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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 vent

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.

epmaybe 7y ago
Respiratory therapists exist
Kalium 7y ago
I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on. Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment. That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.
- marnett 7y ago
  > That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task. This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are. If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...? We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”
  - Kalium 7y ago
    I'm trying to suggest, as gently as possible, that a time when our medical system is verging on being flooded may not be the best of all possible moments imaginable to add a significant resource-consumer in the form of an experimental mass training program. I am attempting to encourage more systemic thinking and greater consideration of context. I understand that some may disagree with some or all of these arguments. Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this. Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.
- mistermann 7y ago
  > I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. Point of contention is what it seems like to me. There's certainly no shortage of people asserting that point, but what confuses me is, how does everyone know with such high certainty what is or is not possible, when it's never been tried before (afaik)? Has anything even remotely similar been tried before?
bamboozled 7y ago
You’re comment reminds me of the reluctant success of sending teenagers on bomber raids in in WWII over Germany. As opposed to relying on only experienced airmen, which there went enough of. Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chance. It sounds like there is some fundamental idealogical opposition to this. I have a friend who is going through her residency now, she has to deal with a lot of very unhealthy psychological and physical treatment (ridiculously long hours) to get through it. Sounds more like a hazing than a professional introduction.
- greedo 7y ago
  It's not the age of the pilot or doctor, but the experience. In WW2, some pilots were considered combat capable after 150 hours of flight time, basically 6 months. They died. Eventually the flight programs ended up taking 1.5-2 years on average to crank out a new pilot. A pilot that also died quickly. Now in war, you have to throw bodies at a problem, and if the bodies end up 6 ft under, that's war. But generally bad pilots only kill themselves, they don't kill patient after patient through malpractice.
  - mistermann 7y ago
    Technically, it is the skill level. Indeed there is a very strong causal relationship between skill and experience, but we have no data in the realm being discussed so it may be helpful if we were to explicitly realize we are speculating, as I'd think this may improve the quality of our thinking and decision making.
    - cycrutchfield 7y ago
      What value did you add to this conversation?
      - DonHopkins 7y ago
        His goal is to subtract value from as many conversations as he can in parallel, and waste as much of everyone's time as possible.
14 7y ago
I have been nursing for years and the battle of skills has never stopped. Only doctors can do A B or C. Then at some point the registered nurses start doing it and then eventually the licensed practical nurses get to do it. The shift in skill set is always happening and often fought from the top ie doctors fighting to keep the skill to theirselves. You are absolutely right there are plenty of people who could efficiently watch the ventilator patients and report back the important facts. And you are also right they don’t need to do a perfect job only better then just letting people die with no chance. That is what triage is all about. All hands on deck. It is just really hard to start giving extra direction and have new people on the ward when the shit is hitting the fan and that alone can fluster staff. But in a pinch we won’t have enough staff so other rolls need to be taken or people will die.
- mistermann 7y ago
  Thanks for adding your expertise to the discussion. It's quite interesting to hear the opinion of someone who has both education and hands on experience directly in the field, and then compare that opinion to the opinions of those who have neither.
alxlaz 7y ago
I'm not an MD but I've had contact, on-and-off, with mission-critical equipment in the energy sector (according to my university I'm an EE but I was cleverly disguised) and then I've worked in the medical equipment industry for a few years. I would be very, very surprised if the parent comment(s) weren't correct. Training, no matter how intensive, is no substitute for education. Getting nurses, doctors from other specialties, or even medical students through an intensive training is one thing, and I suspect it's actually a good idea. These are people who have (or, in the case of students, are at least likely to have) the knowledge required not just to learn how to operate a piece of machinery, but also to understand when they're in over their heads, when to ask for help, and to understand the magnitude of what they're doing. But IMHO -- also based on my experience in other potentially dangerous fields -- putting people with zero medical education except for a thirty-day training in charge of observing people in a life-or-death situation is a really bad idea. Under-educated, even if well-trained assistance has a very high potential of making things worse, not better -- worse than doing nothing at all, that is. Running a ventilator as in pushing the right buttons is something you can learn to do just by reading the manual. I can obviously operate every medical device I've worked on. I've obviously had more than 30 days of exposure to them. And nonetheless, I think the chances of getting someone killed by operating them are extremely high. I am also 100% convinced that they are much higher than the chances of someone who's had some medical education doing the same thing, even if they've never seen that machine and have never read the manual. What doctors and nurses do with the things I've built is way above my level of understanding. I can't speak for medical students but I can guarantee that, if you let 30 final-year engineering students walk around a power plant without constant supervision, one of them will get themselves killed by the end of the day. And that's after three years of education. 30 days shouldn't even get you past the lobby.
- ALittleLight 7y ago
  I fully expect that a person who has only thirty days training will be worse than a professional and their relative incompetence will kill people. I don't understand how that is an argument against the plan to train volunteers though. I'm reading that hospitals may be overwhelmed. I understand that to mean there will be more people requiring intensive care than capacity to give intensive care. If the choice is between the hospital sending people who need ventilators off to die and sending them to someone with thirty days of training and good intentions... Well, my intuition is that you'd have better outcomes with the latter. The point is not "can we do this without killing people." Nope. More people will die with amateur ventilator-operators than professionals. What I'm suggesting is that more people will die without amateur ventilator-operators in the event hospitals are overwhelmed. If we think hospitals are going to be overwhelmed in thirty days then the time to start training amateur ventilator-operators is now.
amelius 7y ago
Also vets could help out if necessary, as they are trained to use ventilators.
- DanBC 7y ago
  ...and in the UK we've already seen calls to use the vents that vets have. https://www.vettimes.co.uk/news/veterinary-sector-primed-to-join-corona-fight/ https://www.vettimes.co.uk/news/veterinary-sector-primed-to-...

epmaybe 7y ago

Respiratory therapists exist

Kalium 7y ago

I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on. Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment. That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.

marnett 7y ago
> That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task. This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are. If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...? We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”
- Kalium 7y ago
  I'm trying to suggest, as gently as possible, that a time when our medical system is verging on being flooded may not be the best of all possible moments imaginable to add a significant resource-consumer in the form of an experimental mass training program. I am attempting to encourage more systemic thinking and greater consideration of context. I understand that some may disagree with some or all of these arguments. Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this. Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.
mistermann 7y ago
> I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. Point of contention is what it seems like to me. There's certainly no shortage of people asserting that point, but what confuses me is, how does everyone know with such high certainty what is or is not possible, when it's never been tried before (afaik)? Has anything even remotely similar been tried before?

bamboozled 7y ago

You’re comment reminds me of the reluctant success of sending teenagers on bomber raids in in WWII over Germany. As opposed to relying on only experienced airmen, which there went enough of. Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chance. It sounds like there is some fundamental idealogical opposition to this. I have a friend who is going through her residency now, she has to deal with a lot of very unhealthy psychological and physical treatment (ridiculously long hours) to get through it. Sounds more like a hazing than a professional introduction.

greedo 7y ago
It's not the age of the pilot or doctor, but the experience. In WW2, some pilots were considered combat capable after 150 hours of flight time, basically 6 months. They died. Eventually the flight programs ended up taking 1.5-2 years on average to crank out a new pilot. A pilot that also died quickly. Now in war, you have to throw bodies at a problem, and if the bodies end up 6 ft under, that's war. But generally bad pilots only kill themselves, they don't kill patient after patient through malpractice.
- mistermann 7y ago
  Technically, it is the skill level. Indeed there is a very strong causal relationship between skill and experience, but we have no data in the realm being discussed so it may be helpful if we were to explicitly realize we are speculating, as I'd think this may improve the quality of our thinking and decision making.
  - cycrutchfield 7y ago
    What value did you add to this conversation?
    - DonHopkins 7y ago
      His goal is to subtract value from as many conversations as he can in parallel, and waste as much of everyone's time as possible.

14 7y ago

I have been nursing for years and the battle of skills has never stopped. Only doctors can do A B or C. Then at some point the registered nurses start doing it and then eventually the licensed practical nurses get to do it. The shift in skill set is always happening and often fought from the top ie doctors fighting to keep the skill to theirselves. You are absolutely right there are plenty of people who could efficiently watch the ventilator patients and report back the important facts. And you are also right they don’t need to do a perfect job only better then just letting people die with no chance. That is what triage is all about. All hands on deck. It is just really hard to start giving extra direction and have new people on the ward when the shit is hitting the fan and that alone can fluster staff. But in a pinch we won’t have enough staff so other rolls need to be taken or people will die.

mistermann 7y ago
Thanks for adding your expertise to the discussion. It's quite interesting to hear the opinion of someone who has both education and hands on experience directly in the field, and then compare that opinion to the opinions of those who have neither.

alxlaz 7y ago

I'm not an MD but I've had contact, on-and-off, with mission-critical equipment in the energy sector (according to my university I'm an EE but I was cleverly disguised) and then I've worked in the medical equipment industry for a few years. I would be very, very surprised if the parent comment(s) weren't correct. Training, no matter how intensive, is no substitute for education. Getting nurses, doctors from other specialties, or even medical students through an intensive training is one thing, and I suspect it's actually a good idea. These are people who have (or, in the case of students, are at least likely to have) the knowledge required not just to learn how to operate a piece of machinery, but also to understand when they're in over their heads, when to ask for help, and to understand the magnitude of what they're doing. But IMHO -- also based on my experience in other potentially dangerous fields -- putting people with zero medical education except for a thirty-day training in charge of observing people in a life-or-death situation is a really bad idea. Under-educated, even if well-trained assistance has a very high potential of making things worse, not better -- worse than doing nothing at all, that is. Running a ventilator as in pushing the right buttons is something you can learn to do just by reading the manual. I can obviously operate every medical device I've worked on. I've obviously had more than 30 days of exposure to them. And nonetheless, I think the chances of getting someone killed by operating them are extremely high. I am also 100% convinced that they are much higher than the chances of someone who's had some medical education doing the same thing, even if they've never seen that machine and have never read the manual. What doctors and nurses do with the things I've built is way above my level of understanding. I can't speak for medical students but I can guarantee that, if you let 30 final-year engineering students walk around a power plant without constant supervision, one of them will get themselves killed by the end of the day. And that's after three years of education. 30 days shouldn't even get you past the lobby.

ALittleLight 7y ago
I fully expect that a person who has only thirty days training will be worse than a professional and their relative incompetence will kill people. I don't understand how that is an argument against the plan to train volunteers though. I'm reading that hospitals may be overwhelmed. I understand that to mean there will be more people requiring intensive care than capacity to give intensive care. If the choice is between the hospital sending people who need ventilators off to die and sending them to someone with thirty days of training and good intentions... Well, my intuition is that you'd have better outcomes with the latter. The point is not "can we do this without killing people." Nope. More people will die with amateur ventilator-operators than professionals. What I'm suggesting is that more people will die without amateur ventilator-operators in the event hospitals are overwhelmed. If we think hospitals are going to be overwhelmed in thirty days then the time to start training amateur ventilator-operators is now.

amelius 7y ago

Also vets could help out if necessary, as they are trained to use ventilators.

DanBC 7y ago
...and in the UK we've already seen calls to use the vents that vets have. https://www.vettimes.co.uk/news/veterinary-sector-primed-to-join-corona-fight/ https://www.vettimes.co.uk/news/veterinary-sector-primed-to-...