Wednesday, March 25, 2020

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)

49 comments:

Reltney McFee said...

Dear Aesop: Best of luck to you. As has been noted in survivalist literature (essays, not novels), it is likely superior to deploy out of the excitement zone a couple of days early, rather than an hour late.

Perhaps, my employer did me a left handed favor, by laying me off!

Vitaeus said...

The Gods of the Copybook Headings


http://www.kiplingsociety.co.uk/poems_copybook.htm

I am self isolating and waiting for proven therapies and tests for post exposure immunity. Every dice roll I make with my health comes up snake eyes...

Aesop said...

Bon chance to both of you.
It isn't an option available to me in my current circumstances, but if I have to bunker in at home, I will.

Anonymous said...


Here in NYC, there is lots of corona media going on.

Cuomo on TV all the time. He's now the new savior, betcha he might take over Biden's spot if there is a mental breakdown there. Deblasio is letting out prisoners - BTW, it 's something he's been wanting to do for quite a while - but he is now blaming the virus - crisis and not going to waste...

There was a photo-op today of a makeshift crematorium in NYC outside of a hospital!

I pulled this data from the city of NYC from 2014. Apparently 56,000 deaths from disease (not murder, pedestrian accidents, etc). That's 145 deaths a DAY. But now they are putting up these tents for 198 deaths over the last 45 days. If you assume most don't die of the virus but with the virus - the deaths are not incrementally significant.

Something very strange is going on here. Especially in the usual areas where all of a sudden lots of money is being thrown at them..

If you have time, this guy walked around Manhattan and actually went to the Javis Center within the last day - he found nothing unusual
https://www.youtube.com/watch?v=Xp2hVSUU0uo

In NY - this virus is being used for manipulation. But, as an FYI, as of right now there is nothing out of the usual. And btw, Central Park was packed this weekend - as was the walkway on the Brooklyn Bridge. A very nice walk!

46 Bubba said...

By chance, due to being above the latest age threshold and placing myself in HAC, Thirteen Monkeys was being televised. I was impressed with the detail applied to suiting up, even if it was the “future”. Going back to my Time in Service 50 years ago, with NBChe basics are still of value. If exposed, consider yourself compromised. Get rid of what ever kind of PPE you been wearing and start the scrub down protocol. Simple but like you noticed, no one practices it, much less utilizes it.

Like your outlook. Good luck and stay or point.

NJdave said...

Aesop,

Any advice for taking the pregnant wife to the hospital in the next 2 weeks or so? We are in central NJ and the cases are growing quickly. So far our hospital is allowing a birthing partner (I hear some are not even allowing that). Other than hoping they have their shit together (and after your post, it's a weak hope) and getting out of there ASAP after the birth, I'm not sure what to do.

Anonymous said...

@NJDave

What about midwife, with plan for hospital in event of problems, for at home birth?

Best of luck

Joe Fahy

Anonymous said...

And what does all the non-preparedness break down to (besides the points Aesop already made obvious as sunrise)? Money. No body wanted to spend the money to be prepared. Corporations or .gov were busy spending money on frivolous shit like nice offices, big bonuses for the C-suite, and fat stock dividends and/or buybacks, and of course donating to any BS PC crap that was in vogue at the time.

Money. Same reason the old lady used to be anti-prep. I prep'd us on the sly when I could and took the hits from her when it couldn't be done on the sly because my main priority was getting us ready. Now its all I'm a genius and thanks for taking care of us. When (if?) the KungFlu and ancillary fuckery is done it has already been made clear that she is now on board with prepping. If we are here to prep, that is.

Aesop - being Kassandra is a bitch. Thanks for doing the dirty work. God Bless and keep you!

Aesop said...

@NJDave,

Minimize time spent.
If masks of any type are offered, wear them.
Touch as little as possible.
If asked to wait, and outside is a possibility, wait outside until called.
Keep your hands off everything. Counters, walls, etc.
Push doors with your butt, push buttons with your knuckle, hold doors with your feet.
Use hand sanitizer if available; wash hands afterwards if not.
Don't touch your face.
Wash your hands.
Wash your hands.
When you get home, wash your hands.

Stefan said...

Question for Aesop: why don't frontline medical people get issued their own goggles and half-mask with standard replacement filters for the whole location? Full face ones using the same system for those in closest contact with known cases. Anything to prevent a person using their own, if it were on an approved list? N100 protection...

Swrichmond said...

Great stuff. Mrs. SWR is an ICU nurse with 40 years' experience (NICU / PICU / adult ICU / Cardiac Cath). She understands the extent to which she is on her own at the hospital. I look forward to sharing this with her tonight.

Aesop said...

@Stefan,

That's great advice...if only it had been in place months ago.
As of now, you may have heard, the country is a wee bit short of all that just yet.

Reltney McFee said...

Aesop: Yep, The Suits. "Bless their hearts!" (enunciated in Southron)

Anonymous said...

Aesop,
Different industry, similar problems. Lack of foresight/planning/a frigging clue is rampant, pretty much everywhere. Seems like those of us that have some form of .mil experience are wired a tad tighter; while everyone else is in the midst of executing a massive flail-ex. At work, the .mil community have self-identified and have banded together to try and bring some sanity to the dumpster fire. The same fire that everyone else seems to be content to try and smother as effectively as a bucket brigade with gas. So far, we've been semi-effective at curbing the dumbassery, but only because we're working to ramp up our influence. At times like this, I wish I had a LAAD kid or two for the good idea fairy that's whispering sweet nothings in management's ear. Couple of friends that are still in at an I&I station in FL and out at The Stumps are telling me that it's close to the same with Uncle Sam's Mobile Circus. MARFORRES is, well MARFORRES. Out in 29, apparently the Lance Criminals are disregarding just about everything, much like the Covidiots in Florida recently. It's gotten to the point where the MCAGCC CG is out and about asking them WTF and they're feigning ignorance as the lance coconuts are wont to do, resulting in staff Memos to the O-types on base. In short, business as usual, with a bit more top-heavy oversight.


Keep your head low and stay safe.
-Sarin

GamegetterII said...

16% as of today.
We'll see what the idiot governor and top woman have to say tomorrow.

https://www.cleveland.com/news/2020/03/16-of-ohios-coronavirus-cases-are-healthcare-workers.html

nick flandrey said...

@aesop, you can forward your manglers this link (which I've listed before but might have been missed.


https://asprtracie.s3.amazonaws.com/documents/aspr-tracie-hcc-pandemic-checklist-508.pdf

Which lists all of your 'yet to come points' and more...

Highlights here--

https://www.ttgnet.com/journal/2018/02/16/fri-feb-16-2018-pandemic-flu-preparedness/

It gives some legitimacy thru appeal to authority....

nick

nick flandrey said...

Wow, ohio has 16%? That's double the reported rate elsewhere in the world.

yikes.

n

nick flandrey said...

the LA hospital boards weren't the only ones

https://www.thegatewaypundit.com/2020/03/stunning-conspiracy-media-attacks-gateway-pundit-after-cuomo-admin-turned-down-purchasing-additional-ventilators-and-focused-on-lotteries-death-panels-instead/

https://www.nytimes.com/2020/02/27/nyregion/new-york-coronavirus.html

https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf

"A pandemic that is especially severe with respect to the number of patients affected and
the acuity of illness will create shortages of many health care resources, including personnel and
equipment. Specifically, many more patients will require the use of ventilators than can be
accommodated with current supplies. New York State may have enough ventilators to meet the
needs of patients in a moderately severe pandemic. In a severe public health emergency on the
scale of the 1918 influenza pandemic, however, these ventilators would not be sufficient to meet
the demand. Even if the vast number of ventilators needed were purchased, a sufficient number
of trained staff would not be available to operate them.
If the most severe forecast becomes a
reality, New York State and the rest of the country will need to allocate ventilators."


Both deblase' and cuomo should have been aware of the documents, and the contents, and of the need to triage patients (allocate vents). If not them personally, then their councilors. Bullshit grandstanding or lying? Why not both?

n

Wendy (KekistanTrans) said...

@ Sarin re: Uncle Sams Misguided Children / E-3 mafia issues:

Young people in their late teens and early twenties don't quite grasp the seriousness of some things - like "safety rules are written in blood" - having not yet experienced the death or serious lifetime crippling injury of a near peer. This is universally true I think to all but the most mature young (late teens to early twenties) people, so you get people who don't take all sorts of good advice and various safety measures as seriously as they should.
They think that slacking off or disregarding some important matter is sticking it to "the man" (the senior NCOs and officers) but it's really putting themselves at risk.
As to the kids who self selected to be exposed to the COVID-19 virus by going on Spring break, well at least we will get some data on how the course of this disease plays out among the younger generation.
Unfortunately, a sick Millennial will likely get the ventilator over a retired Boomer, even if the kid got it by being stupid, so the warning that someone's sloppiness or stupidity can get someone else killed still holds true.

Anonymous said...

Kaiser Hospitals tell nurses they don't need masks for taking care of COVID-19 patients. They threaten to fire nurses who wear their own masks.

https://theintercept.com/2020/03/24/kaiser-permanente-nurses-coronavirus/

Sherm said...

I have a dentist friend across the street that misjudged what he was ordering when he bought a container load of face masks from China a couple of years ago. He has 700,000 masks he's been selling to area hospitals and clinics at cost. One hospital, down to their last 100, couldn't wait for shipping and sent an employee to pick them up, loading them into a horse trailer (this is Montana after all).

Tucanae Services said...

"... 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.]" -- Aesop

I am not defending mgt here, but. The logistic mavens are probably using a IMS configured to adjust for a rolling EOQ number. Hence if you ask for 1K on N95 the damn software will round down. The lazy fucks need to do a manual entry override presuming they know how. A typical management move is to fire the guy that knows the system and hand it over to a clerk who does not know shit cuz, labor costs. Oh and the fuck that suggested the 'realignment' gets a fat bonus check.

Anonymous said...

Windfall in Big Sky Country. Cool.
Feeling fortunate NOT to have cuomo or deblasio in authority out here. Our leftist guv'nor has so far been pretty restrained, far surpassing expectations.
Just heard that cases are cropping up in the rural areas in southern CO now. Dunno if that's incubation, testing or what.
Boat Guy

Anonymous said...

According to the JH map lots of cases showing up in rural areas and small towns now.

DanH

Anonymous said...

SITREP from the retired MIL:

Army G1 just sent out an e-mail to EVERY retiree begging for retired MEDAC personnel to volunteer to return to active duty to help out. Right now the list only included certain medical specialties (MD, RN, enlisted medic and the like). Waiting to see of they also beg on the enlisted worker bee types (those who did most of the scut work anyway)....

Below is a copy of said e-mail (cut and paste - no changes made):

The U.S. Army is reaching out to gauge the interest of our retired officers, noncommissioned officers and Soldiers who would be willing to assist with the COVID-19 coronavirus pandemic response effort should their skills and expertise be required.

These extraordinary challenges require equally extraordinary solutions and that's why we're turning to you -- trusted professionals capable of operating under constantly changing conditions. When the Nation called -- you answered, and now, that call may come again.

If interested and you remain qualified to serve in any of the following health care specialties: 60F: Critical Care Officer; 60N: Anesthesiologist; 66F: Nurse Anesthetist; 66S: Critical Care Nurse; 66P: Nurse Practitioner; 66T: ER Nurse; 68V: Respiratory Specialist; 68W: Medic - we need to hear from you STAT!

If you are working in a civilian hospital or medical facility, please let us know. We do not want to detract from the current care and treatment you are providing to the Nation.

While this is targeted at medical specialties, if you are interested in re-joining the team and were in a different specialty, let us know your interest.

Anonymous said...

Fixing bayonets eh?

https://breaking911.com/breaking-fbi-agents-kill-domestic-terror-suspect-who-was-planning-mass-casualty-attack-due-to-covid-19/

Jester said...

@aseop

And the rest of you all out there when he speaks about why there is not connexes of stuff for pandemics?

This is what the theory of Just in time replenishment does. That is what the medical fields do, to include the VA. In fact with out a waiver you're pretty much stuck to have 30 days of supply on hand that can be turned over. What that means is a box you get in on day 1 has to be used by day 30, or bad marks happen. There is nearly no plans to have stocks of PPE and disposable stuff ever, but even when it does let's just say the pandemic stock at a place I might work for was thrown out because it went out of date. It was not tracked as regular inventory as it was pandemic supplies. So instead of using that stuff and replenishing that stock.. yeah.

I've been advocating for what aesop does, having 3 to 6 months of disposable PPE on hand for full staff, 24 hours a day to last for 6 months WITH OUT A RESUPPLY as I'm sure Aesop will tell you now all the PPE distributors are rationing who gets what down the supply chain, IE the hospitals that are begging for 500 cases of gowns, and 1000 cases of gloves are getting.. well 2 or two cases at times at best. BECAUSE EVERY FUCKING HOSPITAL ONLY PLANS FOR SUPPLIES FOR ABOUT 30 DAYS AT A MAX. If that. 15 days is pretty much across the board in most joints. That's also generally assuming you can get the supplies you need normally. Somewhere there are geniuses in the VA or private/public hospitals that say we save so much money by this Just In Time (JIT) methodology of having supplies available. Can't have thousands of dollars tied up and just sitting you see. Except when it all comes from fucking China. Except when everyone else runs out and needs it too. Except when there is a fucking pandemic threat and the normal usage of stuff goes though the roof. Except when as Aesop also pointed out the shit walks off. There was pallets of stuff walking out the door at various VA facilities. It's better locked down now but I kid you not, folks (Who may have been caught and fired but the stuff is still gone) made off with pallets of wipes, sanitizes and other stuff.

Anonymous said...

ScottAdams episode 871. Forward to 17:00

http://www.smalldeadanimals.com/index.php/2020/03/25/watch-this-and-make-your-own-decisions/#comments

Is it true every doctor is prescribing themselves the Chloriquine and Z-Pack treatment?

I am normally not a conspiracy theorist, but why all the public resistance to TRYING this treatment?
Are the medical specialists all Anti-Trump? Scared to be seen as open minded, which might be seen as Pro-Trump?
Or my favorite conspiracy, "We won't use the drug, because it is generic, and the drug companies are spending billions on new drugs that they can patent and sell for hundreds of dollars per dose."

Nahanni said...

Probably because all those leftist city putzes and toilet licking millennials who were on the beach or in New Orleans are running for the hills.

Have your guns ready, the holes horde is on its way.

https://www.zerohedge.com/markets/overnight-world-became-twilight-zone-exodus-cities-sparks-mountain-dweller-greatest-fear

https://www.zerohedge.com/geopolitical/cape-cod-hamptons-overwhelmed-rich-americans-fleeing-their-summer-homes

Nahanni said...

Holes=golden.

Dammed autocorrect.

MTNBOY said...

I have seen the FSA first hand and it can get very ugly very quickly. In 1992 a statewide request for Mutual Aid went out to every Law Enforcement agency in California. I worked on a department 300 miles north of Los Angeles. Since I was loaned out to a DOJ Narcotics Task Force, I was chosen to go because it would not affect the patrol schedule. A new officer was sent along with me.

Our first night was in Long Beach. We were told by LBPD to "Take Back the Streets". As we left the police station we drove by a L shaped strip mall that had been looted and burned. What was strange is that there were fire hoses on the ground and no fire engines. We drove to Long Beach Blvd, and there were looted buildings everywhere. (I later learned that Long Beach Blvd. goes straight into Compton). I remember a store fully engulfed in flames venting through the roof, with not a fire engine in sight. I recall the sign on the front of the store, Bens Bicycle Shop. Who burns down a bicycle shop because of Rodney King?

I asked the LBPD cop what was up with the fire hoses laying on the ground at the burned out strip mall. He said that the strip mall backed up against the Carmelitos Housing Project. I asked him if they where like condos. He laughed and said not exactly, the firemen cut their hoses with axes and left when residents on the housing project began shooting at them! I told the cop, lets form a task force and go in and clean the place out. He laughed again and said it would take an army to do that.

The second night we worked out of the LASD Lynwood Station which is between Compton and Watts. During the briefing in the parking lot we were told not to stop at stop signs or red lights because we could get shot at. I turned to the LASD Deputy next to me and said, "This riot stuff sounds pretty serious". He looked at me and said, we drive like that all the time even when there is no riot!

We took off in a 7 car element, 7, two man cars. Two LASD cars and 5 cars from all over the state. None of us could talk to each other because we all had different radios on different frequencies and bands.

Right out of the gate we took off code 3 and all we could do is follow the LASD guys. We stopped briefly and the deputies talked to a Hispanic guy who just had his car jacked by a black guy. Again we took off code 3 and ended up at a housing project. The deputies took off running and I was in pretty good shape then, so I went down between some buildings to cut the suspect off. It was only one guy that we were chasing. Within one minute, a sea of black faces streamed out of the buildings, men women and children, screaming that they were going to kill me. I ran at Olympic speed back towards out units with over 50 people chasing me. My young partner advanced towards me with his shotgun pointed at the crowd. I made it to the units and my partner said, "if you went down I would of shot them all". It was very matter of fact. The kid grew up in a rural farming area and told me he had never met a black person before.

Other Units began pouring in and we soon had 30 two man units that were completely surrounded by screaming people. I was standing outside my unit and out of the corner of my eye, I say a stingray bike handle bar fly over my unit about 3 feet from my face.

The LASD Sergeant got on the PA and told us to drive out code 3 and if anyone tried to stop us, drive over them. After we got to a safe space we were told that if we had stayed much longer, they would have made it to the roof tops and shot down on us. The name of the Housing Project was Imperial Courts (sounds nice), where the CRIPS Street gang started.

That night we patrolled around the Compton area. Many of the houses had furniture, TVs and other items stacked out in front waiting for trash pickup. It was stacked out there because they all recently acquired new stuff. (Free Stuff Army).

If at all possible, get out of the city. If things go bad it is not survivable.

Aesop said...

That assumes you only shoot second.
Han shot first.
Rooftop Koreans, baby.
Be the change you want to see!

Anonymous said...

Sherm,

Do you have contact information for your dentist friend with the face masks? My hospital would like to speak with him as soon as possible.

Aesop,

Do you have a way to send a message to Sherm in case he does not read this comment?

Thank you both!

Aesop said...

Nope.
I don't see anything you don't.
His blogger ID is in his handle.

nick flandrey said...

@aesop,

anything in this listing in short supply?

https://www.amazon.com/Medline-Industries-DYNJAA0110-Expandable-Anesthesia/dp/B000K6LJF4

combined with this kit

https://www.amazon.com/Medline-Industries-HCS7851-Suction-Canister/dp/B00BLQPENU

Or is this stuff only for it's intended use? Asking the only medical pro I know who is accessible at the moment. I'll take it to somewhere local if things are desperate if it's appropriate for the need. Mix of slightly out of date, and in date stuff, the kits were out of date by a short time. The prep wipes had expired, and were eating thru the foil packet so they were right to surplus the kits, but maybe not the pieces.

nick

(it's kitted with some other stuff, disposable electrode, suction wand, drape, fingertip sensor)

Anonymous said...

"Staff members ignore this and basic precautions, due to stupidity, apathy, resignation at substandard practice becoming the norm, or laziness."

At a couple of steps removed, I am getting constant accounts of younger medical staff doing mind-blowingly stupid things in their time off and infecting patients shortly afterwards.

I can't even pass along the activities, for persec - the actions in question are just that memorably stupid at a time when so much effort is going into protecting vulnerable patients.

It's not a lot of them, but it only takes one per wing.

Anonymous said...

I have second hand report of individual getting better on the anti malarial. Trusted source.

I have personally played a version of roof Korean game in a different venue. Mine was titled white guys with guns protecting their shit in the dark. It wasn't fun. Nothing romantic about it. The kid walking out of the dark in the hoodie will never know how close he came to becoming fertilizer. He was testing the perimeter head on while his buddy flanked us and observed that we were well armed. We got "tested" three times that night and each time they decided it wasn't worth the effort or blood. But as mtnguy said above, you don't want to be anywhere near the hood if the apple cart tips.

Anonymous said...

Concerning any confusion on Gamegetter II's comment @1:04 The 16% number indicates healthcare workers who have tested positive. Ohio Guy

McChuck said...

Hear! Hear!

Oh, if only TPWB would listen, and look. We know they cannot think, so I guess that really doesn't matter much.

For the movie version of this, watch: Shin Godzilla. The government's completely inept response is the heart of the film.

Anonymous said...

Retired MIL above @4:44 PM:

Do you have any more info that you could pass on? I'm not medical but getting ready to be booted out for being too old, and I'd like to hang around and help out in some way.
Too old? I can run circles around most young guys. Course I'm not very good at Call Of Duty.

"Old" Grunt

Anonymous said...

@Wendy,
Tried replying last night from the phone, but that didn't work. Lance Criminals gonna Lance Criminal is what I chalk it up to. Twentynine Palms sucks. All kinds of problems when I was stationed there. Most of it came from the kids in the infantry. Has everything to do with the lack of basic services in the town outside the base. FFS, the nearest Wally World was 45 minutes down the road in Yucca Valley. No "nightlife" to speak of so, the young'uns decide to escape by getting hammered on the regular. Add to that the fact that for at least 5x months (Bootcamp, SOI and MOS follow-on for those that aren't basic 0311's aka, basic grunts) we've told these kids that they're 10' tall and bulletproof, whether they admit it or not, they start to believe it. The worst of the bunch for me were the TOW gunners. Higher GT requirement which means that, on paper, they're smarter than the average grunt. Reality is that they think that they're slick enough to get away with something, but didn't plan it well enough. Just interesting how society is on about the COVIDIOTS in FL, but isn't aware that the same attitude (albeit for different reasons) exists in the military.

Good point about the vent being given to a millennial vs a boomer; sucks, but that's reality.

-Sarin

Sherm said...

Remington family dental

406-545-0035

Anonymous said...

Old Grunt:

Naw, big Army is still running in circles and flapping their collective arms on this.

nick flandrey said...

data point regarding the normal amount of PPE on hand,



Kaiser’s cancellation of elective surgeries earlier in March is also helping preserve masks and other personal protective equipment. Doing so has reduced the number of patients in the hospital by 15%, Parodi said, and instead of having just five to 10 days on hand of personal protective equipment, that’s increased to more than 30 days of supply.


n

Random63 said...

Found this on another site. I thought you might find it useful at your work.



To all of my nursing colleagues!!! This is from the Covid-19 practitioners group. This is brilliant and can save so much wasted PPE!!

Forwarded: EXTENSION TUBING

INFUSION PUMPS IN HALLWAYS

MD, Anesthesiology, Indianapolis

This was forwarded from a nursing group and seems worth investigating.

PSA: Working last night in our very busy Coronavirus/ Covi-19 ICU I must have single used and discarded over 50 goggles and N-95 masks. Wasteful but necessary. Half the time I had to suit up just to tend to the IV pumps.

This morning I suggested moving the pumps into the hallway and running tubing extensions to the patient.

Today the hospital implemented this and it will save thousands of valuable PPE sets.

Please share this idea with your institutions. Quality PPE will shortly become scarce.

Old Grey Guy said...

I have a question for the medical people re: respirators. Could you just turn up a CPAP machine to help?

Aesop said...

CPAP just forces room air in at higher pressure.
Pneumonia decreases your ability to exchange gasses in your lungs at the alveolar level, so you need more O2 to make up for decreased exchange rate.
If you don't have a source of pure oxygen, CPAP isn't going to be much help.

Aesop said...

@Random63

Problematic, at best.
Extending the tubing? Okay. Say you're giving a 50ml bag of IV antibiotic. 15ml is in the tube when the bag's empty. Add 2-3X the tubing, and all the ABX is in the tube, the bag is empty, and none of it is getting into the patient. So you have to push more normal saline into the tubing to flush out the medicine, every time, which increases fluid dumped into someone who's already drowning in their own lungs.

So probably not going to work well.

You're also observing for reactions, infiltration, etc., which you can't do from outside the room.

Bedside nursing is bedside nursing for reasons.

The correct answer is to have enough PPE to do the job right.
Period.

But thanks for bringing it up.

~Lance - Semper Fi said...

Make your own mask, easy peasy from a furance filter, the kind that we use in our homes.

Filters must be MERV 13 or above to filter out virus’s however the higher the number the harder to breath through the masks. I have no problem breathing through a MERV 13.

1. Take the filter apart slowly as not to tear the material. The wire mesh is glued to the material and it is slow going taking it apart.  2. Cut the material into 6.5” squares, that means that you can make 9 masks per 20”X20” filter. There are six filters in a package so you can make 54 masks. 3. (Or you can buy one 20X20 filter at a time from Lowe's) Place material in-between two regular paper dust masks that can be gotten at the hardware store for ‘cheap’ 12 cents each. If sold out see if you can order on-line.  Trim with scissors around the edges then tape edges with paper medical tape which won’t be harmful to your skin, or use a sewing machine and sew around the edges.
 
From Amazon{ Aerostar Home Max 20x20x1 MERV 13 Pleated Air Filter, Made in the USA, 6-Pack, $35.00 and change.
 
 Gloves: Buy from amazon: Waveform Nitrile Gloves with Textured Fingertips – Latex Free and Powder Free 4 mil Disposable Exam Gloves, Large (100 Count)
Sold by: The Medical Shop   They come in small, medium and large and you get 100 per box. Cost $13.00 and change.
 
 
Goggles must fit tight around your face, swim type.
 
While your sitting at your computer right now reading this, simply bring-up amazon.com and order this stuff. It’s cheap and easy to make this stuff, so just do it, do it now…
 
 
 
PS: Toilet paper fix. From Lowe’s you can buy a Bidet attachment for $45.01 and install it in 30 minutes.