When I signed in I saw my alerts and went from the bottom up and replied to Matt before seeing your response. I needn't have posted the Five Live Breakfast link re. the doctor's reply to Nicky Campbell had I seen your reply first. Lesson learnt. Read all alerts first.
 
Nod said:
Hugely different fields. You try something new and it doesn't work, an engine goes bang - big deal. If a change is made to some medical things and it doesn't work, what goes bang is a human life.
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FFS, all I am talking about is extra staff being drafted in to perform specific functions not all functions.
Some people really ought to learn to read.
 
Retune said:
Coronaviruses aren't related to influenza viruses, so there's no reason to believe that flu vaccinations would have any impact on the severity of COVID-19. In fact, it's a very good idea to have a flu shot, because you don't want to end up in hospital with flu right now, and because people who have both flu and COVID-19 at the same time apparently do worse.
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My wife works in a school and as a result gets the flu vaccination and each year gets a mild dose of the flu as a result. Would that not leave her immune system in a weakened state that could leave her more susceptible to the COVID-19 VIRUS?
 
sphexx said:
I have no idea about that in particular but that is roughly what manufacturers/reseller do, ie employ nurses/doctors as representatives (not called salesmen usually :)) to demonstrate how wonderful and magical their equipment/drug is otherwise any professional’s bullshït detector would kick in :).

Edit to circumvent TP software’s prissy bullshït detector :).
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There is a world of difference between a sales demonstration and actual training on how to use a piece of equipment.
 
I'm sat here in my parent's house garage convered study facing the road, in a quiet village in North Somerset, WFH. An ambulence pulled up and took away a mid-40's guy (according to my parents who knew neighbours). The guy looks can barely walk and had a surgical mask, while the ambulance staff were also wearing PPE........

I thought we'd be safe in this tiny village.

Also today, I'm told I'm in an essential role and has been issued the letter to show police/school. They say I got to be in work 25% of the time. I can do my work from home and I will WFH thank you very much.
(though may go into work fetch some dev hardware this or next week)
 
Jelster said:
The sales of moisturiser must be going through the roof... All this extra hand washing and use of the gel has done quite a bit of damage to the skin on the back of my hands, especially on the knuckles.
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Try standing the bottle of hand gel on top of metal filing cabinet for a couple of weeks and see the results, (useful if you run out of paint stripper) then you'll realise why the skin on your hands is damaged.
 
nilagin said:
FFS, all I am talking about is extra staff being drafted in to perform specific functions not all functions.
Some people really ought to learn to read.
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nilagin said:
My wife works in a school and as a result gets the flu vaccination and each year gets a mild dose of the flu as a result. Would that not leave her immune system in a weakened state that could leave her more susceptible to the COVID-19 VIRUS?
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nilagin said:
There is a world of difference between a sales demonstration and actual training on how to use a piece of equipment.
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Where are all these magical extra staff you want to just take care of a ventilator (ignoring all Ive written before obviously about why it wouldn't work anyway)?

Your wife does not catch a "mild dose of the flu" as a result of a vaccine.

Training on new equipment in the nhs is generally done by the rep and they are usually ex healthcare workers. This trainings usually done on an ad hoc basis, we had some new ventilators last year and they could not be put into general use until 80% of staff were trained, this took well over a month.
 
nilagin said:
My wife works in a school and as a result gets the flu vaccination and each year gets a mild dose of the flu as a result. Would that not leave her immune system in a weakened state that could leave her more susceptible to the COVID-19 VIRUS?
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Adults get an inactivated (killed) vaccine, so they aren't really getting a mild dose of the flu, though it may feel that way for a day or two. These mild side effects are associated with the vaccine stimulating your immune system to protect you against flu. There was a claim a few years ago that flu vaccines in children might make them more susceptible to other respiratory infections, but this did not stand up to scrutiny in later studies: https://academic.oup.com/cid/article/57/6/789/329048 .
 
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nilagin said:
That's not what I meant, I am talking about drafting in extra nurses just to perform certain functions as it will be quicker to do that than train them to perform all functions.
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Who in the NHS will be brave enough to do/suggest that when it might be shown that the lack of fully trained ICU/HDU nurses might have led to unnecessary deaths? Answer - no-one.
If the Health Secretary suggests it I bet the NHS would get on board.

Generally speaking the NHS have prescribed safe practices that stand us in good stead when things are "normal" but things aren't "normal" so someone external to the NHS is going to have to a) put clinicians minds at rest they wont be prosecuted if they "tried their best" (as per good Samaritan rules) and b) tells them that as these are exceptional circumstances anything that is tried will be seen as "best efforts" and to think outside normal parameters.
 
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Donnie said:
Where are all these magical extra staff you want to just take care of a ventilator (ignoring all Ive written before obviously about why it wouldn't work anyway)?
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So the nursing staff from all the areas that are going to be put on a back burner for now will be laid off will they? Or will they be transferred to the higher priority ICU's to help out. That will take up some of the slack. You have already said yourself that nurses in their last year of training will be fast tracked, they won't all be specifically ICU trained.
That's a start.
 
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