Getting nurses, doctors from other specialties, or even medical students through an intensive training is one thing, and I suspect it's actually a good idea. These are people who have (or, in the case of students, are at least likely to have) the knowledge required not just to learn how to operate a piece of machinery, but also to understand when they're in over their heads, when to ask for help, and to understand the magnitude of what they're doing.
But IMHO -- also based on my experience in other potentially dangerous fields -- putting people with zero medical education except for a thirty-day training in charge of observing people in a life-or-death situation is a really bad idea. Under-educated, even if well-trained assistance has a very high potential of making things worse, not better -- worse than doing nothing at all, that is.
Running a ventilator as in pushing the right buttons is something you can learn to do just by reading the manual. I can obviously operate every medical device I've worked on. I've obviously had more than 30 days of exposure to them. And nonetheless, I think the chances of getting someone killed by operating them are extremely high. I am also 100% convinced that they are much higher than the chances of someone who's had some medical education doing the same thing, even if they've never seen that machine and have never read the manual. What doctors and nurses do with the things I've built is way above my level of understanding.
I can't speak for medical students but I can guarantee that, if you let 30 final-year engineering students walk around a power plant without constant supervision, one of them will get themselves killed by the end of the day. And that's after three years of education. 30 days shouldn't even get you past the lobby.
I'm reading that hospitals may be overwhelmed. I understand that to mean there will be more people requiring intensive care than capacity to give intensive care. If the choice is between the hospital sending people who need ventilators off to die and sending them to someone with thirty days of training and good intentions... Well, my intuition is that you'd have better outcomes with the latter.
The point is not "can we do this without killing people." Nope. More people will die with amateur ventilator-operators than professionals. What I'm suggesting is that more people will die without amateur ventilator-operators in the event hospitals are overwhelmed.
If we think hospitals are going to be overwhelmed in thirty days then the time to start training amateur ventilator-operators is now.
It takes an inordinate amount of time just to teach people what they can and can't touch and when and how, how to wash their hands properly, how to put on and take off their masks/gloves, and where to stand so as not to be in the way of people. All this in the context of a pretty contagious disease. I am pretty sure that, within 20 days, most of the volunteers would be infected themselves, and end up putting even more strain on the system.
I've been in an OR as part of my job, and I'd definitely think twice before enrolling in a program like this one (and definitely not just for my own safety, although yeah, that would be a big factor, too).
Given that we likely have more spare doctor cycles now than we will in the future, we should utilize them now. We can also do things like hire doctors from countries not as badly stressed to come teach the classes.
And of course there are many levels to addressing bottlenecks. For example, operators wouldn’t have to be amateurs at first, they could be any of the non-essential medical professionals who are not able operate business as usual due to the virus. Could a podiatrist or urologist operate a ventilator given enough training?
In general we are brainstorming proactive measures. I think, at least in the US, we continue to have a reactive as opposed to a proactive strategy because of our decentralized government structure as well as the delicate balance between effective mitigation and maintaining social order. While we should be leveraging the current shelter in place strategy to build as much healthcare infrastructure as possible (both physical and technical, as per the thread) to handle slowly returning society to normal operations, we probably are not moving fast enough. In several weeks, as the unemployment and anxiety builds, so too will unrest. And I guess then it will really be a test of a nation’s people.
To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on.
Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment.
That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.
This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are.
If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...?
We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”
Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this.
Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.
This will happen soon or not at all. The AMA and its equivalents worldwide have a very consistent attitude to anyone, anywhere being allowed to do anything a doctor can do. It should not be allowed. Psychologists should not be allowed prescribe; nurse practitioners should not be allowed practice independently under any circumstances, etc.
Indeed, doctors did more harm than good until the early 1900s at the earliest, and we can only be sure that they were on net leading to lower rather than higher mortality with the introduction of antibiotics.
Or rather, this should be common sense, but the over-inflated egos on HN don't understand that it takes more than knowing which button does what to operate a ventilator. Being able to hold a paint brush is a very different skill level than painting a portrait.
Painful given some past threads on this subject.
Other than that: spot on.
If there is relevance to this conversation in the 10,000 or so words that you have spent on this thread then I fail to see it, so I really don't know what this particular comment is trying to achieve other than that it has me considering whether I shouldn't just plain give up on HN.
Don Hopkins has it right, sealioning is the perfect term to describe what you are doing and it is a destructive thing on something as fragile as this forum because it narrowly fits the guidelines and yet makes it impossible to have a normal conversation. It's the online version of passive aggressive belligerence with a veneer of sincerity on top.
His arguments are incoherent, rambling, and and focused on nothing but derailing the conversation and wasting everyone's time. He perfectly fits the definition of "sealioning". He even admits he knows what it is and is familiar with the web comic that coined the term, then in the same post, he continues to behave as if he's working directly off the wikipedia definition, acting out its every point and symptom, as if it were his playbook.
When confronted with arguments that directly address his points, he complains and runs away and refuses to respond to them. His "concern" for the topic and interest in having a conversation is totally insincere. His only goal is to waste time. Only when he can waste time and divert the conversation away from the point, does he bother to reply. But once there is no way out but to confront the glaring contradictions in what he wrote, his suddenly disappears and has no more to say.
It's supremely ironic and proves he's a troll with absolutely no sense of self-awareness, when he says things like "I'm not seeing much relevance to this conversation", after spending so much time and energy trying to derail the conversation with irrelevant bullshit. That should serve as a warning and warning sign to anyone tempted to engage him in conversation, or take anything he says seriously.
https://knowyourmeme.com/memes/sea-lioning
Another tactic you can see him practicing, which we're all familiar with coming out of the White House, is psychological projection. Trolls like misterman are fully aware they're sealioning, know all the terminology because they study and emulate it, and they love to throw around and misuse terms like that themselves, to attack other sincere people for doing what they're actually maliciously doing themselves, to make it seem like it's just "both sides", which it's not.
It's not just an internet thing. Here's an example of how racists sealion and project in real life:
https://medium.com/@codeGrit/a-story-about-sealions-gamergat...
Sealioning is related to the Gish Gallop, to which there are some countermeasures that work (beyond systematically flagging his post every time he does it, which is the least we all can do to protect the community).
The approach that worked for me, and shut him up cold in his steps and made him suddenly retreat, is to be very calm and structured about your replies, and not let him derail you, which is something that we can all cooperate together on, and support each other by doing together as a tag team.
Carefully chose and enumerate your questions, and repeat them when he doesn't answer them, but don't get distracted by his off-topic diversions, or his passive aggressive belligerence with a veneer of sincerity on top. His pseudo-intellectualism and pretend-open-mindedness and saccharine-sincerity is all just an act, and you don't owe him the level of courtesy that he is pretending to extend to you and mocking you with. I can practically see him laughing to himself (and his Gamergate veteran buddies) behind the keyboard every time he thinks he's fooled anyone into taking him seriously, because he certainly doesn't believe what he says.
Just calmly point out every time he ignores one of your questions or somebody else's questions, or tries to derail the conversation. Keep relentlessly pushing him back onto the topic, and never let him derail you. When I did that, he was mortified and childishly complained that I was not the boss of him, and that I could not tell him what to do, or force him to answer my questions, then he immediately lost interest and fled without another word, because the last thing he actually wanted to to was to stay on topic and answer the questions I would not stop asking.
https://en.wikipedia.org/wiki/Gish_gallop
Technique and counter measures
During a Gish gallop, a debater confronts an opponent with a rapid series of many specious arguments, half-truths, and misrepresentations in a short space of time, which makes it impossible for the opponent to refute all of them within the format of a formal debate.[3][4] In practice, each point raised by the "Gish galloper" takes considerably more time to refute or fact-check than it did to state in the first place.[5] The technique wastes an opponent's time and may cast doubt on the opponent's debating ability for an audience unfamiliar with the technique, especially if no independent fact-checking is involved[6] or if the audience has limited knowledge of the topics.
Generally, it is more difficult to use the Gish gallop in a structured debate than in a free-form one.[7] If a debater is familiar with an opponent who is known to use the Gish gallop, the technique may be countered by pre-empting and refuting the opponent's commonly used arguments first, before the opponent has an opportunity to launch into a Gish gallop.[8]
Common sense does not determine how difficult something is, how difficult it is determines that. Reality, for the most part, flows into the brain from the outside world, not the other way around.
> An emergency doesn't change the hard technical requirement of administering ventilation.
Neither does common sense. The "the hard technical requirement of administering ventilation" is precisely as hard as it is. So, how hard is that? You represent (in poker parlance) that you know the answers to such things, but you seem reluctant to provide evidence.
> Or rather, this should be common sense, but the over-inflated egos on HN don't understand that it takes more than knowing which button does what to operate a ventilator.
This seems a bit ironic, because no one other than you has made that specific claim.
> Being able to hold a paint brush is a very different skill level than painting a portrait.
Now this statement is actually correct, but unfortunately I don't think it has much relevance to the topic at hand.
https://news.ycombinator.com/newsguidelines.html
Edit: it looks like you've been using HN mostly for political and ideological battle. We ban accounts that do that. Please stop doing that.
For starters, sincere apologies. You asked me nicely to stop this behavior in the past, I didn't, and you subsequently rate-limited me. After some time, once I had gone through some "personal work" as they say, I asked for this to be removed, you kindly accommodated me while repeating your earlier warning, and I promised to comply.
I think it is more than fair to say that I have clearly violated your trust - although, I would also say, only in a sense. I will describe the details of my thinking on that (the method to my madness so to speak), in a reply to your last email when I can find the time (next few days or so). Not that you care I imagine, just an fyi.
Just as a preview of that email, I won't be arguing for a removal of my rate-limiting. You have your hands full on HN maintaining some reasonable level of decorum (herding cats) in discussions, in a world that seems to have almost gone mad. This is no small task, and I fully appreciate why you must resort to this. No disagreement from me on this particular decision.
Rather, in the email I will attempt to explain the reasoning behind my (deliberately) anomalous conversation style (this entire comment, for example). Whether you will agree with my thinking, or even have the time to give it any serious thought, is of course up to you. As I said, you are a busy guy with a thankless job, and if you decide that you can afford little time to spare on entertaining the out-of-the-box theories of some random crackpot (who also exhibits numerous signs of classic schizophrenia) on the internet - no disagreement from me on the decision. You have been more than fair and patient with me under the circumstances as you understand them (and yes, I am aware of the ~"implied condescension" in that statement - I believe noting such things can be useful to minimize misunderstandings regarding beliefs &/or intent).
I've anticipated the day your hammer would come down on me, as did some of the folks I was in conversation with - it seemed quite inevitable. The only ways that quickly come to my mind for how this eventuality could have been avoided are:
- I personally decide to "knock it off" (rather unlikely, to say the least)
- Multiple people happening to notice a pattern in behavior, and realizing "what it is I'm up to", or "what I am trying to draw people's attention towards". To my mind, "what I am up to" is so blatantly obvious that it boggles my mind that not one single person, in a community of thousands of the planet's best and most logical minds, has noticed the method. One person I can think of noted it somewhat, but I got no sense that they noticed the systematic and intentional pattern, but rather were merely thanking me for "pointing out" when we were straying from evidence-based discussion in his particular sub-thread. One thing I speculate people may be overlooking in this situation, or "the point I am trying to make", is that there is a "pattern in behavior" that can be observed not only on my behalf (this one is easy to see), but also in the behavior of my counterparts, in essentially every conversation I've participated in recently.
Wrapping up, I'll just say: no hard feelings on my end. On the contrary, I am sincerely grateful for your patience with me. You've got a job to do here, you did it with amazing restraint under the conditions, but at the end of the day, sometimes pragmatic justice must be dispensed to maintain overall order.
https://news.ycombinator.com/newsguidelines.html
Edit: it looks like you've been posting other flamewar comments to HN too. We ban accounts that do that, so please don't do that.
It's quite interesting to hear the opinion of someone who has both education and hands on experience directly in the field, and then compare that opinion to the opinions of those who have neither.
Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chance.
It sounds like there is some fundamental idealogical opposition to this.
I have a friend who is going through her residency now, she has to deal with a lot of very unhealthy psychological and physical treatment (ridiculously long hours) to get through it. Sounds more like a hazing than a professional introduction.
Now in war, you have to throw bodies at a problem, and if the bodies end up 6 ft under, that's war. But generally bad pilots only kill themselves, they don't kill patient after patient through malpractice.
https://www.vettimes.co.uk/news/veterinary-sector-primed-to-...
Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.