akflightmedic
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GEICO just "paused" all policy cancellations for non-payment through April 30th...nice job. (Coronoa related right?) 
Coronavirus Discussion Thread
- Thread starter Akulahawk
- Start date
I also saw Senator Warren wants to pause all student loans and give healthcare/first responders $10,000 off their loan balance.GEICO just "paused" all policy cancellations for non-payment through April 30th...nice job. (Coronoa related right?)
DragonClaw
Emergency Medical Texan
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My partner got tested for COVID. Wonder how long till he gets results.
RedBlanketRunner
Opheophagus Hannah Cuddler
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@Summit Decontaminating and reusing. Excuse if I sound redundant or whatever here.
Sterilizing is pretty much the same as debridement. If you can't supply an environment where all organisms and spores cannot survive mechanical energy has to be applied to facilitate the kill. In an autoclave molecular acceleration supplies the energy and the more energetic, the faster the kill. The alternative is a toxic environment which involves time for the toxin to work it's way into all molecules and shut down reproductive cycles.
Simplified. Disinfectant sprays are only effective against some of the organisms. They shut down reproduction and inhibit regrowth of the organsms they are able to come in contact with. They are largely ineffective against spores. Also, they do not have the full ability to invade individual cells and kill the viruses contained in them. Simple mechanics - the disinfectant molecules, massive blocks so to speak, aren't wet enough or small enough to get in and do the job.
So spray downs of PPEs just does superficial kills.
The quickest and simplest way to effect a very high kill ratio along with a reproductive cycle knock down is solutions like chlorine baths. The problem with chlorine is the molecules are gigantic and ... best analogy would be a blindfolded wrecking crew going into a room armed with sledge hammers to eradicate a roach infestation. Give them, the chlorine bath, sufficient time they will get all the roaches except the eggs, the spores lurking in the corners.
Other disinfectant chemicals operate much the same as chlorine and some are much faster but usually far more expensive. H2O2 is another cheap alternative but has a severe limitation. Replace the crew's sledge hammers with one shot cannot be reloaded pistols. Once the extra oxygen atom explodes, is freed, doing a kill, it's done and gone, turned into ordinary water and gas. And H2O2, like chlorine, is a big clunky molecule, not all that wet and has difficulty penetrating materials.
So, lacking access to autoclaves or EO chambers, your cheapest and most reliable sterilizer is a chlorine bath soak, preferably 24 hours. An additional advantage of chlorine is you can reuse the bath as long as you maintain the chlorine concentration ~ 2500 PPM, and keep the solution clear of particulates. Not perfect, but a reliable 99%.
(Perfect, 100% kill of all life-> an oven >500F for 8 hours. Even then, some dead spores have demonstrated the ability to revive themselves, mechanism unknown.)
Sterilizing is pretty much the same as debridement. If you can't supply an environment where all organisms and spores cannot survive mechanical energy has to be applied to facilitate the kill. In an autoclave molecular acceleration supplies the energy and the more energetic, the faster the kill. The alternative is a toxic environment which involves time for the toxin to work it's way into all molecules and shut down reproductive cycles.
Simplified. Disinfectant sprays are only effective against some of the organisms. They shut down reproduction and inhibit regrowth of the organsms they are able to come in contact with. They are largely ineffective against spores. Also, they do not have the full ability to invade individual cells and kill the viruses contained in them. Simple mechanics - the disinfectant molecules, massive blocks so to speak, aren't wet enough or small enough to get in and do the job.
So spray downs of PPEs just does superficial kills.
The quickest and simplest way to effect a very high kill ratio along with a reproductive cycle knock down is solutions like chlorine baths. The problem with chlorine is the molecules are gigantic and ... best analogy would be a blindfolded wrecking crew going into a room armed with sledge hammers to eradicate a roach infestation. Give them, the chlorine bath, sufficient time they will get all the roaches except the eggs, the spores lurking in the corners.
Other disinfectant chemicals operate much the same as chlorine and some are much faster but usually far more expensive. H2O2 is another cheap alternative but has a severe limitation. Replace the crew's sledge hammers with one shot cannot be reloaded pistols. Once the extra oxygen atom explodes, is freed, doing a kill, it's done and gone, turned into ordinary water and gas. And H2O2, like chlorine, is a big clunky molecule, not all that wet and has difficulty penetrating materials.
So, lacking access to autoclaves or EO chambers, your cheapest and most reliable sterilizer is a chlorine bath soak, preferably 24 hours. An additional advantage of chlorine is you can reuse the bath as long as you maintain the chlorine concentration ~ 2500 PPM, and keep the solution clear of particulates. Not perfect, but a reliable 99%.
(Perfect, 100% kill of all life-> an oven >500F for 8 hours. Even then, some dead spores have demonstrated the ability to revive themselves, mechanism unknown.)
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My wife is still waiting on test results of a patient she cared for on Sunday. At this point im just assuming the hospital never actually tested the patient. Patient had atypical bilateral Viral pneumonia/ARDS presentation.
It's a bit annoying that I worked full time through my BS and BSN to graduate without loans and those who took out 100k+ for a nursing degree get rewarded.
We have had some low priority tests taking 5 days to get back.
DragonClaw
Emergency Medical Texan
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I assume my partner won't be back for a bit
RocketMedic
Californian, Lost in Texas
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Those pansies with their vaccines, air conditioning and pavement!
DragonClaw
Emergency Medical Texan
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Wait it's actually given? Not just talked about?
Not that I know of.
No, we follow our basic training. We DO NOT enter an unsafe scene. Attending a COVID-19 pt without MEGG (mask, eye protection, gown, and gloves) is an UNSAFE scene. Universal Precautions work well but only at all when used universally.
Would you ever enter a burning structure without SCBA just because your department didn't have enough working ones on hand?
No SCBA = no entry ---------------------- no mask = unsafe scene
EMS's core safety concept is we do not ever enter an unsafe scene. To do so is critical fail and irresponsible.
A guideline we have learned from day one is "it's not our emergency." We ALWAYS put our safety first, followed by our partner's, and our patients'.
These life sustaining guidelines are just as true at a one patient call, a huge bus crash, or yes one heck of a nationwide pandemic.
Would you say that includes cops and firefighters who's job is to enter an IDLH environment? We may mitigate risk but it is very real.
DesertMedic66
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I don’t think anyone is advocating to approach a suspected COVID patient wearing no PPE at all. We are running very low on supplies so for now we must make them last and we have the CDC approval to do so. Times have changed greatly in EMS. When I first started EMS was only ever to operate in the cold zone where we could say “the scene is safe” but more and more EMS is starting to operate in warm zones.
Guess what? We were all also taught in medic school to never ever use a medication that is expired however when there is a severe shortage of medications we get clearance from the FDA and drug manufacturers to use medications past their expiration date.
Cops and firefighters ALWAYS face a higher risk level than EMS. But they are trained for those threats and let's face it, they are better able physically to defend themselves than are we (admittedly, that varies from person to person bit is true in general.) Also, cops and firefighters have safety rules and precepts that they are trained not to cross. My example of the SCBA is relevant to your point. No SCBA = no entry. I hope you are not suggesting that we think outside the box and use a tire inflating air tank with a mouthpiece? No way!!
Single-use medical equipment (and even more so, medical supplies) can, under federal law and regulations, only be reused if cleaned and repackaged by an entity holding federal license to manufacture equipment of that type. No EMS provider holds such a license. This reuse is not only unsafe and dumb, it is ILLEGAL.
Please post a link to the applicable federal law. Curious to read that. Even more curious if there is an actualy federal law, or if youre referencing and administrative rule.
DragonClaw
Emergency Medical Texan
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Calls be like
On this point my experience is entirely different from yours. When I started, we routinely restrained patients on our own (without law enforcement) unless they had firearms or knives). Now, we are required to "stage" (basically hide around the corner and await law enforcement) on many calls including preteen and early-teen suicide gestures by pills. What is the kid going to do, throw the pills at my partner and me? On a call a while back, my partner and I were required to remain staged for just shy of an hour while a man with a gunshot wound was prone on the dark blacktop on a sunny afternoon with the temperature at 105 degrees. We watched him try to crawl, then just move arms, finally seize, then never move again as he had died. Law enforcement told us the scene wasn't safe because they were searching for a suspect who, it turned out, did not exist as the deceased had shot himself then staggered into the street.
It is now accepted as proven that SARS-CoV-2 virus lives on some hard surfaces for 3 days or more and on porous materials for hours. When a single-use mask is over you mouth the outside catches droplets which carry virus. You gown performs the same function and gathers droplets and thus virus particles. The act of bagging, storing, unbagging, and reusing means that you are handling a contaminated item. Pathogens from the already used item transfer to your hands even if gloved. You then touch the inside part of that same mask and you have just placed virus inside the mask and ready to be sucked into your mouth with you inhale through the mask. You are contaminated. And that has nothing to do with whether the single-use mask is mechanically able to perform properly once its designed single use has taken place.
Contaminated, you go home each evening as the virus count increases and you pass the infection to your souse, kids, parents, and grandparents. The improper and unsafe reuse of a disposable medical supply has now compromised your loved ones. That my friend is why we ALWAYS use Universal Precautions and NEVER enter an unsafe scene. Our professional responsibility requires that we not contaminate others. Above all else, do no harm!
There is no single paragraph that says all that in one place. That is not unusual in the federal legal area. Statutes usually contain broad directions and form departments, administrations, agencies, bureaus, services, ,etc, etc. Each of those governmental sub-parts drafts, publishes, and eventually adopts rules, regulations, directives, and the like. It is truly a field day for lawyers. Complexity = confusion, confusion = disagreements, disagreement = litigation, litigation = big, big buck for lawyers.
If you have a taste from reading very long, very complex sentences, you can research and navigate the legal tree. Basically, it is that only federally licensed manufactures can produce anything for use in medical care. Rules, regulations, and court rulings going back years, have found and defined anything after the first use as reuse but once used the original certification is gone, so, the logic goes, the item is uncertified* until it is re-manufactured by a licensed manufacturer, who by packaging and labeling the item(s) is deemed to be certifying it. Otherwise it is not certified and cannot be used in medical care. Yes, it is a long and rambling sequence of transitions from one step to another. But, AND THIS IS KEY, it is not unusual because that's how most federal regulation of medicine works. Really!!
* If you notice, the packaging of medical supplies has a notation something like "Single Use Only." With bulk items, this statement may not be on every single item but will be on the packaging somewhere.
DesertMedic66
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Several things about this post make me cringe. Firstly if you are staged so close to a location that you are able to see someone crawling just in front of the residence, that defeats the purpose of being staged...
I would also like to see how you would explain your refusal to enter a scene, despite you having the CDC recommended equipment/PPE, to your employer and licensing agency. At that point you have a duty to act but you are breaching that duty and depending on the circumstances it could very well lead to further injury or death to the patient.
Are we seeing doctors and nurses refusing to treat patients because they are running on very limited supplies? At least in my area I haven’t.