Ventilators: the perfect the enemy of the good?

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Thornyone
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Ventilators: the perfect the enemy of the good?

Postby Thornyone » 17 Mar 2020, 5:05pm

It seems that there will be a need for a large number of ventilators to cope with expected demand during the developing coronavirus crisis. The government has called for an effort from the non-medical engineering sector to produce a large number. I’ve seen cold water poured on this idea by one specialist manufacturer, quoting problems with standards, timescales etc. But surely this is an example of an urgent need to “think outside the box”. If a fairly simple machine could be designed, which may be far from ideal in terms of normally accepted standards, but performs the basic job of helping a patient to breathe, would it not be a lot better than nothing? If the alternative is to leave a desperately ill patient with no ventilation whatsoever, surely it would be worthwhile. Presumably the best equipment could be used to help the patient with the best prognosis, and the less-than-perfect equipment used for those who would otherwise simply be triaged to lie in a darkened room to expire for lack of any ventilation whatsoever. Any thoughts?

Psamathe
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Re: Ventilators: the perfect the enemy of the good?

Postby Psamathe » 17 Mar 2020, 5:20pm

Another issue is that nurses need specialised training to operate such machines (or to be ICU nurses). We already have around 100,000 unfilled vacancies in the NHS so where are we going to recruit these already trained people from?

Ian

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Paulatic
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Re: Ventilators: the perfect the enemy of the good?

Postby Paulatic » 17 Mar 2020, 5:52pm

In December 2016 the UK Gov ran a 3 day national pandemic flu exercise codenamed Exercise Cygnus,

CMO Sally Davies said

We’ve just had in the UK a 3-day exercise on flu, on a pandemic that killed a lot of people..It became clear that we could not cope with the excess bodies”.
...

Inadequate ventilation capacity was specifically identified

So in 3 years the Tories have done absolutely nothing about it. Brexit and looking after their tax affairs are definitely more important than looking after anyone’s health.
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Cunobelin
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Re: Ventilators: the perfect the enemy of the good?

Postby Cunobelin » 17 Mar 2020, 6:29pm

Psamathe wrote:Another issue is that nurses need specialised training to operate such machines (or to be ICU nurses). We already have around 100,000 unfilled vacancies in the NHS so where are we going to recruit these already trained people from?

Ian


The retired nurses who aren’t already working as part of Boris increase in Nursing, or bailing out Priti Patel’s flawed immigration package by working in social care.

They can do these jobs in their spare time

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Cunobelin
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Re: Ventilators: the perfect the enemy of the good?

Postby Cunobelin » 17 Mar 2020, 6:34pm

I can remember having an ICU with spare capacity

If that bed was not filled for a few days, no- one cared because on Wednesday it would save someone’s life

That person will now have to either be denied a bed or shipped around the country to one of the few empty beds

These facilities have been cut and cut until we can barely keep pace

Oldjohnw
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Re: Ventilators: the perfect the enemy of the good?

Postby Oldjohnw » 17 Mar 2020, 6:34pm

Thankfully, the much maligned EU has said they will pool resources, including to the ungrateful UK (my adjective).
John

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Re: Ventilators: the perfect the enemy of the good?

Postby Ben@Forest » 17 Mar 2020, 6:44pm

Oldjohnw wrote:Thankfully, the much maligned EU has said they will pool resources, including to the ungrateful UK (my adjective).


Not entirely true. Germany refused to sell medical supplies to Italy. In these situations national interest often comes first. Any EU statement of the type you mention could be an aspiration rather than a reality.

https://www.google.com/amp/s/amp.ft.com ... 4680ea68b5

Psamathe
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Re: Ventilators: the perfect the enemy of the good?

Postby Psamathe » 17 Mar 2020, 7:23pm

Ben@Forest wrote:
Oldjohnw wrote:Thankfully, the much maligned EU has said they will pool resources, including to the ungrateful UK (my adjective).


Not entirely true. Germany refused to sell medical supplies to Italy. In these situations national interest often comes first. Any EU statement of the type you mention could be an aspiration rather than a reality.

https://www.google.com/amp/s/amp.ft.com ... 4680ea68b5

Also, does the EU have the power to override national governments on this? I suspect not as the EU stays out of national health service provision (but that is opinion/guess as I don't know the control the EU has to force these issus through).

Ian

botty
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Re: Ventilators: the perfect the enemy of the good?

Postby botty » 17 Mar 2020, 7:33pm

Also, does the EU have the power to override national governments on this? I suspect not as the EU stays out of national health service provision (but that is opinion/guess as I don't know the control the EU has to force these issus through).


What is the EU going to do if a country refuses? Send in the army? Who's?

Oldjohnw
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Re: Ventilators: the perfect the enemy of the good?

Postby Oldjohnw » 17 Mar 2020, 7:45pm

John

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Re: Ventilators: the perfect the enemy of the good?

Postby Ben@Forest » 17 Mar 2020, 8:03pm

Oldjohnw wrote:https://www.euronews.com/2020/03/16/ursula-von-der-leyen-tells-eu-countries-to-share-medical-supplies



Yep - aspirational. Ironically since Germany blocked the sale of medical supplies to Italy they were sourced from China.

mikeonabike
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Re: Ventilators: the perfect the enemy of the good?

Postby mikeonabike » 17 Mar 2020, 8:15pm

Paulatic wrote:In December 2016 the UK Gov ran a 3 day national pandemic flu exercise codenamed Exercise Cygnus,

CMO Sally Davies said

We’ve just had in the UK a 3-day exercise on flu, on a pandemic that killed a lot of people..It became clear that we could not cope with the excess bodies”.
...

Inadequate ventilation capacity was specifically identified

So in 3 years the Tories have done absolutely nothing about it. Brexit and looking after their tax affairs are definitely more important than looking after anyone’s health.

+1
Perhaps Tory voters could remind us why they thought Corbyn was such a danger to us all?

Thornyone
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Re: Ventilators: the perfect the enemy of the good?

Postby Thornyone » 17 Mar 2020, 8:30pm

So at least as far as the NHS is concerned it would seem that this “all hands to ventilator production” is probably a nice-sounding irrelevance, given the shortage of trained nurses to operate them, and given the likelihood of large numbers of those nurses having to isolate with family for 14 days, a shortage only likely to worsen. I’m certainly well aware of the extreme reluctance to have any slack in the NHS system, because I used to work in an area where the extremely expensive, very complicated equipment, prone to minor or more major downtime on an almost daily basis, was run with no slack whatsoever. The concept of slack gives accountants apoplexy.

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Syd
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Re: Ventilators: the perfect the enemy of the good?

Postby Syd » 17 Mar 2020, 8:42pm

I have a meeting with a government minister and a local manufacturer tomorrow. The manufacturer in question has some experience in medical equipment, just not ventilators.

Everything with be done under the watchful eye of the MHRA but will still be a challenge.

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Re: Ventilators: the perfect the enemy of the good?

Postby fullupandslowingdown » 17 Mar 2020, 10:11pm

As Boris de Piffel Johnson is almost the same age as me, he obviously remembers the Stephenson Minuteman Resuscitator and thinks all modern Ventilators are similar but with more groovy plastic and flashing lights. They were very simple mechanical devices for ambulance crews to use, with one fatal problem. They cycled on pressure not volume, and were unreliable and prone to damage. The later Pneupac Resuscitator was a lot better, and bit lighter to carry up 4 flights of stairs and it cycled by volume.

Been mechanical in design, such devices could be easily made by firms like JCB, they might be more used to using hydraulic valves etc, but not a great deal of difference to pneumatic. No idea what is on modern ambulances now. Just a question if_____

Of course, now it all makes sense, just remembered the good new that Nottingham had last year. A compressed cylinder manufacture, Luxfer, won a massive order for cylinders. So there was intelligent fore planning in all of this after all

______ BOC can produce enough Oxygen to meet the considerable demand not just of those on ventilators, but the even greater number on oxygen therapy.

Modern ventilators costing thousands, require power afaik, and there's the recommended staffing ratio of one nurse to one patient in ICU as patients require frequent care whilst on ventilators; clearing tubes, checking drips etc etc etc. So Boris could solve the problem caused by the tories cutting ICU beds by half over the last decade: Use paramedic crews to nurse patients in mobile single occupant critical care rooms AKA ambulances. sarcasm alert

Problem sorted. Well until the ambulances are needed for other purposes. Though with waiting times at A&E over the last few years gone up to a few years, ambulance operators have become accustomed to been used as mobile critical care providers. But Boris has thought of everything, by banning large groups, sporting events and Le Tour de France, the expected number of accidents should rapidly fall.

Edit: noticed boris.gov.uk has revised the estimate of ventilators up from 5000 to 7000; he must have had the same nutty idea as I did.
Sir Simon said the health system in England has about 7,000 ventilators


note he said the health system which includes all privately owned ones, broken ones, prototype ones, 3D printed plastic ones, oh and those in permanent use by people with conditions such as spinal injury, or degenerative neuromuscular diseases. This government is quite good at counting things up.... :?
apologies to tory voters for my anti tory rant. My rant has nothing to do with the fact that my friend, a staff nurse in A&E told me yesterday that they received instructions from management that if a patient presents with signs of coronavirus, they should take a test to confirm.

Then only if it is positive, then don protective wear such as masks. Like quite a few on this forum, she has asthma, and last night when I saw her, she looked absolutely rudeworddeleted tired. Years of under-funding, mismanagement and outsourcing has brought us to this situation.

Don't blame doctors from having to make life and death triage decisions when it's down to our government not funding the NHS properly.