New York State ventilator guidelines . Como was right but he chose to be wrong .

Recent news articles have brought up the fact that Andrew Como opted not to buy 16,000 ventilators.

Counterclaims peaked my interest so I dug into it . To my surprised the end result was a completely rational understanding on how things would play out during a major flu pandemic.


The report at hand is from the New York State task force on life and law.

Titled “VENTILATOR ALLOCATION GUIDELINES” it was first issued in 2007 and adopted by other states as their approach. The report at hand is a update for 2015. Which means this will likely happen in more states . I hope those governors are more pragmatic .

New York State was following these guidelines when the decision was made on 16,000 extra ventilators .

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.

I hate to say it. But they’re 100% right for a tragedy of that scale. The need for ventilators could not be met. Nor would there be enough medical personnel to meet them.

It proposes setting up a triage system by age group. The moment triage is implemented is the moment you come to the practical realization that some people on the list are going to die due to lack of resources.

The fact that the legal aspect of doing so what is considered. Is proof enough that they were serious about this protocol.

Here is what still offends me.

Instead of acknowledging these facts which he based his decision on. Como chose the liberal ideology of hypocrisy. Instead of explaining guidelines that have been in place since he assumed office.

He ignored the indisputable facts of the matter and chose to blame the “mean orange man” . His ghoul like rationale must be that he can use those bodies to his political advantage. Which comes as no surprise . It is a pattern that the left uses regularly. (Guns)

And of course the lefts water carriers have backed the play.

30,000 ventilators or a moot point when you have no one to operate them.

272 Pages here I gave it a hard skim . To me the specifics of how the triage would be implemented are irrelevant. The people that are most likely to die and are denied access usually do anyway. Their families are going to be upset. The family and patients granted access Will be glad it wasn’t on a first come first serve basis.

Cold hard facts of a pandemic

So did you mean to post this in the Mud Pit? Because you middle paragraphs seem more pitish than an actual pandemic discussion.

If this devolves into a mud pit style political discussion then it may need to be closed and moved to the pit.

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That being said:

yes the triage guidelines are strict and brutal. I am trained in mass casualty triage for disasters and I have to tell you I'd do it, but not sure how I would cope with it afterwards. We will be asking MD's and even RN's to make god like life or death decisions and unless some of us are total sociopaths (I have a few coworkers......) none will be unscared.

That being said. In a outright disaster you upend the usual ICU Hierarchy (and in my humble beginnings as an new grad overwhelmed in the PICU) we did this all the time:

1) Traditional documentation goes by the wayside in favor of short form. This save a ton of time. If I have a one to one patient int he ICU that is one RN to one patient. about 2-3 hours of my shift is spend documenting. You free that up, I can cover more.

2) Your average ICU nurse can make simple changes and run a ventilator. For transport teams this is SOP. so what you do is stick 1 ICU nurse in a room with 4 patients on a ventilator and have a nursing assist there to help. YOu can then stretch your respiratory therapists into say covering 2-3 rooms of 4 to troubleshoot etc.

3) The MD's will have to change practice to good enough. No more elaborate procedures, MRI's just to take a peek. THis will free up Nursing to provide for more patient than normal

4) If your short ventilators then you use the patent pending FredT vent. Yes, once a definitive airway is established patients can be manually ventilated using a flow inflating bag and mask. Not as good and oh so labor intensive but it works. If you switch to a self inflating bag you can teach anybody and we have in a pinch used a pilot to help who had ZERO training. We were flying back from hawaii and not long after liftoff the vent malfunctioned. I switched to the flow inflating bag which requires skill, while we trouble shooted the vent. It was dead. We also could not go back as the child needed definitive care to survive and it was not available there. We jury rigged the nitric oxide into a self inflating bag and everybody from the mother to the backup pilot helped us bag the kid for 6 hours. In transport lingo the If I had you bagging a patient it would be the "fallingdown vent"

Families, administrators, housekeepers can all do this

If you get the vents they can be put to use

a reply to: FredT

I didn’t think it was too over-the-top. But if you guys feel the need of course move it . As matter of fact I request you do so to prevent confusion .

As far as the personnel shortage . I’m more or less followed what the report said. But after your post I felt I needed to look into it. There are 62 acute care facilities in New York State .

30,000 ventilators would work out to 483 more ventilators per hospital . I doubt that work load could be met by current personnel .

a reply to: Fallingdown

True. You would be hard pressed to actually find the ability to use all of those. But you could put alot of them to use using the measures outlined above. Plus for every ten vents in use you would need 2-3 backups plugged in are ready to go

In your hospital count, did you include federal beds? Like VA or Military?

a reply to: FredT

Just a simple search for hospitals in New York .

It wasn’t the point I was getting it anyway. Como’s decision was based on the guideline that they’ve been following since 2007 .

All of a sudden the guideline is immaterial when balanced against political gain .


Edit; Plus the count was for New York City only. Please disregard . 🤦‍♂️

Lots of experts make many mistakes. Always have always will. 😷

a reply to: Fallingdown

Fair enough.........

Trust me NOBODY is prepared and the blame lies in EVERY administration from Bush 41 to Trump. They all paid lip service and we pay the price.

So If NY is doing this for political reasons whats the deal with Louisiana governor warns New Orleans could run out of ventilators by early April

Is this political as well? Or reflective of a State and nation that is simply unprepared

a reply to: FredT

The first two assumptions on which Louisiana-based their response are as follows .

1. High attack rates will place overwhelming demands on the healthcare system.
2. The number of individuals seeking healthcare (inpatient and outpatient) is likely to exceed normal capacity

They too approached a pandemic with a sober mind . Recognizing that would be shortages .

Source


At the crisis level Louisiana’s triage is similar to New York except that it provides for unhooking hopeless cases from ventilators .

Louisiana crisis state hospital standard care

To answer your question about politicizing .

Unlike Como governor Edwards has accepted the consequences of the state’s planning. He’s not pointing a finger at the Trump administration every chance he gets . Which might explain why he’s not on TV 10 times a day .

Comey knew what the states response would be . It was the basis of his administration’s reason not to buy 16,000 ventilators . But that’s conveniently forgotten when there’s a chance to play politics especially against Trump .


Edwards is just trying to locate ventilators .

Everybody’s going to be wanting them.