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Thread: What can we learn from this

  1. #16
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    Quote Originally Posted by Ronald Blue View Post
    As for the ventilator shortage. It would seem there is enough blame to go around here but it's easy to blame the federal government for all the shortage. Obviously they have some in reserve which they are distributing. What about the hospitals? Medical supply companies? States? I know the military certainly would have some as well. I don't know how many ventilators are typically needed in a normal week without such a catastrophic event. How many are they supposed to have available? It's easy to have 20/20 hindsight. Sometimes the view out the windshield has a lot of bug splatter. I'm not sure that the combined response hasn't been excellent.
    I can answer that.......
    23 ventilator for a 320 bed hospital and 18 for a 280 bed hospital. That's what the hospital owns. During our busy season will typical rent 5-7 extra vents when we need them. These rental ventilators cost us about $300 a month EACH. It's just not possible to have on hand and store ventilators for something like this.
    As soon as we got wind of the crisis we ordered as many vents as we could. All we got were 10 extra to cover both hospitals. That is all the rental company would give us because every other hospital needed vents also. Guess how many we've used now? 2 ventilators relating to the COVID19. My county has only had 2 positive patients hospitalized out of the 14 total we have had.
    There's just no way of being prepared for something like this.
    Jeff Body
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  2. #17
    Quote Originally Posted by Jeff Body View Post
    I can answer that.......
    23 ventilator for a 320 bed hospital and 18 for a 280 bed hospital. That's what the hospital owns. During our busy season will typical rent 5-7 extra vents when we need them. These rental ventilators cost us about $300 a month EACH. It's just not possible to have on hand and store ventilators for something like this.
    As soon as we got wind of the crisis we ordered as many vents as we could. All we got were 10 extra to cover both hospitals. That is all the rental company would give us because every other hospital needed vents also. Guess how many we've used now? 2 ventilators relating to the COVID19. My county has only had 2 positive patients hospitalized out of the 14 total we have had.
    There's just no way of being prepared for something like this.
    I worked in the finance office of two 120 bed hospitals and I would say the above numbers are very typical. Our ventilator fleet was a bit bigger than Jeff's but that's because our hospitals were critical care specialty hospitals and the nature of our program required more ventilators and a larger respiratory therapy department than general hospitals with med-surg floors.

    One of the limitations for all hospital providers is that it is just not feasible, economically or logistically, to be warehousing a lot of equipment that would not be used under normal circumstances. I don't see it mentioned in the news is that ventilators are specialized life support devices, and they have specific maintenance needs referred to as bio-med services in the industry. Larger hospitals have their own bio med staff, smaller hospitals might contract it out. When a vent is taken out of service with one patient it must go through a thorough bio med check before being deployed again. Even if it is in storage, there is periodic bio med that must be done, at least under best practices. The point is the equipment needs care and feeding beyond the initial capital cost.
    In fact, I am wondering how the bio med checks can even be done in an emergency situation like what NYC is experiencing because each vent needs to go back into service immediately after a patient is weaned or expires.
    Yes, none of our disaster plans contemplated something like this.

  3. #18
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    Quote Originally Posted by Jeff Body View Post
    I can answer that.......
    23 ventilator for a 320 bed hospital and 18 for a 280 bed hospital. That's what the hospital owns. During our busy season will typical rent 5-7 extra vents when we need them. These rental ventilators cost us about $300 a month EACH. It's just not possible to have on hand and store ventilators for something like this.
    As soon as we got wind of the crisis we ordered as many vents as we could. All we got were 10 extra to cover both hospitals. That is all the rental company would give us because every other hospital needed vents also. Guess how many we've used now? 2 ventilators relating to the COVID19. My county has only had 2 positive patients hospitalized out of the 14 total we have had.
    There's just no way of being prepared for something like this.
    That's what I was getting at. You obviously have first hand knowledge of this. I also know that mothballing equipment has it's drawbacks as well. The longer it is unused the more likely there will be issues bringing it online. I can't imagine this being any different. Could production have been ramping up sooner? Probably but how much and would it be a game changer? As I said it's easy to make claims after the fact and claim that the federal government isn't doing enough. If they aren't available they aren't available.

  4. #19
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    Quote Originally Posted by Edwin Santos View Post
    I worked in the finance office of two 120 bed hospitals and I would say the above numbers are very typical. Our ventilator fleet was a bit bigger than Jeff's but that's because our hospitals were critical care specialty hospitals and the nature of our program required more ventilators and a larger respiratory therapy department than general hospitals with med-surg floors.

    One of the limitations for all hospital providers is that it is just not feasible, economically or logistically, to be warehousing a lot of equipment that would not be used under normal circumstances. I don't see it mentioned in the news is that ventilators are specialized life support devices, and they have specific maintenance needs referred to as bio-med services in the industry. Larger hospitals have their own bio med staff, smaller hospitals might contract it out. When a vent is taken out of service with one patient it must go through a thorough bio med check before being deployed again. Even if it is in storage, there is periodic bio med that must be done, at least under best practices. The point is the equipment needs care and feeding beyond the initial capital cost.
    In fact, I am wondering how the bio med checks can even be done in an emergency situation like what NYC is experiencing because each vent needs to go back into service immediately after a patient is weaned or expires.
    Yes, none of our disaster plans contemplated something like this.
    Yep, I'm actually the Biomed for the hospital and the factory trained person for the Puritan Bennett 840 ventilators. You're close but it's not quite as bad. As life support equipment I'm required to perform test and checks 2 times a year based on manufacturer's spec. In between patients there's nothing but cleaning to do and the respiratory therapist handles that. We use nothing but disposable patient circuits with excellent filters so nothing bad gets into the equipment. There's nothing more then wiping it down and waiting the proper amount of kill time for the cleaner. Normally about 3-5 minutes.

    Quote Originally Posted by Ronald Blue View Post
    That's what I was getting at. You obviously have first hand knowledge of this. I also know that mothballing equipment has it's drawbacks as well. The longer it is unused the more likely there will be issues bringing it online. I can't imagine this being any different. Could production have been ramping up sooner? Probably but how much and would it be a game changer? As I said it's easy to make claims after the fact and claim that the federal government isn't doing enough. If they aren't available they aren't available.
    Each ventilator cost about $45,000-$50,000 each. It's just not possible for a hospital to have that kind of money sitting around waiting for a pandemic.
    Medical equipment is a whole different story than most manufacturing. It's highly monitored and regulated by the FDA. I'm not a manufacturing expert but it's not a field you can just ramp up productions. Everything has to be done exactly as it was approved. You can run into supply issues and we are talking about the whole world wanting extra vents in a matter of a month. Normally it takes 1-2 months just to get an order of 5 vents.
    It would all be nice but it's just not possible.
    Jeff Body
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  5. #20
    Quote Originally Posted by Jeff Body View Post
    Each ventilator cost about $45,000-$50,000 each. It's just not possible for a hospital to have that kind of money sitting around waiting for a pandemic..
    I hear the Chinese economy is recovering. Maybe Harbor Freight could start selling them. Heck, soon the Chinese might be flooding the used market. Re cleaning them for reuse, it can't be any harder than flushing a paint sprayer (although if you've ever _rented_ one, you'd have reservations about that.)

  6. #21
    Quote Originally Posted by Doug Dawson View Post
    I hear the Chinese economy is recovering. Maybe Harbor Freight could start selling them. Heck, soon the Chinese might be flooding the used market. Re cleaning them for reuse, it can't be any harder than flushing a paint sprayer (although if you've ever _rented_ one, you'd have reservations about that.)
    Well, THIS is cool!:

    https://media.ford.com/content/fordm...ntilators.html

    Made in the USA.

  7. #22
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    "Just in Time" or JIT manufacturing is very effecient during normal operations. If you break, delay or lose flexibility in one link in the supply chain, it causes the flexibility in all other links to become almost useless. This is why you should always have multiple sources from multiple countries (including our own) for all steps in the supply chain if possible.

    We are seeing issues with the supply chain in the medical (pharmaceutical and devices) and PPE arenas now. The auto, electronic and other major industries are seeing (or will be seeing) these issues as well.
    Last edited by Dick Strauss; 03-25-2020 at 8:58 AM.

  8. #23
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    Please....STAY AWAY FROM THE POLITICAL HERE. If you can't do that, don't post in these threads, please, as there is good discussion that shouldn't need to get shut down.

    Jim
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  9. #24
    Even if we stockpiled millions of ventilators, who's to say the next virus pandemic would be respiratory in nature?

    PPE, yes. but the medical devices needed can vary dramatically depending on the nature of the disease. For example if another virus attacked the kidneys we'd need more dialysis machines than we have and ventilators might not be as needed as they are for this pandemic.
    Last edited by Edwin Santos; 03-25-2020 at 12:25 PM.

  10. #25
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    Quote Originally Posted by Jeff Body View Post
    ...
    Medical equipment is a whole different story than most manufacturing. It's highly monitored and regulated by the FDA. ...
    FDA requires cradle-to-grave tracking on medical 'devices'. I have done automation for systems making dialysis components (basically, bags of salts). They use a typical form-fill-and-seal machine to bag the materials, and as the bag drops out of the filler, it is assigned a serial number (device number). The S/N gets dumped into a bullet-proof data historian. That S/N has to stay with the bag until its disposed of. And that is a tremendous challenge in most manufacturing environments. The automation system had to recognize and alarm if a bag was removed from the line before it was boxed with its opposite component (paired bags). The box also got a device number. Did the box make it to the warehouse? etc..

    Not familiar with specifics of a ventilator manufacturing line, but assume they have multiple components -- and each requires tracking? Maybe not ideal for a home shop DIY effort?
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  11. #26
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    The public health and emergency preparedness folks have been preaching about pandemics coming for decades. It was always when, not if. Pandemic planning and response are part of the emergency preparedness curricula. There has been planning and exercises going on at all levels for years, up to and including last year's Crimson Contagion fed exercise. All these critical issues of laboratory capacity, coordination, ventilators, hospital beds, protecting first responders and health care staff, vaccine capacity, medical ethics, critical manufacturing capacity, etc., have all been identified in the past. Its just that we wont do anything about preparing because that costs too much money. Too many people who thought swine flu, avian flu, Ebola, SARS, Zika, MERS, etc., were all just hype.

    We learned a lot of lessons from Katrina, most of which still haven't been addressed. There's a book Five Days at Memorial by Sheri Fink that describes the situation at one hospital in New Orleans that describes what happened when they had to make decisions on who gets the ventilator and who dies.

  12. #27
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    Should we be so reliant on China to make most of our prescription drugs? I understand we no longer have any operational lead mines due to the EPA and we now rely on China for our lead supply. Oh well, I guess we don't need lead anymore.
    Life's too short to use old sandpaper.

  13. #28
    I think it is possible that we might have to make some hard decisions about the dividing line between our personal freedoms and the cause of public health. Whether we like it or not, 9/11 resulted in many limitations to our personal liberty, especially in the course of travel, and in the name of safety for the greater good. This pandemic could do the same in other areas of life. I wonder how willing people will be to accept a societal push for we over me.

    Probably the whole pandemic will have to play out for us to evaluate the complicated issue and come to grips with what new "normal" might be.

    Edwin

  14. #29
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    I hope one positive is anyone who was not aware of the fragility of our situation, now is. I am not a cynic but, I do not hold out much hope. It's not as we didn't have previous experiences to learn from with SARS, H1N1, MERS, Ebola, E coli, hurricanes, tornadoes . . .

    I'm no doomsday prep'er but, my career has taught me that there is nothing to get people to think about disaster recovery like a disaster. It is maintaining the momentum and building preparedness into everyday thought and deed that is a challenge.
    Last edited by glenn bradley; 03-25-2020 at 1:13 PM.
    "What kind of chump do you take me for?"
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  15. #30
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    Edwin, some percentage of folks will be ready and willing to accept certain limits of freedom to serve the greater good during a societal event like a major pandemic, some percentage will need to be convinced and some percentage will say something akin to "over my dead body". We've seen exactly this already here in the US as jurisdictions issue guidelines or stronger mandates. There have even been legal actions taken by some kinds of businesses mandated to close; one here in PA went right to the PA Supreme Court who also denied the relief. The governor later allowed a waiver to be worked out but with restrictions around health safety kept in mind.

    Glenn, I agree with you, but as we all know from multiple experiences...after great urgency comes great forgetfulness. We can hope, however!
    --

    The most expensive tool is the one you buy "cheaply" and often...

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