27 ms·

I wonder how long it would take to teach someone to be more help than harm? After 30 intensive days of training, what would candidates lack?

cycrutchfield 7y ago
About 4 years of medical school, and around 4 more years of residency training.
- onetimemanytime 7y ago
  Most Covid patients die on respirators anyway, can a nurse do 90% of the job ("good enough") and ask a doc if the rest is needed? The other option is worse and I doubt USA can afford to have docs sitting for decades waiting for another Covid like scenario. Remember these ventilators will be produced and go in storage to wait...
  - rajandatta 7y ago
    I would think you could augment with other personnel - interns, students, volunteers - who are trained and who's only job is to watch the ventilator and monitor a patient. They do not try and treat a patient but call for help if the patient's condition takes a downturn or equipment shows a problem they have not been trained to address. This is not general purpose training - but very bounded / specific notes. That's got to be better than exhausting more vital personnel.
  - verytrivial 7y ago
    The numbers from Wuhan were something like 30% fatalities for those moved to ventilation. That doesn't detract from your point but does support why the path "make a ton of ventilators" is being persued.
    - onetimemanytime 7y ago
      Technically I should provide a citation and searched, but couldn't find it. I'm almost certain that I've read that wayyy more than 50% (prob 70% die) once placed on ventilator. Maybe because those ending there are already with one foot+ on the grave. The ventilator can save,say 30%, and also make us feel good "we did all we could," after all, we will all reach that point one day ;)
      - hiram112 7y ago
        There is a small study / report released with 32 patients in Wuhan who were put on ventilators. 31 died. I have not been able to find any larger case reports. Though on Tucker Carlson a few nights ago, a doctor on the front lines in NYC was interviewed and gave a similar report: If you reach the point of intubation and ventilation, the chances of survival is quite low. A lot of these stats now coming out are going to be harder and harder to interpret going forward, regardless of the true numbers, as the media twists things around for their own political purposes. If ventilators turn out to be not the difference between life and death, even according to the raw stats, the media who wants to use lack of ventilators to blame one political party or another for the incompetency, isn't likely to tell the truth anyway.
      - barry-cotter 7y ago
        Most people who get put on a ventilator die under the best of circumstances.
- ALittleLight 7y ago
  Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and come get me if this or that happens".
  - cycrutchfield 7y ago
    Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?
    - choeger 7y ago
      Look how radiologists work nowadays. They don't see their patients face to face. Everything except the decision making has been handed to someone else so they can be most efficient. That's the model a huge COVID19 ICU could work like.
      - cycrutchfield 7y ago
        Still, it’s an ICU, not an outpatient clinic. I think you are a bit over-optimistic about just how much care can be delegated.
        choeger 7y ago
        Forget about an ICU as we know it. Think about a field hospital near the beaches on D-Day.
    - ALittleLight 7y ago
      I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.
- URSpider94 7y ago
  Doctors don’t run ventilators. Respiratory therapists do. A respiratory therapy degree is a 2-year associates degree that includes basic training on physiology and biology. I’m betting that someone with an undergraduate degree in biology could learn the role in a few months of intensive training. Doctors would still be responsible for reviewing the care protocol and making decisions on treatment, but one doctor could oversee many respiratory therapists, each caring for many patients.
  - cycrutchfield 7y ago
    It was a tongue-in-cheek comment. The point was that it takes more than a 30 day bootcamp to be more of an asset than a liability in a critical care environment. HN denizens apparently seem to disagree, and believe that if you can learn some JavaScript framework in 30 days you can do anything in 30 days, but the world doesn’t work like that.
    - URSpider94 7y ago
      I think the push-back is that it's not black and white. If we end up in a situation where somehow we get 10x the number of ventilators and staffing becomes the limiting factor, you can bet that hospitals will get creative on how to operate them. You're right, pulling in people off the street is not the place to start (even 1337 Javascript coders). I would think you would start with trained physicians from other disciplines, PA's, NP's, RN's.
- barry-cotter 7y ago
  > About 4 years of medical school, and around 4 more years of residency training. This is not universal in the US. You can do Bac + Med School in six years even there[1]. That’s the standard route outside the US’ former colonies and those countries with colonial cringe. Medical school in the UK and Ireland varies from five to six years with undergraduate entry. Graduate entry is four years like in the US, but pre-med doesn’t exist; you can start med school with a degree in dance[2]. Even in the US you can do med school in three years[3] [1] https://www.forbes.com/sites/noodleeducation/2018/06/18/3-bsmd-programs-only-6-years/ https://www.forbes.com/sites/noodleeducation/2018/06/18/3-bs... [2] https://www.ul.ie/gems/programmes/bmbs-programme https://www.ul.ie/gems/programmes/bmbs-programme [3] https://med.nyu.edu/education/md-degree/accelerated-three-year-md https://med.nyu.edu/education/md-degree/accelerated-three-ye...
deleted 7y ago
[deleted]
marcoperaza 7y ago
Yes, people in this thread are letting the perfect be the enemy of the good. Everyone knows that doctors are overqualified for the vast majority of tasks they are responsible for. Normally, there's good reason for this, because you want a highly-trained eye to spot unusual and atypical cases. But when you're dealing with a pandemic, you can do without. Do you really think that your typical doctor spent all that much time in med school or residency learning how to operate a particular kind of machinery? If we have the ventilators, we'll be able to find people to operate them.
- omar_a1 7y ago
  > Yes, people in this thread are letting the perfect be the enemy of the good No, it's because medicine has a very low fault tolerance, and requires a large body of technical knowledge to even understand what needs to happen for your patient. Having a team of incompetent clinicians perform complicated medical procedures "good" as a layperson still results in disproportionate people dying, that would have survived under a competent practitioner.
  - marnett 7y ago
    > [...] would have survived under a competent practitioner. Bringing us back to the topic of this thread, a potential lack of competent practitioners if the pandemic worsens, and what the best solution to address this would be, such as a COVID-specific ventilator training.
    - omar_a1 7y ago
      Because the difference between letting someone die under inappropriately-applied ventilation versus just letting someone die is the occupation of a perfectly good ventilator. One that could be used to actually save someone. If you're in the business of killing patients, a gun would be more economical than a ventilator.
      - mistermann 7y ago
        I believe there is a third possible outcome that you overlooked.
Rapzid 7y ago
Heh, if it comes down to it we will see a lot of creative new processes that are apparently beyond the imaginations of many here. The army knows how to train people to basic competency very fast, and they know a thing or two about drafting volunteers ;) Not everyone need be coming in completely untrained. And job shadowing is the obvious thing most people are over looking. Nobody is going to dump a bucket of scrubs with 30-days classroom training all over the ER floor. Groups of trainees would be shadowing trained professionals 15 hours a day.

cycrutchfield 7y ago

About 4 years of medical school, and around 4 more years of residency training.

onetimemanytime 7y ago
Most Covid patients die on respirators anyway, can a nurse do 90% of the job ("good enough") and ask a doc if the rest is needed? The other option is worse and I doubt USA can afford to have docs sitting for decades waiting for another Covid like scenario. Remember these ventilators will be produced and go in storage to wait...
- rajandatta 7y ago
  I would think you could augment with other personnel - interns, students, volunteers - who are trained and who's only job is to watch the ventilator and monitor a patient. They do not try and treat a patient but call for help if the patient's condition takes a downturn or equipment shows a problem they have not been trained to address. This is not general purpose training - but very bounded / specific notes. That's got to be better than exhausting more vital personnel.
- verytrivial 7y ago
  The numbers from Wuhan were something like 30% fatalities for those moved to ventilation. That doesn't detract from your point but does support why the path "make a ton of ventilators" is being persued.
  - onetimemanytime 7y ago
    Technically I should provide a citation and searched, but couldn't find it. I'm almost certain that I've read that wayyy more than 50% (prob 70% die) once placed on ventilator. Maybe because those ending there are already with one foot+ on the grave. The ventilator can save,say 30%, and also make us feel good "we did all we could," after all, we will all reach that point one day ;)
    - hiram112 7y ago
      There is a small study / report released with 32 patients in Wuhan who were put on ventilators. 31 died. I have not been able to find any larger case reports. Though on Tucker Carlson a few nights ago, a doctor on the front lines in NYC was interviewed and gave a similar report: If you reach the point of intubation and ventilation, the chances of survival is quite low. A lot of these stats now coming out are going to be harder and harder to interpret going forward, regardless of the true numbers, as the media twists things around for their own political purposes. If ventilators turn out to be not the difference between life and death, even according to the raw stats, the media who wants to use lack of ventilators to blame one political party or another for the incompetency, isn't likely to tell the truth anyway.
    - barry-cotter 7y ago
      Most people who get put on a ventilator die under the best of circumstances.
ALittleLight 7y ago
Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and come get me if this or that happens".
- cycrutchfield 7y ago
  Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?
  - choeger 7y ago
    Look how radiologists work nowadays. They don't see their patients face to face. Everything except the decision making has been handed to someone else so they can be most efficient. That's the model a huge COVID19 ICU could work like.
    - cycrutchfield 7y ago
      Still, it’s an ICU, not an outpatient clinic. I think you are a bit over-optimistic about just how much care can be delegated.
      - choeger 7y ago
        Forget about an ICU as we know it. Think about a field hospital near the beaches on D-Day.
  - ALittleLight 7y ago
    I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.
URSpider94 7y ago
Doctors don’t run ventilators. Respiratory therapists do. A respiratory therapy degree is a 2-year associates degree that includes basic training on physiology and biology. I’m betting that someone with an undergraduate degree in biology could learn the role in a few months of intensive training. Doctors would still be responsible for reviewing the care protocol and making decisions on treatment, but one doctor could oversee many respiratory therapists, each caring for many patients.
- cycrutchfield 7y ago
  It was a tongue-in-cheek comment. The point was that it takes more than a 30 day bootcamp to be more of an asset than a liability in a critical care environment. HN denizens apparently seem to disagree, and believe that if you can learn some JavaScript framework in 30 days you can do anything in 30 days, but the world doesn’t work like that.
  - URSpider94 7y ago
    I think the push-back is that it's not black and white. If we end up in a situation where somehow we get 10x the number of ventilators and staffing becomes the limiting factor, you can bet that hospitals will get creative on how to operate them. You're right, pulling in people off the street is not the place to start (even 1337 Javascript coders). I would think you would start with trained physicians from other disciplines, PA's, NP's, RN's.
barry-cotter 7y ago
> About 4 years of medical school, and around 4 more years of residency training. This is not universal in the US. You can do Bac + Med School in six years even there[1]. That’s the standard route outside the US’ former colonies and those countries with colonial cringe. Medical school in the UK and Ireland varies from five to six years with undergraduate entry. Graduate entry is four years like in the US, but pre-med doesn’t exist; you can start med school with a degree in dance[2]. Even in the US you can do med school in three years[3] [1] https://www.forbes.com/sites/noodleeducation/2018/06/18/3-bsmd-programs-only-6-years/ https://www.forbes.com/sites/noodleeducation/2018/06/18/3-bs... [2] https://www.ul.ie/gems/programmes/bmbs-programme https://www.ul.ie/gems/programmes/bmbs-programme [3] https://med.nyu.edu/education/md-degree/accelerated-three-year-md https://med.nyu.edu/education/md-degree/accelerated-three-ye...

deleted 7y ago

[deleted]

marcoperaza 7y ago

Yes, people in this thread are letting the perfect be the enemy of the good. Everyone knows that doctors are overqualified for the vast majority of tasks they are responsible for. Normally, there's good reason for this, because you want a highly-trained eye to spot unusual and atypical cases. But when you're dealing with a pandemic, you can do without. Do you really think that your typical doctor spent all that much time in med school or residency learning how to operate a particular kind of machinery? If we have the ventilators, we'll be able to find people to operate them.

omar_a1 7y ago
> Yes, people in this thread are letting the perfect be the enemy of the good No, it's because medicine has a very low fault tolerance, and requires a large body of technical knowledge to even understand what needs to happen for your patient. Having a team of incompetent clinicians perform complicated medical procedures "good" as a layperson still results in disproportionate people dying, that would have survived under a competent practitioner.
- marnett 7y ago
  > [...] would have survived under a competent practitioner. Bringing us back to the topic of this thread, a potential lack of competent practitioners if the pandemic worsens, and what the best solution to address this would be, such as a COVID-specific ventilator training.
  - omar_a1 7y ago
    Because the difference between letting someone die under inappropriately-applied ventilation versus just letting someone die is the occupation of a perfectly good ventilator. One that could be used to actually save someone. If you're in the business of killing patients, a gun would be more economical than a ventilator.
    - mistermann 7y ago
      I believe there is a third possible outcome that you overlooked.

Rapzid 7y ago

Heh, if it comes down to it we will see a lot of creative new processes that are apparently beyond the imaginations of many here. The army knows how to train people to basic competency very fast, and they know a thing or two about drafting volunteers ;) Not everyone need be coming in completely untrained. And job shadowing is the obvious thing most people are over looking. Nobody is going to dump a bucket of scrubs with 30-days classroom training all over the ER floor. Groups of trainees would be shadowing trained professionals 15 hours a day.