Coronavirus Updates, Important Information, and Ancedotal Experience

Scoresby

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So a few days ago I was sent up to a furniture manufacturer in Austin as our plant manager had wind there was a furniture company trying to convert their manufacturing into N95 masks (the material they use in lining is the same as that in masks). Turns out there is a heavy demand for not just masks but also disposable gowns. There was clearly a big opportunity as my company does high-volume manufacturing, whereas these guys typically make customizable furniture which, by nature, is high-mix doesn't lend itself to high-volume. So far we've been able to ramp output up around 2000% from where they were and are being gated by their CNC that cuts the patterns. Looks like we'll be in good shape to support everything from Austin-San Antonio for the near-future. I think the discussion now is to figure out how to take what we've learned here and spread it around (I know the guys at MyPillow were doing something similar). Alternatively, we are kicking around building a CNC in-house and doing some of this ourselves (comparing to typical millwork this is a simple machine).

We are also working with the major automakers to develop ventillators although personally I feel the strategy they are using will be too slow. It looks like the big players are trying to leverage their suppliers to build pieces, then they will build the ventilators (sourcing an existing design through NDA). In this event, our plant would build part A, someone else part B, etc. It ends up creating a long-chain where you have to address parts that don't have a clear build path. While this is do-able (3D printing for instance would be fine in many cases as the mechanical requirements aren't uber critical), it does add delay to the overall process. Granted, once you figure it out you have this well oiled machine that can crank out high-volume like nobody's business. My point is, the complexity of a ventilator isn't that high and I'd rather just design an opensource variant and let everyone build it. There is some slack in our current project lineup (for some reason?) so I may have to get a few of my guys working this.
 
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karma

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North Carolina Governor just issued a 30 day SiP effective Monday at 5pm. It's funny, I have been operating that way for almost 3 weeks, but it feels different now.
 
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Scoresby

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This was needed and hopefully will be the kick in the pants that speeds sourcing up.
 
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Larnix

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This was needed and hopefully will be the kick in the pants that speeds sourcing up.


I think it was a wise decision to announce that he could do it then wait awhile and give large companies the chance to do it on their own. He had the press and states begging him to do it. He would have been called a tyrant otherwise.
 
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Springbok

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So you medical guys on the board - those showing up needing supplemental oxygen/beds/vents - how long before they get prescribed the Hydrochloroquine/zpack? Is this something hospitals are actively pushing, or just certain doctors/hospitals? If somebody were to show up needing hospitalization and requested that medicine for treatment would you submit it or refuse? Just curious
 

Blazin

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So you medical guys on the board - those showing up needing supplemental oxygen/beds/vents - how long before they get prescribed the Hydrochloroquine/zpack? Is this something hospitals are actively pushing, or just certain doctors/hospitals? If somebody were to show up needing hospitalization and requested that medicine for treatment would you submit it or refuse? Just curious

I believe in this country it is just currently a trial in NYC
 

Kuriin

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Plaquenil/ZPack are being used in our hospital as a preventive measure for healthcare workers. If a patient needs oxygen, then they'll be put on the broad spectrum antibiotics and be sent home and pray. If they need a vent...well...hopefully they survive? ;\
 

Springbok

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I ask because I'd read a doctor in New York City kind of went off the rails and started prescribing all of his hospitalized patients that combination to great effect. I understand it's still in trials, but the medicine is widely available. Is it just a case-by-case basis currently? Basically, you get a cool doctor willing to take the risk of prescribing and you get the medicine, in other cases you get somebody unwilling and you're simply SOL?
 

ver_21

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I ask because I'd read a doctor in New York City kind of went off the rails and started prescribing all of his hospitalized patients that combination to great effect. I understand it's still in trials, but the medicine is widely available. Is it just a case-by-case basis currently? Basically, you get a cool doctor willing to take the risk of prescribing and you get the medicine, in other cases you get somebody unwilling and you're simply SOL?

Can you link the article?
 

ver_21

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This isn't the original article and quite honestly I'm not even sure it's the same doctor from earlier this week (news moves too quickly around this thing) but here's a link


Yeah I think the article that was posted on this forum earlier was not a Hacidic or Russian doctor. Similar story, though.
 

Blazin

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Daily dose of anecdotal reporting. Things went from slow to overdrive for wife at hospital rather quickly. Worked a lot of hours last few days and now the phone calls, conferences, texts and emails are non stop. What's a little scary is this is with very little confirmed covid patients. Testing is still extremely slow and unresponsive that they are filling up with suspected covid patients that then still require the same level of precautions. The testing issue has to be resolved or it really seems untenable with any kind of volume.

There are a good number of nurses who don't want to be working with COVID patients, they have a review process based on risk factors to be excluded.

On the equipment front they are now saving all N95 masks after use and they are being recycled for re use. Had seen a blurb on the news about this, I'm not sure by what means they are cleaning them.
 
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Captain Suave

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Things went from slow to overdrive for wife at hospital rather quickly.

My sister is in a similar boat. She's a nurse working with critical oncology patients in LA. No confirmed cases in their hospital/staff, but they're running low on PPE and all terrified of being the one to bring it in because basically every one of the patients will die if exposed.
 

Mist

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Daily dose of anecdotal reporting. Things went from slow to overdrive for wife at hospital rather quickly. Worked a lot of hours last few days and now the phone calls, conferences, texts and emails are non stop. What's a little scary is this is with very little confirmed covid patients. Testing is still extremely slow and unresponsive that they are filling up with suspected covid patients that then still require the same level of precautions. The testing issue has to be resolved or it really seems untenable with any kind of volume.

There are a good number of nurses who don't want to be working with COVID patients, they have a review process based on risk factors to be excluded.

On the equipment front they are now saving all N95 masks after use and they are being recycled for re use. Had seen a blurb on the news about this, I'm not sure by what means they are cleaning them.
Apparently N95 masks can be baked in an oven for 30 minutes at around 160 F to disinfect them without damaging the mask.

Not sure how you would get any debris off beforehand though.
 
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Blazin

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Was able to listen to several management crisis team conference calls today interesting hearing the particulars of things they are dealing with at a trauma center. Number of issues that need addressed, supply chain issues etc. Far more informative than New York times articles
 
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Borzak

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I assume they were dropping some off in New Orleans and other areas and not just 2,000 in BR from MI.

 

AngryGerbil

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We in EMS are now 're-using' our N95 masks, but only to a certain extent.

It's crazy to think but only 3 months ago we would burn an entire N-95 mask on a new-hire just to fit test them, and then throw it away. We would use 20-30 masks a month just on testing and then toss them. It seems crazy in hindsight. I doubt our company will ever adopt this practice ever again. We will still fit-test people of course, but I imagine we will tell the person to keep the mask.

Now? Now we have to use the same mask for an all-day shift and even then some employees are choosing to keep them after their shift.

We are telling them that if they use an N-95 mask, and if in their own best judgement the patient did NOT have COVID19, then they can re-use that mask for the rest of their shift. If the patient might well have or confirmed does have COVID19, then we are telling them that the mask is contaminated and to throw it away and get another one.

We are becoming stretched. As part of the Operations leadership team we have to find the fine line between protecting our people now, and protecting our people 6 months from now.

It's easy to say to our EMTs and Paramedics, "Wear full PPE on every call no matter what." And that would in fact offer our people the best possible protection. But if we do that, then in 3-6 months we might very well have nothing left to give them and then we'd be seriously up shit's creek. Then the best we could do is tell them to pull their t-shirts up over their nose.

It's not easy to find the middle ground. Right now we are trying our best to work with Dispatch (which is complicated because they just recently joined the Teamsters and have become a bunch of angry little Soviets who care more about being allowed to dye their hair green than they do about making our operation function) to try to give the EMTs a 'best guess' as to when they might want to wear their PPE, and combine that with educating our own EMTs on our end as to how to define a potential COVID patient.

------

For instance, 2 days ago we had a crew who was Dispatched to a 36 year old male who 'had a cough'. Dispatch told the crew to 'Wear Full PPE' because he had a cough. The crew did this and put on all of their PPE before they made patient contact. Then they got on scene and discovered that this was actually just a psych patient was was pretending to have a couch because he thought it was funny to fuck with people.

We burned through 2 full sets of PPE because this one motherfucker thought it was funny.

If PPE supplies were infinite then this would be no problem. But PPE supplies are very much not infinite, so this is a problem. We have a lot of stock, and we could keep going down this path of hypervigiliance for probably a few months. But what happens if we keep going down this path and COVID is still a threat in September and we have finally run out of stock? Then what?

So in the last 3-4 days we have issued protocols that are designed to give our people all of the access to the PPE that they need, but in turn we are also advising them to not waste any of it on frivolous claims.

------

We're in a real pickle. It's not even about money. We have the money. It's that we need to protect our people right now, but also need to be able to protect our people 6 months from now.

How do you draw that line? How do you tell a group of 300+ 20-something year old EMTs to be fully vigilant against COVID... but also not to waste supplies or else we might all be in big trouble come Autumn?

-----

Dispatch is telling them to wear PPE on damn near every call, and we are forced to tell them to NOT wear PPE on every call. We are telling them to take each patient on a case by case basis. Protect yourself, yes. But understand that if you go too far in this direction then you might not be able to protect yourself later down the road. We are THROWING MONEY at the manufacturers and they are telling us, simply, that no amount of money can make their machines work faster. It's not a money thing it's a capacity thing.

Crazy times. I've been taking pictures of my base. It's like an alien world. Things are SO different than they were just 3 weeks ago.
 
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Burns

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We in EMS are now 're-using' our N95 masks, but only to a certain extent.

It's crazy to think but only 3 months ago we would burn an entire N-95 mask on a new-hire just to fit test them, and then throw it away. We would use 20-30 masks a month just on testing and then toss them. It seems crazy in hindsight. I doubt our company will ever adopt this practice ever again. We will still fit-test people of course, but I imagine we will tell the person to keep the mask.

Now? Now we have to use the same mask for an all-day shift and even then some employees are choosing to keep them after their shift.

We are telling them that if they use an N-95 mask, and if in their own best judgement the patient did NOT have COVID19, then they can re-use that mask for the rest of their shift. If the patient might well have or confirmed does have COVID19, then we are telling them that the mask is contaminated and to throw it away and get another one.

We are becoming stretched. As part of the Operations leadership team we have to find the fine line between protecting our people now, and protecting our people 6 months from now.

It's easy to say to our EMTs and Paramedics, "Wear full PPE on every call no matter what." And that would in fact offer our people the best possible protection. But if we do that, then in 3-6 months we might very well have nothing left to give them and then we'd be seriously up shit's creek. Then the best we could do is tell them to pull their t-shirts up over their nose.

It's not easy to find the middle ground. Right now we are trying our best to work with Dispatch (which is complicated because they just recently joined the Teamsters and have become a bunch of angry little Soviets who care more about being allowed to dye their hair green than they do about making our operation function) to try to give the EMTs a 'best guess' as to when they might want to wear their PPE, and combine that with educating our own EMTs on our end as to how to define a potential COVID patient.

------

For instance, 2 days ago we had a crew who was Dispatched to a 36 year old male who 'had a cough'. Dispatch told the crew to 'Wear Full PPE' because he had a cough. The crew did this and put on all of their PPE before they made patient contact. Then they got on scene and discovered that this was actually just a psych patient was was pretending to have a couch because he thought it was funny to fuck with people.

We burned through 2 full sets of PPE because this one motherfucker thought it was funny.

If PPE supplies were infinite then this would be no problem. But PPE supplies are very much not infinite, so this is a problem. We have a lot of stock, and we could keep going down this path of hypervigiliance for probably a few months. But what happens if we keep going down this path and COVID is still a threat in September and we have finally run out of stock? Then what?

So in the last 3-4 days we have issued protocols that are designed to give our people all of the access to the PPE that they need, but in turn we are also advising them to not waste any of it on frivolous claims.

------

We're in a real pickle. It's not even about money. We have the money. It's that we need to protect our people right now, but also need to be able to protect our people 6 months from now.

How do you draw that line? How do you tell a group of 300+ 20-something year old EMTs to be fully vigilant against COVID... but also not to waste supplies or else we might all be in big trouble come Autumn?

-----

Dispatch is telling them to wear PPE on damn near every call, and we are forced to tell them to NOT wear PPE on every call. We are telling them to take each patient on a case by case basis. Protect yourself, yes. But understand that if you go too far in this direction then you might not be able to protect yourself later down the road. We are THROWING MONEY at the manufacturers and they are telling us, simply, that no amount of money can make their machines work faster. It's not a money thing it's a capacity thing.

Crazy times. I've been taking pictures of my base. It's like an alien world. Things are SO different than they were just 3 weeks ago.

What sterilization methods are there for PPE reuse? Does alcohol break down the material?

As an idea, after reading about the UV light setup, some people have built:
You could carry around sandwich bags and bag the masks as you use them. Then, once you get home, tape/clip/adhere all the bagged masks outside, to cook in the UV sunlight for a day or 2. Write your name on the bags, to make sure you are using your own masks, and all that. You could expand this to full PPE suits, maybe? Dry cleaners have large clear cheap bags and one could tape the openings together, to seal it, then hang it outside (on a cloths line, or on a table, 1 day on one side, then flip, for a second day).​
You could even set up an interior room (and eliminate wind issues), to hang all these things up for reuse, with a wall of the proper UV lights running (different grow lights spike UV and IR differently).​