Hospital/ICU beds/ventilators

Just so you all have some perspective, my hospital had (guess) 50 ventilators and maybe as many ICU beds. It would be pretty easy to increase the number of ICU beds rather quickly. What makes a bed an ICU bed mostly is the dedicated nursing staff at low ratios. In an emergency the ratios can be adjusted of course.
The thing to remember is that on any given day there are 30-40 patients already on a ventilator. So thinking there are 50 spots available for extra cases due to coronavirus is not true.
Frankly, I go to conferences where some company is always trying to sell a newer, better, ventilator. I am surprised there aren't a reasonable number already made but not sold (prior to the crisis).
As I may have mentioned before, every OR has an anesthesia machine which has a ventilator. At my hospital that would add 17 more if they were not being used for surgery. Probably a couple hundred in Buffalo if you add up all the hospitals and surgicenters.
It would be interesting if somehow the hospitals wanted to confiscate the ventilators from stand alone surgi centers.

After the MGM shootings, most elective surgeries were postponed. I imagine that will be the case elsewhere soon. My neighbor is scheduled for cataract surgery in three weeks and is worried about it being canceled.

Quote: billryan

After the MGM shootings, most elective surgeries were postponed. I imagine that will be the case elsewhere soon. My neighbor is scheduled for cataract surgery in three weeks and is worried about it being canceled.

I wouldn't be surprised if they start asking all kinds of MDs from every profession to provide assistance, in areas they haven't worked in since a training internship.

What kind of ratio beds to nurses for people on ventilators?

Is Buffalo like Detroit dependent on a huge number of nurses from Canada? So much so that they would have to basically live in Buffalo should or when they shut the border/ bridges there down?

Friend here in Windsor area that's a nurse had a post on her facebook about Seattle area trying to get Nurses for a few weeks $3500 for 48 hr weeks . Crisis pay

Quote: SOOPOO

Just so you all have some perspective, my hospital had (guess) 50 ventilators and maybe as many ICU beds. It would be pretty easy to increase the number of ICU beds rather quickly. What makes a bed an ICU bed mostly is the dedicated nursing staff at low ratios. In an emergency the ratios can be adjusted of course.
The thing to remember is that on any given day there are 30-40 patients already on a ventilator. So thinking there are 50 spots available for extra cases due to coronavirus is not true.
Frankly, I go to conferences where some company is always trying to sell a newer, better, ventilator. I am surprised there aren't a reasonable number already made but not sold (prior to the crisis).
As I may have mentioned before, every OR has an anesthesia machine which has a ventilator. At my hospital that would add 17 more if they were not being used for surgery. Probably a couple hundred in Buffalo if you add up all the hospitals and surgicenters.
It would be interesting if somehow the hospitals wanted to confiscate the ventilators from stand alone surgi centers.

Maybe another country bought the surplus up before anyone here in the US even thought of it . Happened kind of but not really. Just read an article saying Germany ordered 10,000 machines and the US has ordered none. They can be made, but our government hasn't ordered them and hospitals haven't because they don't want to be stuck with expensive never will be used ventilators. It can be almost done enough.

The NYS Governor says there's 3,000 ICU's in the state and 80% of them are already in use pre-COVID-19. So that leaves 600 beds statewide. 65 patients with COVID-19 were already in the ICU a couple days ago. Cuomo wants the Army Corps Of Engineers & the U.S. military to convert SUNY campus dorms into ICU beds. A company that makes ventilators says they'll only make more if the Federal Government orders it. So that leaves the cliffhanger within the White House whether anything gets done. Ventilators are $40K each, so a thousand of them would be $40 million; 10,000 would be $400 million; and 100,000 of them would be $4 billion.

In other news, the Federal gov't is issuing expired N95 masks to hospitals for the staff to use in numbers about equal to single digit percents of what was asked for.

Quote: ChumpChange

Ventilators are $40K each, so a thousand of them would be $40 million; 10,000 would be $400 million; and 100,000 of them would be $4 billion.

Hell, if it came down to it, I would pay $40k out of my own pocket to have a ventilator built if it would save my life... We should be throwing money at building these things.

I will admit to knowing nothing about ventilators but assume they run on electricity. Would adding a few hundred of them in a hospital overpower their electric grid?

Quote: billryan

I will admit to knowing nothing about ventilators but assume they run on electricity. Would adding a few hundred of them in a hospital overpower their electric grid?

Not an engineer, nor an electrician, but I am nearly certain the answer is no. The number of electricity sucking devices used in a hospital is staggering. An extra 100 ventilators would be a blip. Assume also that the electricity heavy use location of the OR is now shuttered. Elective clinics shuttered. Etc....

precorona resource allocation was determined by Pandemic Protocols, largely SOFA based. SEQUENTIAL ORGAN ASSESSMENT SCORE, and never any demographic data.

CORONA seems to have prompted changes based on fragmentary, politicized data wherein possible, but unlikely events, are given undue weight and demographic stratification trumps a purely clinical-based triage response..

Ten days after infection the virus is detectable on mucousal surfaces, but the patient is probably not infectious. Political decisions regarding possible but unlikely consequences are being used to allocate resources.

Quote: SOOPOO

As I may have mentioned before, every OR has an anesthesia machine which has a ventilator. At my hospital that would add 17 more if they were not being used for surgery. Probably a couple hundred in Buffalo if you add up all the hospitals and surgicenters.
It would be interesting if somehow the hospitals wanted to confiscate the ventilators from stand alone surgi centers.

At the White House news conference today this exact solution was mentioned. Specifically attributed the help to anesthesiologists.
NY has two 1000 bed Navy Hospital ships to use. Apparently they are expecting to put non_COVID patients there to free up space for regular hospitals to have COVID patients.
One local Buffalo hospital is now going to exclusively be a COVID hospital.
The hospital I retired from is now (finally!) not doing elective cases. Just a drop in the bucket, but that may be costing $1 million a day in lost business.

I'll put this in every post I make. I think as dire a financial picture as is being posted, the harm is being WAY UNDERESTIMATED.

I was hoping we could maybe be a society of people all wearing masks and gloves, but apparently China won't let us have any. Times like this tell us the fundamental need to have our own manufacturing. All we can do is buy and sell, kind of useless in a catastrophe. Am I being too closed minded, I don't know, maybe something can be used not specifically meant for a mask, like a wrapped tee shirt or bandana.

Quote: SOOPOO

At the White House news conference today this exact solution was mentioned. Specifically attributed the help to anesthesiologists.
NY has two 1000 bed Navy Hospital ships to use. Apparently they are expecting to put non_COVID patients there to free up space for regular hospitals to have COVID patients.
One local Buffalo hospital is now going to exclusively be a COVID hospital.
The hospital I retired from is now (finally!) not doing elective cases. Just a drop in the bucket, but that may be costing $1 million a day in lost business.

I'll put this in every post I make. I think as dire a financial picture as is being posted, the harm is being WAY UNDERESTIMATED.

NYC is going to get the use of a 1,000 bed Navy ship, when it is ready in a few weeks, but my understanding is it will come with a skeleton crew. It should free up some beds,as will canceling all elective surgeries.
As bad as you think this will get, double it and then double it again. The only way I see to getting back to anywhere near normal is the government adopting Andrew Hangs $1,000 a month for the foreseeable future.

Ventilators use a small pneumatic compressor, the power consumption should be less than a refrigerator or (I guess) about the power consumption of an in-window air conditioner.

In the U.S. , all hospitals are required to have their own generators for back-up power; almost all hospitals have two generators for double redundancy. These generators are very large units, comparable in size to a tractor trailer vehicle, almost always located in the basement or sub-basement of the facility.

Quote: billryan

NYC is going to get the use of a 1,000 bed Navy ship, when it is ready in a few weeks, but my understanding is it will come with a skeleton crew. It should free up some beds,as will canceling all elective surgeries.
As bad as you think this will get, double it and then double it again. The only way I see to getting back to anywhere near normal is the government adopting Andrew Hangs $1,000 a month for the foreseeable future.

The ship comes with 1200 medical people, deployed by USN.

Quote: billryan

After the MGM shootings, most elective surgeries were postponed. I imagine that will be the case elsewhere soon. My neighbor is scheduled for cataract surgery in three weeks and is worried about it being canceled.

It's already the case at my gf's hospital. Elective procedures have been canceled. But since they are a children's hospital, they have little work right now. She might get called off tomorrow.

Quote: beachbumbabs

The ship comes with 1200 medical people, deployed by USN.

It was my understanding that it comes with the ships crew and a bunch of corpsmen but very few medical professionals. Looked at a possible roster but cant find one anywhere. I see where they expect the deployment to last at least three months and the ships personal are not permitted off the ship for that period.
A NY station asked what may or may not be a valid concern. Several insurance companies are waiving co-pays and deductibles for Corona Virus patients, but this ship and the Javitz center are not supposed to house any, just regular illnesses. Unless the insurance waives its out of network rules for everyone, will someones insurance cover a stay in a hospital not approved by your carrier?
Will insurance companies waive all their in and out of network procedures? I've seen them waive some Corona fees but not a blanket waiver.

Quote: billryan

It was my understanding that it comes with the ships crew and a bunch of corpsmen but very few medical professionals.

I am watching CNBC right now and they just showed one of the ships docking in NYC. They mentioned it has over 1000 medical personnel, in addition to support staff and the usual naval logistics crew.