For Concerned American, via LTGEN Russel Honoré:

Regarding CA's comment at WRSA:

"Do you see anybody thinking about the impact on med staff (MDs to newest hire nurses and techs) of this first wave?
Last time I checked, it takes more than a season to grow a credentialed med pro of any label, let alone make one that is truly competent."

Only tangentally.

The Good :

All students, interns, volunteers, etc. were told to Eff Off and stay home. No clinicals, etc.
That's cost some of them some valuable pre-graduation clinical bedside experience, but it spares them from in-hospital exposure risk.
It's also the right thing to do.
They're students, and unpaid, not hired and licensed professionals (Yet, kids. Patience.).
Their job is to pass school, and their boards, not be casualties for zero pay in a battle they haven't been vetted for, at this point. Don't worry, their day will come.

I told my department leadership waaaaaaay back in early February about getting alternate sourcing for the 40+% of our everyday supplies (including some pretty important sh*t) that only comes from China.
Surprising the hell out of me, they kicked it up the chain, and gave me credit. So the important thing is that we did get alternate sources of a lot of things, and the China problem for our supplies is less of a factor going forward.
The minor factor is that my management (and I) are now certified jet-fuel geniuses compared to TPTB that run the joint, because none of them were even paying attention to this until my memo popped up on their radar. Still no pay raise, but I'll settle for the street cred. Less than a year in this gig, and they asked me about joining managemanglement. Pass. I like doing my job, for now. Not waving my arms and telling other people how to do theirs all day, and flying a desk. And I'm not interested in the pay cut. Besides, when this is over, and things return to normal, the first cuts are always desk jobs, not bedside. Color me employed and making six figures right where I am, thanks very much.

Some docs have been epic at telling b.s patient visits to "Get Out of My E.R!" (which is where the backstage medical term GOMER came from). They have literally chased dumbasses out of the lobby the minute they signed in for silly-ass stuff that should have gone to Urgent Care, PMDs, or been treated at home using the patients' own common sense, generally in short supply. The dropped jaws when this happens are worth the admission price to see the show.

And we've told visitors, point blank, to stay home. Except with newborns, and those visiting expectant patients and DNRs. Yay, 500 fewer Kung Flu reservoirs trooping in and out every day, and using up all the other masks and gloves. Brilliant.

Cops, criminals, and homeless are even afraid to come in and get Kung Flu, so daily census is low, until stupidity breaks out. So far. Meanwhile, what does come in is really sick, and we've lost a few spots creating Kung Flu dedicated beds on all wards, so we have less than a dozen available beds in the whole hospital, most nights.

Still, we've had enough PPE (mostly). So far. But this has barely begun. Which brings me to

The Bad :

Our entire first batch of N95s, for the entire hospital, grew legs and walked away by the 15th of February. (Staff pilfering, patients and their gypsy families helping themselves, etc.) February, BTW, was our month to do Annual Mask Fit Testing. Being a good boy, I trotted right down by the 2nd or 3rd, and got checked off. Then had to do it again on the 16th, because the first brand (everyone's favorite 3M Item #) had walked away, and we had a new brand of N95s. We have burned through all of those, and are now on our third version of N95 masks. Which are running low. Because, never having had 4 to 20 rule-outs for Kung Flu, and 10-20 admits under surveillance (or active confirmed cases, we have a couple of those) before, the planning for how much stuff we'd go through daily, weekly, monthly - masks, gloves, gowns, face shields - was, to put it gently, rather exuberantly optimistic.

[Hospital Manglement/Purchasing/Supply Dweebs EVERYWHERE! - Word to your mothers: If you haven't planned for every nurse on every shift to go through twenty complete uses of PPE, for every patient in the hospital, at 200% of normal peak visit capacity, for 6 months non-stop, you're fucking this up by the numbers. You should have 40' conex boxes of this sh*t (FFS, they're paper, etc., and they don't go "bad" in the cartons) stored in the hospital parking lot, and every 90 days, the oldest month's stock should be rotated into use, so you're using up old stock and replenishing it with fresh stock, always, forever. This is Disaster Prep 101-level common sense, you cheap lazy bastards.]

No one AFAIK anywhere is doing this like they should. Consequently, things are running out. Masks are rationed through supervisory staff, and it still runs out.
My take on this, is that in this sort of pandemic/disaster, three things will run out.
1) First will be beds.
2) Second will be PPE.
3) Third will be staff - out the back door, when asked or voluntold to "suck it up" and walk into a bonafide hazmat room with faulty, inadequate, or no PPE.
We get to that point, and that's the day I file for a personal leave of absence. I've seen me do it.
(I will work for you. I will not get sick or die for you. Especially because you were cheap, stupid, short-sighted, or all three. I can't spend my paycheck from Forest Lawn Memorial Park. You wanna threaten to replace me with fuckheads who will, suture self. My starting rate after they die will be 200% of what I make now, minimum, after this all blows over. Suck it, or learn a lesson. Florence Nightingale and Dr. Schweitzer are dead. If loyalty only goes one way, the only love you show me is in my paycheck. I will live to spend it, or seek other employment, with someone less f**kheaded. I'm not a dewy-eyed 20-year-old nitwit. You're paying me for my common sense, clinical experience, and mature judgment. Don't be surprised or butthurt when I and my brighter co-workers exercise it. Period.)

Which brings me to

The Ugly :

The "guidelines" for this are worse than the Pirates Code. Which really are guidelines, per Capt. Barbossa.

First, they change daily. Or more normally, multiple times per day. That'll work well.

Second, they get finger-banged, re-interpreted, and outright ignored, depending on the IQ of the nurse/doctor/charge nurse/house supervisor/infection control person/CNO/CEO/County Health Office flunkie in question. And every one of them, in the last two weeks especially, has proved the truth of the contention that 50% of everyone graduated in the bottom half of their class. Patients are being run through "isolation" rooms with no filtration or negative pressure. Patients who meet all criteria for a Kung Flu rule-out, and full precautions, are being waved into regular patient care areas, with minimal PPE in use, because there aren't enough isolation rooms and PPE supply carts to do that. This exposes all staff, and other patients, to potential infection who didn't have it previously.
Staff members ignore this and basic precautions, due to stupidity, apathy, resignation at substandard practice becoming the norm, or laziness. All of this is a recipe for disaster. Ask the entire uniformed military services, or Cunard Lines, or Boeing, or Airbus, or NASCAR, or NASA, how that works out in field tested situations.

Safety Rules Are written in blood.

Don't make it yours.

I would have it otherwise, could but wishing make it so. But stupidity reigns, more often than not. We're going to pay for that, and by extension, so are you.
I'm not looking forward to writing Solzhenitsyn's "how we burned later" Lament for the medical field, in a year or two, but it will be written by someone over this, mark my words.

The only thing I'm sure of now is that I didn't have Kung Flu 14 days ago. Until I do.

Third, because in the immortal words of Gen. Honoré,  "you didn't plan for a disaster, you only planned for an inconvenience", none of the shit - pardon me, I meant to say SHIT - we have pulled out of storage to use for this has ever been field-tested for fifteen minutes.
What they seem to know about basic tent usage wouldn't impress a boot camp private on his first attempt to set up a shelter half with a buddy. Recent rains collapsed - COLLAPSED - the tents in which we were going to house patients outside the building. Electrical cords and generators were/are snaked through sudden deep puddles of water in driving rainstorms, because they only ever do disaster drills briefly, on sunny, warm, non-windy days. God help them when we get a good Santa Ana wind day. Temperature-sensitive equipment includes thermometers, FFS, which we kind of need to check for fever, but they become unreliable or fail in normal outdoor temperatures that aren't 68-72º. And no one thought to have actual no-shit mercury bulb glass thermometer backups, that have worked since 1800 and earlier, because it gives the EPA a case of the vapors.

Radios fail. People - and I'm talking educated folks with science degrees, not just Joe Average - don't understand simple concepts about how they work. (Oh, and not one swinging Richard in the whole house, top to bottom understands basic radio use or protocol. I had mine beaten into me both as a member of Uncle Sam's Misguided Children, and again as a Red Cross Volunteer by a Navy LDO Lt. Cmdr. who did truly legendary meltdowns on the clueless, via landline, at wee events of 1-2M people, which all of you have seen on TV in your lifetime. O, to get him to come out and teach that class where I work now, for but an hour...). When you have hundreds of people making mistakes that a simple hour of training could cure, it's because the planners don't know what they don't know, and never asked anyone who does what they need to know.

The concept that generators run out of gas has been an amazing discovery.
In tomorrow's news, water is wet, and the sun comes up in the morning.
I can hardly wait until they discover that gasoline fumes and vapors are flammable and explosive. Maybe they can get the FD or Burn Center to hold a powerpoint or something.
Ideally, before the FOOM!

And it's cold now. Wait until this stretches into May, and they've made no provision for when it's hot outside instead. Nothing like heatstroke for staff and patients to get your attention to what you're fucking up, daily, by the numbers. Stuff any decent assistant director in Hollywood could have told people, because TV and the movies work outside 24/7/365, but the hospital is a bunch of wilting orchids once they exit the building.

What I really don't want to point out, but will have to in another week or two, is to ask WTH their plan is for when, quite literally, the natives get restless, and storm the bastion. Who's going to provide more than kabuki token security the day we have 40 scared people in the outside tents, or the community decides we have food, medicine, etc., which they want and don't have?

Does anybody really think that Joe Rent-A-Cop and glass doors will avail when the Free Shit Army comes calling? Well, I mean does anybody besides the idiots running the joint who haven't thought that far ahead...

Somebody's hospital, mark my words, is going to be the bellwether for when it's time to deploy the Notional Guard, with fucking bayonets and loaded mags, and tell them to repel boarders with extreme prejudice. I don't want it to be mine. But the day may well come when I'm carrying at work, and sporting a discreet kevlar undershirt, and it'll be NDBBM*, with something larger and louder in the vehicle rack. Or, I'll simply self-deploy home, for the duration.

That's before I get to lack of thought for any provision whatsoever for anything but the everyday JIT supply of normal materials, let alone water, sanitation, food, power, and all the other necessities that make a functioning hospital possible.

The lessons of hospitals and disaster relief from the Northridge Quake, Rodney King free tennis shoes and TVs Riots, or hospitals in Nawlins during Katrina, are like stories about trench warfare, Greek myths, and the Jurassic period: ancient history. People who should be able to quote how to do this from memory don't have the first fucking clue what they're doing, or going to do, if anything seriously untoward happens, or one person out there so much as says "Boo!"

They've planned for a grade school fire drill, not for the Paradise Fire sweeping through the city.

It's going to be an expensive OJT lesson, for a lot of people.

So no, in sum, they've given the safety and well-being of the medical (and all other) staff, and patients, and by extension the entire community we serve, far too little thought (and I use that word loosely) to suit me. And that's not just the hospital, it's ALL the entities, private and public, and agencies involved, from the city council to FedGov, and everyone in between the two, at every level.

I've been through two major earthquakes, and two region-wide riots, and what I'm seeing is what happens when jackholes with zero experience in either try to run something they've never even imagined.

If anything, I'm sugarcoating this.

And yet again, the safety rules are going to be re-written, in blood.
Hopefully, not mine, nor yours.






*(Nobody's Damned Business But Mine)