[songgao]

This might be an unpopular opinion but this is a pretty awful headline and it makes it look way worse than what the EMS documents actually say. There’s a bold text [1] “shall not be transported if return of spontaneous circulation is not achieved in the field”. There’s a pretty big difference between abandoning patients with little chance of survival in general, and giving up after failure to achieve ROSC.

Perhaps at some point we’ll be at the place where EMS really have to give up without even attempting CPR, but we’re not there yet.

That’s not saying the situation is not bad — it’s terrifyingly bad. But a headline designed to make incorrect impression just doesn’t help.

[1] https://twitter.com/Pervaizistan/status/1346295476405084168

EDIT: link, to focus on the right tweet. typo.

[GavinMcG]

In emergency medicine, you've got patients who are dead, and patients who are dead dead.

Patients who are just dead might still be brought back. This isn't about them. Patients who are dead dead because they haven't responded to resuscitation efforts aren't going to be taken to the hospital, is all. And in a lot of places that's already the norm.

[saberdancer]

Isn't the instruction in fact to limit resuscitation efforts to in field? To take it to an extreme, if someone collapses and has a heart attack near a hospital, by this instruction they would have to revive the person (get a pulse/breathing) before transporting them to a hospital.

It sounds very different to what normal procedure would be. I am assuming that usually they try to get the pulse back but that they can continue to do that while in the ambulance (at least that's how it works in the movies). This change would limit that.

[DanBC]

Movies give a very unrealistic example of chance of survival after heart attacks or cardiac arrest.

People are likely to survive one, but not the other. You wouldn't know that from film where almost everyone survives.

[Noumenon72]

Could you specify which one they survive, possibly using "former" and "latter"?

[robbiep]

A ‘heart attack’ is an episode of myocardial ischaemia (restricted blood supply to the heart) usually through a blockage of an artery. Angina is a pain associated with myocardial ischaemia of a usually temporary nature. A cardiac arrest is the stoppage of the heart.

Lots of people survive the first (apart for the 250,000 Americans for whom the first presentation of heart disease is sudden cardiac death), not so many survive the latter

[oasisbob]

Normal procedures for emergency cardiac care are going to vary depending on where you are in the world.

The general dichotomy is "stay and play" vs "scoop and run".

https://doi.org/10.1007/978-88-470-2215-7_31

[GavinMcG]

Transporting these patients (the ones whose pulse hasn't returned in the field) appears to worsen their chances.[0] States vary widely in what protocols they require, but normal procedure in a lot of places is to not transport if resuscitation in the field has been unsuccessful.

[0] https://www.cardiovascularbusiness.com/topics/electrophysiol...

[Quequau]

I feel like there's a quote from "Princess Bride" in there but I guess now is not the time.

[Faaak]

Don't they need to be brought to the hospital for organ donation though ?

[VBprogrammer]

The circumstances in which organ donation is viable are surprisingly rare. I have a friend who worked in a head injury specialist unit, naturally this was a pretty good source of donors. You ideally need someone who is alive but only by virtue of life support so that you have time to turn off the machine and get the processes started.

[bitcharmer]

This would be the case only in those countries where everyone is a donor by default (unless explicitly you opt out).

I don't think most countries have laws like that though.

[FlyMoreRockets]

The state where I live has opt-in organ donation option when you apply for a driver's license/state ID. As a retired EMT in a rural area, I encountered organ donation cases twice in my career. Once, the patient was flown out, the other time, the orgqan donation crew was flown in. The first case, the patient had suffered a gunshot wound to the head that spared the autonomic functions, he was breathing on his own.

[wdr1]

There's a lot of bad reporting happening in Los Angeles.

There were a lot of headlines recently about "0% ICU capacity", which led most readers to think there are no ICU beds when there have been about ~50 since mid-December.[1].

The issue is the County Health department set a target of keeping COVID cases to under 30% of an ICU, so when when it exceeds 30%, for each point above 30% they deduct 0.5% from capacity.

I'm not a doctor, so that could very well be an appropriate way to do it, but when it comes to newspapers communicating with the general public, it misinforms people. (And I'm really worried about when we do hit 0 ICU beds -- as we probably will -- that people will be confused and/or lose trust.)

[1] http://file.lacounty.gov/SDSInter/dhs/1070348_DHSCOVID-19Das...

[wbl]

When have they ever run out of oxygen before?

[MattGaiser]

My understanding is that some hospitals have a central oxygen system, no different from how we are all connected to the water system and water comes out of the tap.

If too many taps were open, nobody would get enough water. Well, too many oxygen taps are open.

[sjg007]

Too many taps open increases flow which causes freezing.

[labster]

Hospitals are running out of oxygen in a way: so much is going through the pipes that the upper floors have low pressure, and the oxygen pipes occasionally freeze from adiabatic expansion. In LA.

[Cthulhu_]

You'd think they would test systems like that at maximum consumption.

Mind you, electricity and water systems are also not designed for every outlet to be maxed out. Whomst among us hasn't caused a breaker to trip from having too much stuff on at the same time.

[EliRivers]

Without knowing at all what I'm talking about, wouldn't be surprised if they are beyond maximum rated consumption.

[WrtCdEvrydy]

Why would you? There's almost no cases where you would need oxygen to every room...

[labster]

I doubt they tested for the case where they needed oxygen for the patients in the conference rooms and gift shop, either. It’s not like they can order more rooms on AWS; physical infrastructure has a breaking point and LA hospitals hit it.

[pfdietz]

Is it from adiabatic expansion, or is it just the LOX vaporizer/heater being overwhelmed?

[labster]

Honestly wasn’t sure when I wrote it, I’m an atmospheric scientist, not an engineer, so it seems typically adiabatic to me... quite possibly the answer is “both”.

[bradhe]

> But a headline designed to make incorrect impression just doesn’t help.

Yet this is basically all we get. Because it makes people click. It’s so hard to tell what’s real and what’s exaggerated these days. And if you try to make the case that something is exaggerated, you come off as a right wing nut job.

[ibejoeb]

For example, here are some excerpts from just one other LA Times article:

> Many hospitals also say they’re too full to accept any more patients or ambulances

> when paramedics are allowed to drop off patients at a hospital, the emergency room is often so crowded that there aren’t available staff members

> Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones

> canceling surgeries and erecting tents in their parking lots so they can triage the hordes

https://archive.is/VxZL9

If context matters, I'd expect an organization like the LA Times to be capable of addressing it. It's so frustrating to have to work backward just to find out if anything is remarkable. At this point, this kind of thing is seriously affecting the well-being of the audience.

[sjg007]

So where are the hospital ships?

[ibejoeb]

The one that was deployed is now being overhauled in drydock in Portland.[1]

But what's the point? I posted this article to criticize the LA Times' handling of the messaging. If you wouldn't mind taking a look at the original article from which those excerpts are drawn, I think you'll get it.

1: https://www.marinelog.com/shipyards/shipyard-news/vigor-wins...

[ithkuil]

> And if you try to make the case that something is exaggerated, you come off as a right wing nut job.

Doesn't it depend on the topic? I mean, remember when right wing news outlets were exaggerating the hordes of migrants invading borders etc and "left wing nut jobs" yelling that people are blowing things out of proportion?

I don't think each if these tactic necessarily belong to one political orientation. It's just a particularly infuriating way humans communicate and deal with verbal conflict.

Nowadays the general level of education is much higher than a century ago, yet there is still a long way to go; hopefully we'll have many more centuries to learn how to build a public discourse more effectively.

[justin66]

> It’s so hard to tell what’s real and what’s exaggerated these days.

You had to click through and read a few words in order to determine what was meant in the headline by 'little chance of survival.'

> And if you try to make the case that something is exaggerated, you come off as a right wing nut job.

In this case, you come off as perhaps just a little bit lazy?

edit: in the original complaining post about this topic, songgao links to a 4-post twitter thread that explains how EMS will handle things succinctly and nicely. The first post underneath is someone saying "So will they be left at home to die?"