Coronavirus-Are we ready to talk about rationing care?

[dinah77]

Alright, I'm gonna be the soulless monster who brings it up......

Have those of us in critical care/inpatient started to think of the possibility that rationing care will occur?

IF this spread gets bad, and large numbers of people need vents, we will have to start triaging and rationing

There is a woeful lack of vents overall and there will be even fewer numbers of nurses available to manage those ventilated patients

Which means, rationing, and choosing who gets that care

If we follow the utilitarian model, of who will benefit the most from that care, the elderly, especially those with comorbidities are poor candidates to get those spaces, particularly when we look at numbers of that demographic who survive being intubated and return to a somewhat normal life (it's shockingly few, FYI)

Links here to support my last statement- would love to hear some thoughts from others

https://www.sciencedaily.com/releases/2010/03/100302162247.htm?fbclid=IwAR1c_TR50jkAbEM2n0v4BPnRAaLAge2u69i6QZnZhJV0HL2uSMxUZUe2P0o

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127042/

[LovingLife123]

4 hours ago, MunoRN said:

I'd take those "ALL IS WELL" reassurances with a grain of salt.

Trump had a conference call today with all the governors, and they all reported told him they're screwed when it comes to vents and equipment.

You have to consider how many vents we're talking about for instance. Some states have said they've managed to scramble together extra vents, the largest number I've heard is 100 vents.

Hopefully these numbers aren't right, but they have been so far: One third of the population will become infected, about 6 percent of those will require ICU care, almost all due to the need for a ventilator. On average, that means each state will have about 130,000 people requiring a vent, so scrounging up an extra 100 vents doesn't do a whole lot.

Again, hopefully our numbers don't keep going in that direct, some countries are surprisingly unscathed so far, but then there are countries like Italy where their numbers are far worse than that. Their current mortality rate in confirmed cases is about 7%, and that's with most of the confirmed cases not yet being to the point where deaths are known to occur.

They specifically said that our state had a bunch of older vents in storage and they would pull them out and use those if needed. I put state has more than 100 vents!! I live in a major metro area with 3 Level One Trauma centers alone. I know it still may not be enough, but I at least felt like we are covered even if we have a moderate outbreak of people needing them.

I personally don’t feel we will have a enough negative pressure rooms. That’s my concern before vents.

[toomuchbaloney]

33 minutes ago, LovingLife123 said:

They specifically said that our state had a bunch of older vents in storage and they would pull them out and use those if needed. I put state has more than 100 vents!! I live in a major metro area with 3 Level One Trauma centers alone. I know it still may not be enough, but I at least felt like we are covered even if we have a moderate outbreak of people needing them.

I personally don’t feel we will have a enough negative pressure rooms. That’s my concern before vents.

If 85% of your service area got sick and 20% needed intensive care before 2% died, do you think you would have enough. We won't here in the interior of Alaska and there's not even a million people total in the state.

[Rose_Queen, BSN, MSN, RN]

Don’t forget that anesthesia machines can be used as vents. My facility has flipped an entire floor into negative pressure, has 5 more vents than critical care beds, plus an additional 60 anesthesia machines. If we mirror Italy, it still won’t be enough, but it’s something.

[Walti, LPN, LVN, RN, EMT-I]

I know that vents are high tech nowadays but maybe we should reconstitute some of the older equipment. I'm showing my age here but here has to be a few old Birds or Bennets out there. They were very simple machines and I mention them because I believe they could be produced easily with the use of 3-D printers. Multiple printers each producing a single part for a centralized assembly area.

Circuits might not lend themselves easily to printing but we have plenty of plastics companies cranking out plastic water bottles by the billions. Maybe some of these companies could repurpose some of their equipment to produce the tubing needed. Now that I've planted a seed it's going to be up to you guys to water it. Talk to your RT departments and see what they can do with this. Somebody somewhere knows how to get this ball rolling.

P.S. The Chinese built that 1000 bed hospital with the help of 3-D printers. And they did it in 5 days.

[LovingLife123]

On 3/17/2020 at 11:20 AM, Walti said:

I know that vents are high tech nowadays but maybe we should reconstitute some of the older equipment. I'm showing my age here but here has to be a few old Birds or Bennets out there. They were very simple machines and I mention them because I believe they could be produced easily with the use of 3-D printers. Multiple printers each producing a single part for a centralized assembly area.

Circuits might not lend themselves easily to printing but we have plenty of plastics companies cranking out plastic water bottles by the billions. Maybe some of these companies could repurpose some of their equipment to produce the tubing needed. Now that I've planted a seed it's going to be up to you guys to water it. Talk to your RT departments and see what they can do with this. Somebody somewhere knows how to get this ball rolling.

P.S. The Chinese built that 1000 bed hospital with the help of 3-D printers. And they did it in 5 days.

That’s what they said we would go here. We would pull out and repurpose old vents.

[Tegridy]

I think the important question is when are all the facebook nurses going to stop reminding us that they have to work while coronavirus is floating around. Already bored of the “blah blah I’m a nurse front line in pandemic” posts.

CONGRATS want a sticker?

[Hoosier_RN, MSN]

On 3/18/2020 at 6:02 AM, Tegridy said:

I think the important question is when are all the facebook nurses going to stop reminding us that they have to work while coronavirus is floating around. Already bored of the “blah blah I’m a nurse front line in pandemic” posts.

CONGRATS want a sticker?

My hubby is a truck driver and farmer. No awards there either. We all need to just do the best that we can and remember it's a part of our job, like it or not. I think some of the FB nurses are just looking for a pat on the back

[Tegridy]

1 hour ago, Hoosier_RN said:

My hubby is a truck driver and farmer. No awards there either. We all need to just do the best that we can and remember it's a part of our job, like it or not. I think some of the FB nurses are just looking for a pat on the back

I know I think most people still have to work. And we should be glad we aren’t service workers and out of work. It’s so annoying, just do your job and shut up LOL!

[Walti, LPN, LVN, RN, EMT-I]

Most people are totally clueless as to how important truck drivers and farmers are, as well as so many others. What happens when there is no harvest because farmers were too sick to plant or drivers too sick to drive. I had a talk awhile back with my DS who is a cook about getting ahead on his groceries just in case there was a disaster. He was not worried as he was a cook and ALWAYS had access to food. He is also one who is not known for thinking with the organ between his ears. Kudos to you, your husband and everyone else who keeps society functional.

[Walti, LPN, LVN, RN, EMT-I]

Sadly, most of those old vents have probably been tossed or sold to third world countries when they became obsolete.

[Kooky Korky, BSN, RN]

On 3/10/2020 at 5:28 AM, twinmommy+2 said:

This conversation makes me sad but it is one that we should be having. As a previous poster said, America is in for a rude awakening and that has been coming for quite a long while.

It was disturbing to see the fresh produce shelves nearly empty Sunday night. Also, there was a shortage of canned vegetables and frozen vegetables that night. Quite disturbing.

Our borders should have been shut down IMMEDIATELY, the moment Trump learned of this virus and the devastation it could cause. And the nation should have been on forced quarantine since then, too. And he should completely stop bashing Dems. There is just no place for throwing rocks now. he needs to be uniting the nation, not tearing it apart and saying everything is great.

Oh, well, too late now.

[Kooky Korky, BSN, RN]

On 3/10/2020 at 6:38 PM, kat7464 said:

Where does the rationing of care end? Will you ration the nursing care of my hospice patient? How is one life valued above another and thus receives more care? No human being has the right to determine human value or privilege - only God can do that. A pre-born baby who is unable to vocalize their needs/wants has just as much rights as my late stage demented patient who cannot vocalize his/her needs/wishes either. Do not play God....you won't win.

Unfortunately, God has put Mankind in charge of this world. I agree that He is sovereign, but He requires us to use our brains quite often, not sit back and say, "God's got this", and then wait for some sign from Him.

So we do wind up playing God.

Your demented patient has lived her life. She would probably be delighted to escape her imprisonment here on Earth because of all the suffering she has endured already. Anyway, she's on Hospice.

Would it be easy to hasten her passing? No, certainly not, but if it comes down to a patient such as you depict and someone who has a clear mind and an overall better chance to survive, shortage of supplies and personnel would seem to require giving the best care to someone else who could truly benefit from them.

A weighty and painful subject.

If there was a 3rd patient who was stronger and more likely to recover than the preemie or your hospice patient, I'd give the vent to that person.

It's triage. Do the most good for the greatest number who can actually have a fighting chance to survive.

Painful but necessary.