#we get all the units emergency issued + the platelets are ordered and issued normally after the t&s is done since it doesnt need a xmatch

[unjest]

ITS BEEN A FUCKING WEEK. PASS THE DETRITUS

[kk095]

Happy Hour

I felt a bit creative tonight, so here's what I came up with. The story may need some additional tweaking, so bear with me a bit! I hope everyone likes it and feedback/constructive criticism is appreciated 🙂

*****

Most people like to go to the bar every now and then to have a few drinks to unwind a bit after a long day at work. However, some people lack control over their drinking and take things a bit too far. Their lack of control in this case resulted in the death of our latest patient.

The patient's name was Danielle “Dani” Mitchell. She was a bartender at a local neighborhood bar who was 28 years, had pin straight blonde hair just past her shoulders, beautiful hazel eyes, a near perfect suntan, was 5’6 and average build with perky, natural breasts, had a bright, colorful tattoo sleeve on her left arm, and had an engaging, jovial personality, but was a bit rough around the edges at times due to the nature of her job.

Things started off pretty mundane for Dani that evening. She was making drinks and chatting up some of the bar's regulars about the day's events. About an hour into her shift, a new customer came in. He was a tall, bald, muscular white man in his mid 30s with a scorpion tattoo on her right upper arm. He ordered a lot to drink in a short time. He was a nasty drunk with a bellicose demeanor, causing trouble amongst the other bar patrons. The man sitting next to him started to grow a bit frustrated. “You can't just come in here and start shit with us!” he exclaimed. “so what're you gonna do about it?!” the new customer said in response, challenging the man's assertiveness. The scene became more and more tense by the second until the 2 grown men started shoving each other. Dani hurried around the other side of the bar, trying to get to the men before serious blows were delivered. This wasn't Dani’s first bar fight under her watch, but little did she know, it would be her last. While trying to break up the skirmish, the new customer pulled out a pocket knife and attempted to stab his opponent. However, Dani was the recipient of the knife's blade since she got in between the men, attempting to break up their drunken quarrel.

Dani felt something touch her back, just to the right of her left shoulderblade. It was hard tap with a bit of pressure. She initially thought it was from one of the men throwing a punch, but quickly realized the severity of the situation once she turned her head. She saw the new customer who started the disagreement with their right arm extended, holding a pocket knife with a bloody tip. He had a look of horrified bewilderment on his face, realizing he had made a life-changing mistake. Dani realized the back side of her dark grey tank top was beginning to become soaked in her own blood.

One of the other bartenders called 911 right away. Dani reached for her back with her left hand. She felt warm wetness and drew her hand back quickly. The palms and fingers of her left hand were saturated in a significant accumulation of blood. Dani began breathing heavily, becoming panicked by the shocking turn of events. The man with the knife quickly sprinted out of the bar without paying his tab; but a tip was the least of Dani's concerns at this point. One of Dani's coworkers dashed over to her with a large clump of paper towels, attempting to plug up the gaping wound in her upper left back with them. The paper towels did very little to stop the surge of blood that emerged from Dani's back.

Dani began to feel dizzy and cold within the first few minutes of her injury. She shivered a bit while her coworker continued applying pressure to the knife wound. A small crowd began to gather around Dani and her coworker, with a few additional 911 calls being made from customers attempting to expedite the first responders’ arrival.

Her symptoms worsened shortly before EMS arrived. Dani had trouble remaining conscious, sitting in a moderate sized pool of her own blood. Dani peed herself (a sign of severe shock and rapid blood loss), sickening some of the members of the small, but nosey crowd around her.

Despite a slight delay, emergency personnel appeared on scene. The police officers dispersed the small crowd to give the medics room to work. When EMS got to Dani, she was in and out of consciousness, sitting on the floor up against the bar counter in a small puddle of her own blood. The paramedics removed Dani's top, exposing her black bra and tan body, with a belly button piercing. Dani was tachypneic and barely conscious. One of the medics leaned her forward, identifying a 2.6cm stab wound in the interscapular space, but missing the spine and slightly closer to the left side of the back.

Based on the amount of blood loss, the medics were able to deduce that Dani had a major hemorrhage actively wreaking havoc. “let's get 2 large bore IVs set up. Get me a bag of lactate and 1 of codeine” ordered the lead paramedic, who was searching for a vein in Dani's left arm. After getting both IVs set up (1 in each arm), a bag of ringer's lactate was hung to initiate fluid resuscitation, and a single dose of codeine was given to help with pain management since Dani lingered in a semi-conscious state. “she tore something major in there. We gotta get her out of here. Tell the ER our ETA is 5 minutes.” Stated the other paramedic. Dani was placed on a stretcher, partially sat up, and hastily wheeled out of the bar, into the ambulance which sat in the parking lot nearby.

Once in the ambulance, the paramedics set up the bartender on a portable heart monitor. Dani's vital signs were: BP: 87/60, heart rate: 119 bpm, pulse ox: 94%. An oxygen mask was placed on the patient to help ameliorate some of her respiratory symptoms, but her eyes rolled backwards every few seconds. Dani was breathing rapidly, but each breath was shallow and inefficient. “the knife might've nicked her left lung. Should we do a needle decompression?” asked the younger medic to the lead medic. The lead medic placed their stethoscope up against the front side of Dani's chest. They heard distant, raspy breath sounds on the left side, triggering immediate concern. “diminished breath sounds on the left. Good call!” said the medic in praise of the young medic's observation. “let's do a needle decompression” ordered the lead paramedic after a brief pause.

A 14 gauge lancet was procured by one of the medics as the ambulance sped towards the ER. Dani was lowered to a supine position on the stretcher and the 2nd medic poked their bony fingers along Dani's upper left chest, trying to locate the 2nd intercostal space. After the position was accurately located, the area was sterilized and the thick beveled lancet was quickly placed into Dani's 2nd intercostal space. A popping, hissing sound was heard when the needle reached the correct depth. Air rushed out of the hull of the lancet and Dani groaned, feeling a pressurized pinching sensation in her chest. Dani's pulse ox increased a bit after the needle decompression, but her blood pressure and heart rate remained unstable, suggesting she sustained more than a collapsed lung.

Dani remained hemodynamically unstable for the rest of the ambulance ride, but remained semi-conscious with a pulse. She groaned and mumbled every 30 seconds or so. Even though she wasn't saying anything audible while mumbling, the medics knew Dani was trying to beg them to save her life. Dani knew she was in grave danger, and was well aware she was walking a fine line between life and death.

Upon arrival at the ER, Dani's condition worsened slightly. Her blood pressure lowered a bit and her heart rate went into the 120s. Dani's eyes rolled retrally in her head, while hectically trying to remain awake. The medics updated the trauma team while pushing the gurney through the ERs main corridors into the allocated trauma bay.

Dani was lifted onto the table once she was in the trauma room. The nurses removed her jeans, shoes, socks, and the rest of her clothes, stripping the 28 year old completely nude in a room full of strangers. The blanket that was on top of the medic's gurney now laid on the floor of the ER, soaked in dark, warm blood, fresh from Dani's stab wound. The massive transfusion protocol was started, giving Dani 4 units of B-positive blood since that's all they had due to a national shortage of donated blood, 1500 units of Rhogam, 2 units of platelets, and 2 units of FFP.

Shortly after arrival, Dani went unconscious. At that point, the trauma team decided to intubate her in order to keep her airway intact. A 7.5 ET tube was placed into her airway and held in place with a blue tube holder, with a light blue ambu bag being attached after the procedure. Her oxygen saturation was only at 95% despite the needle decompression and the intubation, so a chest x ray and echocardiogram were ordered. The chest x ray showed a collapsed lung and possible pulmonary laceration on the left side. The echocardiogram showed cardiac tamponade, which surprised the trauma team. Based on the chest x ray, it appeared the lining of the left lung was lacerated by the knife. Because of that, friction increased during respiration, causing a pinching, burning sensation during breathing. Air leaked from the left lung and became trapped in the torn segment of Dani's left lung, and began seeping into her chest cavity. The needle decompression was simply a band-aid for this type of injury, so a left sided chest tube was ordered by the attending physician.

The chest tube was placed by the trauma team, aspirating a significant volume of air from her chest cavity. Her pulse ox increased a bit, becoming borderline normal, but she still remained hemodynamically unstable due to cardiac tamponade. The likely culprit was the knife penetrating the posterior aspect of Dani's heart.

Since cardiac tamponade was still a present issue, the trauma team made an unconventional move. They decided to perform a percutaneous balloon pericardiotomy in the emergency department. This is a procedure typically reserved for the operating room or interventional radiology suite to alleviate excess fluid in the sac around the heart. The procedure involves the placement of a needle into the chest wall, and into the lining of the heart. Once the needle is in place, a catheter with a small inflatable device (balloon) is navigated through the body of the needle, into the bevel, and into the lining of the heart. Repeated inflation of the balloon causes blood/fluid to drain into the catheter, removing the blood from the pericardium and improving cardiovascular function under ideal circumstances.

The procedure drained significant amounts of thick, coagulated blood. The first attempt didn't improve cardiac function; the echocardiogram still showed tamponade. The 2nd go-around withdrew fresh, dark colored blood. This dark, fresh blood began leaking out of the catheter, becoming deposited all over Dani's bare chest. The bleeding was profuse, which was a sign of a major hemorrhage. “get me a thoracotomy tray. We have to get to the bottom of this” ordered the attending ER physician.

Betadine was splashed all over Dani's chest in preparation of the procedure while the procedure's equipment was withdrawn. The doctor decided to access Dani's chest via a left anterolateral thoracotomy. A large cut was made in her anterior chest wall starting just millimeters to the left of her sternum, extending across the left side of her chest just under her perky left breast, and ending near the left armpit. In the following minute or so, Dani's chest was cracked open.

Her heart could be seen beating at a hurried pace. Luckily, no air or blood rushed out of Dani's chest upon entering it. A clamp was placed on the hilum of the left lung since there was sufficient evidence of a pulmonary laceration. Once the clamp was placed, the pericardium was incised so the tamponade could be released.

The line of sight became flooded with copious amounts of blood after the pericardium was incised. Suction was applied to the area, but blood began leaking out of Dani's chest cavity, situating itself on her bare chest, the table, and the floor below. A drain was placed in the pericardium, but it did little to better the situation. A 2nd chest tube was placed since the bleed was significant.

Blood shot out of the tube, spattering on the gown of one of the trauma doctors and onto the floor below. The heart monitors began chirping since Dani's cardiac function decreased rapidly from the hemorrhage. The trauma team knew there was a bleed in the back of Dani's heart, but the exact spot remained a mystery to them.

During the initial search for the mystery wound, Dani became pulseless, going into V-Fib. Her heart spasmed and trembled inside her now exposed chest cavity. One of the residents wrapped their hands around the fidgeting organ and began manually pumping it, almost as if they were demonstrating to the heart how to do its own job. Epinephrine and atropine were pushed into Dani's IV to stimulate positive cardiac activity. In the meantime, the internal defibrillator paddles were called for. The large, circular, spoon shaped paddles were charged to 20j and placed around each side of Dani's heart. In a moment's notice, everyone backed away from the table in anticipation of the impending shock.

A dull, wet thump was heard as the dose of electricity was sent directly into Dani's twitching heart. The shock failed to restore a normal rhythm, so internal massage was resumed and the internal paddles were recharged to 30j. A high pitched, electrical hum was heard while the internal paddles were being charged. A wet, clumpy sound was audible during this cycle of internal compressions.

Seconds later, the internal paddles were placed back into the blonde's chest and shock #2 was delivered. Dani's feet twitched and kicked around a bit from the increased strength of the shock, showing off a few thick, meaty wrinkles in the soles of her feet.

The 2nd shock didn't convert Dani to sinus rhythm, so the code ensued. A vascular clamp was placed on her aorta near the diaphragm to redirect additional bloodflow back to the heart in an attempt to keep the atria and ventricles filled. The blood soaked internal paddles were recharged to 30j and placed back into the bartender’s chest, delivering the 3rd shock. A dull, wet thunk was heard as her torso flopped abruptly on the trauma room table. Shock #3 sent Dani into PEA, so internal massage continued.

A second dose of epi and atropine were given, and the first dose of sodium bicarbonate was pushed after a short while of no improvement. The trauma team vigorously massaged Dani's weakly fidgeting heart, but it took yet another round of drugs and 4 and a half minutes worth of internal compressions to get her back to V-Fib.

Finally, the paddles were charged to 30j and the 4th shock of the code was promptly delivered. Dani's cold, limp body jolted on the table, but she remained in dire condition upon returning to her previous position. V-Fib still raced across the EKG screen, so the internal paddles were requested for the 5th time in this code. The internal paddles delivered a quick, controlled dose of electricity back into Dani's heart. The dying organ wobbled and shuddered for a few seconds before coming to a complete stop, appearing as if someone hit a metaphysical pause button, drawing her heart to a cadence. The trauma team frantically resumed internal compressions and continued the search for the unknown wound in the back of her heart.

Dani's heart sat stagnant and motionless as it was manually pumped to no avail by the ER team. The trauma team gave her 1 more dose of drugs and continued massaging her eerily still heart for another 5 minutes. The trauma team's efforts failed to produce cardiac activity, so the code was terminated, with time of death being called at 7:03pm after a prolonged battle to save the young bartender’s life.

The ambu bag was detached and the flatlined monitors were turned off. The nurses removed equipment from Dani's lifeless body while her heart sat completely still inside her exposed chest cavity. Once the nurses completed their job, a cover was placed over Dani's body and a toe tag was placed on the big toe of Dani's left foot.

Dani's autopsy revealed that she died from a laceration to the coronary sinus. The coronary sinus is a large vein present in the posterior portion of the heart of all primates, and is responsible for draining oxygen-poor blood in the myocardium. Injuries to this vascular structure are uncommon, but are lethal, causing death in a vast majority of patients, especially when combined with other injuries.

[covid19updater]

COVID19 UPDATES: 03/26/2020

Brazil: Brazil’s coronavirus-driven political meltdown seems to be moving very fast and not in a good direction. Governors of all Brazil’s 27 states to convene later tonight to discuss president Bolsonaro’s behaviour

France: French Public Health Official Reports 2,827 People In Need Of Life Support Due To Coronavirus (prev 2,516) - Latest French Death Toll From Virus Stands At 1,331 Deaths (prev 1,100)

NYC: Despite #coronavirus restrictions, NYC subway cars are still PACKED. This video, taken YESTERDAY, shows passengers in an overcrowded train with little evidence of social distancing LINK

Michigan:  2 members of Detroit PD die from COVID 19

US: At least 11 states have reported over 100 new cases of coronavirus on Wednesday, according to updates from each state's Department of Health or state officials. Here is the breakdown from each of these states: New York added over 5,000 cases New Jersey added over 700 cases Louisiana went up 400 cases Pennsylvania reported 276 new cases Texas increased by 259 cases Florida jumped over 215 cases Georgia went up 150 cases Ohio added 140 cases Indiana gained 112 cases North Carolina climbed 106 cases Virginia added 101 cases

US/DOD: EXCLUSIVE-U.S. DEFENSE SECRETARY ESPER ISSUES A STOP MOVEMENT ORDER HALTING ALL TRAVEL AND MOVEMENT ABROAD FOR UP TO 60 DAYS

US: BREAKING: 5 more U.S. Navy sailors aboard aircraft carrier Theodore Roosevelt test positive for Covid-19 in Western Pacific, bringing total to 8 in past two days: U.S. officials The warship has a crew of 5,000.

NYC: CoV patient died in NYC hospital lobby waiting for bed

World: Wednesday's major coronavirus updates: - USA: +11,204 cases, +146 deaths - Spain: +7,457 cases, +656 deaths - Italy: +5,210 cases, +683 deaths - Germany: +3,907 cases, +47 deaths - France: +2,931 cases, +231 deaths - Iran: +2,206 cases, +143 deaths - UK: +1,452 cases, +43 deaths

RUMINT (Massachusetts): So some very solid info that I just got from my LEO friend down in Massachusetts... people here had posted a few days ago that they noticed a ton of power company trucks all over the place, both convoys and just sitting around in parking lots. Apparently the deal with that is authorities are extremely worried that a normal power outage due to a tree going down or a car hitting a pole would cause mass panic, making people think shit just totally hit the fan because of CoV. Because of this they are having the linemen pre-staged all over the place to respond immediately to any power outage and get it back on as soon as possible so people don't run downtown and start looting stores thinking society just collapsed.

Florida: Miami Commissioner Joe Carollo says he has heard of two additional cruise ships coming to Port Miami with passengers who have tested positive for COVID-19. He says he is concerned because the port is controlled by the county, not the city.

US: Hospitals across U.S. consider universal do-not-resuscitate orders for coronavirus patients LINK

NYC:  An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.” LINK

NYC:  manager at Mount Sinai West hospital in NYC - where staff were forced to wear TRASH BAGS as protective equipment - dies of coronavirus at age 48 LINK

California:  17-year-old teenager died of coronavirus after being released from a Los Angeles hospital LINK

UK:  London hospitals are facing a "tsunami" of coronavirus cases and are beginning to run out of intensive care beds, a senior hospital figure has said. LINK

Italy: Italy's death toll from Covid-19 could be severely underestimated. The town of Nembro, near Bergamo, had 158 deaths so far this year vs 35 on average in the recent past. Only 31 deaths were attributed to Covid-19.

Portugal: 60 deaths and 3544 cases now in Portugal! +17 deaths, +549 new cases and 18,3% rise on cases.  61 critical.

Texas: Warning: 2 men wearing scrubs, masks trying to perform in-home coronavirus tests LINK

Singapore: Health officials in Singapore reported 73 new confirmed cases of the novel coronavirus on Wednesday, making it the country’s largest single-day increase in cases.

Italy: ITALY'S LOMBARDY REGIONAL GOVERNOR SAYS CORONAVIRUS DATA ON WEDNESDAY "NOT VERY GOOD", NUMBER OF CASES UP BY SOME 2,500

Switzerland: A strange pattern has emerged in COVID-19 CFRs in Switzerland. COVID-19 has been twice as likely to kill patients in French-speaking cantons of Switzerland than in German-speaking, and more than twice as likely to kill patients in Italian speaking cantons than in French ones.

UK: BREAKING - United Kingdom is changing how #COVID19 deaths are recorded and made public, a Downing Street spokesman confirmed. Seems the UK is starting to hide deaths now.

Germany: BREAKING - "We already have many infected with #COVID19. And we have many dead already." Germany's Health Minister adds: "This is still the calm before the storm."

Russia: BREAKING - The Russian Ministry of Defense has allocated 8.8 billion rubles for the construction of 16 makeshift field hospitals for #COVID19 patients across the country.

Germany: BREAKING - Germany's Minister of Agriculture complains about staff shortages in the food supply amid #COVID19. Foreign seasonal workers are lacking in slaughterhouses and dairies. Sowing of grain also at risk.

RUMINT (New Orleans): "I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know. Clinical course is predictable. 2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue. Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma. Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours. 81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical. Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town. China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails. Diagnostic CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox. Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95% CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated. Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner. Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that. A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation. An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes. Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal. Disposition I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation. Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020. Treatment Supportive worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle. Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post. We are also using Azithromycin, but are intermittently running out of IV. Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry. Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed. Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours. The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room. Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis. We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads. One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many. I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."

China: BREAKING - China is drastically reducing the number of international flights from Sunday, as they fear a second wave of #COVID19 from foreign countries. But they cried when others banned flights from China.

US/DOD: US Army Goes To Highest State of Health Protection: SUBJECT: FRAGO 13 TO HQDA EXORD 144-20 ARMY WIDE PREPAREDNESS AND RESPONSE TO CORONAVIRUS (COVID-19) OUTBREAK// (U) REFERENCES. REF//A/ THROUGH REF//WW/ NO CHANGE. REF//XX/ [ADD] FRAGO 12 TO HQDA EXORD 144-20 ARMY WIDE PREPAREDNESS AND RESPONSE TO CORONAVIRUS (COVID-19) OUTBREAK, DTG: 230210Z MAR 20// 1. (U) SITUATION. [ADD] MITIGATION MEASURES TAKEN BY THE ARMY TO BLUNT THE SPREAD OF COVID-19 HAVE PROVEN INSUFFICIENT. COVID-19 CONTINUES TO SPREAD GEOGRAPHICALLY AS THE NUMBER OF INFECTED PERSONS CONTINUES TO RISE. CIVILIAN CAPABILITY AND CAPACITY ARE BECOMING MORE STRESSED AS DENSE POPULATION CENTERS CONTINUE TO REPORT HIGHER RATES OF INFECTION THAT ARE IMPACTING MAJOR TRANSPORTATION HUBS AND SUPPLY CHAINS. ADDITIONAL MEASURES AND ACTIONS ARE REQUIRED TO PROTECT THE FORCE FROM FURTHER SPREAD OF COVID-19. FOR EXAMPLE, TO MAINTAIN STRATEGIC READINESS AND PRESERVE OUR RAPID-RESPONSE CAPABILITIES, WE ARE PLACING RAPID-RESPONSE FORCES UNDER HPCON DELTA.

France: The newspaper "Die Welt" reports on Italian conditions in France: A team of German doctors discovered during a visit to Strasbourg that triage had long reigned in Alsace. Means: Patients are sorted according to chances of survival. Brigitte Klinkert, President of the French department Haut-Rhin, to "Die Welt": "We have been doing triage for two weeks. Patients over 80, over 75, and sometimes over 70 can no longer be intubated because we simply lack the ventilators. It cannot be said often enough, because not only the German neighbors, but also the French outside of Alsace are not yet aware of the situation here. "

NYC: BREAKING - Last night EMS in New York took 6,406 medical 911 calls. The highest volume ever, surpassing the level of calls on 9/11 when the terrorist planes hit the WTC.

US: BREAKING - U.S. Navy to test all sailors on aircraft carrier in Pacific as #COVID19 cases grow, and grow, and grow. 24 sailors aboard USS Theodore Roosevelt have now tested positive for the virus. TR pulling into Guam soon, Navy says

World: GLOBAL CORONAVIRUS CASES REACHES HALF MILLION MARK WITH CHINA, ITALY AND US ON TOP 3 LIST #breakingnews

New York: 34% OF NEW YORK CORONAVIRUS TESTS ARE COMING BACK POSITIVE

Italy: BREAKING - Italy reports 6,153 new #COVID19 cases and 662 new deaths. Total now 80,539 coronavirus infections in the country and 8,165 dead.  MOST NEW CASES IN FIVE DAYS

Louisiana: Another update on hospitalization of covid patients in Louisiana: Today, 676 patients (29%) are hospitalized. 239 of them are on ventilators, which are in short supply, especially in New Orleans.

US: FAUCI SAYS THINKS CORONAVIRUS WILL CONTINUE ON THROUGH SUMMER, DOES NOT THINK IT WILL "DISAPPEAR"

New Jersey: NEW JERSEY CORONAVIRUS CASES INCREASE BY 2,492 FROM DAY EARLIER TO 6,876, DEATHS UP BY 19 TO 81 -GOVERNOR PHIL MURPHY

New York: The number has now climbed to 351 members of the NYPD that have tested positive for coronavirus

UK: BREAKING: UK reports 2,129 new cases of coronavirus and 113 new deaths, raising total to 11,658 cases and 578 dead

France: LATEST DEATH TOLL IN FRANCE FROM CORONAVIRUS STANDS AT 1,696 DEATHS (VS 1,331 yesterday) - PUBLIC HEALTH OFFICIAL

NYC: NBC News: 131 FDNY members have tested positive for COVID19. More than 2,000 members of the agency are on medical leave, most of them with flu-like and coronavirus-like symptoms, per senior FDNY official. 

RUMINT: Report from a friend who is an ER PA in a mid size city. No, I will give no other identifying info about him. Testing 250-300 per day. Some positives with low grade (101 and below) fever, but those also have diarrhea. Their first cases were idiots who went to Mardi Gras. No, he in not in NOLA. These assholes transported the virus to their hometown. They expect it to really ratchet up next week, and go full on crazy the week after.

RUMINT (NYC): So many police officers in NY infected, many in quarantine, and more to follow. When the “urban youths” figure out the cats are unable to come out, it will be full on mayhem time. The guard will be necessary to tamp that shit down. If the rubber bullets don't at first work, I suspect there will be shoot to kill orders. Otherwise, the non rape/pillage/loot people will be butchered.

Anonymous Doctor’s Evaluation of COVID19: Ebola is a knock out expert. HIV plays the long game but only ends 1 way, COVID is the illegitimate brother to them both.

US: BREAKING: U.S. overtakes China as the country with the highest number of confirmed coronavirus cases

[phawareglobal]

Rebecca Hamilton - phaware® interview 260

Rebecca Hamilton was diagnosed with portopulomnary hypertension in 2015. She details her multi-year court battle for disability benefits. 

My name is Rebecca Hamilton. I am 44 years old and I was diagnosed with portopulomnary hypertension on December 20th, 2015.

From my understanding, portopulmonary hypertension is diagnosed when someone has chronic liver disease and somehow that affects the cleaning of the blood so they believe that liver disease has caused the problems with my heart and my lungs.

I was 41 and I had just given birth to a little boy on December 7th, 2015. What seemed like a normal pregnancy, a normal delivery other than the fact that I had to be put under general anesthesia due to low platelets which is something that often happens with liver disease patients, I had to be put to sleep to have him. I had my fourth C-section and went into recovery. Had a normal hospital stay with a newborn and was released back home with the rest of my family about three days later.

When I was discharged, I noticed I started getting some swelling in my ankles and my feet and that had never happened before in any of my other pregnancies. Again, this was my fourth one, so I thought that it was very strange because I've never had that problem. I noticed that I was just really tired and kind of lacked energy, but my doctor just basically said it was just extra fluid from having the baby. He put me on Lasix to try and get the fluid off.

He sent me home after I had my one week follow up and put me on a Lasix for one week and then I came back to his office and basically the swelling hadn't gone down and I was becoming more and more short of breath. It was around Christmas, we had gone to a family function. We took the kids to see Santa and I had to climb these stairs into Cleveland Browns stadium and I couldn't make it up the stairs without taking breaks.

The next day, I went back to the ER and they got me in immediately. The first test that they decided to do was an echocardiogram. The tech came in to do that test. I had never really had one of those before and didn't really know what was happening other than I thought they were looking to see if I had a blood clot. As we were waiting there, three or four doctors came into the room and said to me and my husband that I had pulmonary hypertension. I didn't even know what that meant, because I had never heard of it.

They basically just said that they were very sorry. That there was no cure. That some people go on to have a heart and lung transplant. So, of course, I was just completely overwhelmed with the amount of information that was coming at me within the matter of an hour of being sent to the emergency room.

From there they told me that I would be admitted to the Intensive Care Unit at that hospital and they were going to start me on some medications and do a right heart catheterization. All of these things were being thrown at me and I was stressed, overwhelmed, sad and I thought, "I'm dying."

Well unfortunately, I had a setback when I started the medication. I was at local hospital in my town. It was a smaller hospital and they were just actually starting a pulmonary hypertension department there, so there was about three patients total that they had even worked with that had pulmonary hypertension [who were] diagnosed. So, it was fairly new to them. When they started me on IV Veletri, which is what they put me on, I had some hypotensive issues in the ICU and I had adverse reactions where my blood pressure dropped to 58 over 12. At that point they were bringing crash carts and talking to my husband on whether not I was even going to survive at that point.

My husband immediately put in for a transfer to Cleveland Clinic Main Campus in Cleveland, Ohio and they transferred me on New Year’s Day. From there I was monitored more closely and stabilized, but I remained in the ICU for 20 days. I was having some arrhythmias, again low blood pressure issues. They finally got me stable and I was able to titrate to a good point to where I could then be released, but I was in the ICU for 20 days. It was very traumatic. I suffered from some post-traumatic stress disorder after having my son and then all these things happening. ICU delirium. It's been quite an adjustment, because I did get post-traumatic stress disorder after, some depression, and some severe anxiety over the whole situation.

It was horrible at first, but once I finally got to go home and settle in to my new normal, I did a lot better. However, it wasn't simple for me, because what I thought was going to be a happy time of my life, I went out on medical leave to have my son and was going to return back to my career, all of that changed in the blink of an eye.

We were hoping that I would be able to return from work but my pressures upon diagnosis were in the high 90s. I was considered very, very severe. So, I worked for an End-Stage Renal Dialysis [Center] as a financial coordinator, or insurance coordinator. I took care of about 900 patients who were on end-stage dialysis waiting for kidney transplants. I applied for grants and did social security disability paperwork for all of those patients and I had worked there for 15 years.

I had assumed that I would be able to go back to work and everything would be fine, but unfortunately that didn't happen, because I was still having quite a bit of problems so I went out on my company's short-term disability and then I switched to long-term disability while I filed for my social security disability.

With social security, unfortunately, if you're still getting paid from your employer you're not considered disabled. So, I had to make the decision to allow them to terminate me which took about three months. I was completely on long-term disability and then was able to file the social security disability paperwork. Unfortunately, it was denied even though I was on IV therapy and my pressures were in the 90s and I couldn't really do anything. Walking was exhausting. Climbing stairs was exhausting. There was no way that I could drive and cover 16 different clinics doing what I was doing in the past, so I had assumed with my condition the way that it was that I would get approved. But, unfortunately, I was denied. Then I appealed it. The appeal was denied. Basically, my next opportunity would be to go in front of a judge and plead my case, which took three years. I was just waiting, and waiting, and waiting to see the judge, [to] hopefully get approved.

In those two years, I was getting paid supplemental pay through my long-term disability company, but because I was denied for social security twice they decided to terminate my benefits also. For the last two years we've had no income coming in other than my husbands and he's a professor at Kent State University. We took a huge financial loss, because our mortgage and things like that went to zero dollars. Financially, for a family of six it was very, very difficult.

I finally got my court hearing date which was March 5th. I went before the judge and [he] did not make a decision that day when I was there. He told me that he would make a decision in two to three weeks. The judge was very empathized and very sympathetic to my situation. He let me explain what pulmonary hypertension is. My doctors wrote letters explaining what it was as well and why they felt I couldn't work. I was being referred also to liver transplant to possibly get worked up for a liver transplant in hopes that I could possibly come off of the IV pump medication.

Basically, the judge, three weeks later sent a letter that he was favorable in me winning my case all the way back to 2015. Now, I'm at the point where I'm just waiting for back pay and I'm waiting for my first check. It will be a huge relief, because it's been financially stressful. A financial burden and a hardship just all the way around for our family, for our marriage. It's just been quite the struggle.

My advice if I could do it a little differently would have been to get an attorney at the very beginning. But since I worked in disability and understood the rules and the laws, I assumed I was doing everything that I could with the knowledge that I had from my career.

In hindsight, maybe things would have been a little different had I made sure that my medical records all were received and got a copy of all those myself to review before just having a hospital send them straight to social security, or at least if you want to try it the first time yourself on the first denial, get an attorney to help you with the appeal process, because unfortunately I think you have to be represented in order for them to take you seriously.

And to advocate for yourself. I contacted my doctors and asked them to write letters explaining what my condition was and how they felt if I could work or not. Having my doctors on my side to say, "No, she should not work. She can't lift more than 10 pounds. She needs to rest through the day. She needs to elevate her feet."

There's no job out there that's going to allow her that type of work environment. There are some people who can work with pulmonary hypertension and then there's some of us who can't. Unfortunately, I can't. The best thing I could say is get an attorney and advocate for yourself and just do your due diligence in making sure that your attorney's getting all the documentation that you need. Ask to review it. Ask for those letters and just fight for yourself.

My name is Rebecca Hamilton and I'm aware that I am rare.

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[rolandfontana]

Private Health Provider Endangered Arizona Inmates: Whistleblower

The sound of coworkers crying. Sprinting to stabbings and hangings. The hiss of an empty oxygen tank. The inevitable loss of life. These are the memories of Jose Vallejo from his time in an Arizona prison.

Vallejo worked for Corizon Health in the Arizona Department of Corrections for two years from December 2016 to December 2018. He alleges the company is violating state regulations, purposefully misleading state auditors, and putting patient lives at risk.

U.S. District Judge Roslyn Silver, overseeing the Parsons v. Ryan prison health care settlement, recently appointed an independent expert to review the entire Arizona prison health care system after similar allegations were made by previous whistleblowers.

Vallejo read their accounts and came to KJZZ with his own story, after he says his concerns fell on deaf ears at Corizon and the Department of Corrections.

MORE: On The Inside: The Chaos Of Arizona Prison Health Care

Vallejo is no stranger to the correctional world. He has worked as a correctional officer and a police officer, as well as a correctional nurse. For the past two years, he was employed as a licensed vocational nurse at the Arizona State Prison Complex – Eyman in Florence.

Much of his time was spent working in the SMU-1 unit, where some of the most seriously mentally ill patients in the state prison system are housed.

Vallejo worked as an hourly employee for Corizon Health, logging 12-hour shifts, four or five days a week. His duties included distributing medicine and providing health care to thousands of patients. He estimates he was putting in between 120 and 150 hours every two weeks at the prison.

“It’s mentally exhausting — emotionally — physically,” he recalled in a recent interview at his home. “We have to stop what we’re doing to respond to emergencies. We have inmate stabbings, inmate hangings. It takes a toll. It really does.”

Lack Of Staffing, Training

When Vallejo first started at Eyman, he said he was forced to hit the ground running. Instead of the two weeks of training he was promised, “I literally got two days of training, and I was thrown into working nights by myself.”

He says his previous work experience helped steel him against the pressure, but other nurses were simply not prepared.

“There’s RNs there that don’t even know how to start an IV,” Vallejo said. “There are nurses that can’t operate an oxygen tank. A lot of them have no type of training. They’re book-smart, but when it comes to a hands-on situation, they have no idea what’s going on.”

Vallejo says the lack of training provided by Corizon sets nurses up for failure.

An independent expert hired by Magistrate Judge David Duncan in 2018 to review Corizon’s staffing woes found that “recruitment and retention are an ongoing issue, resulting in staff being stretched too thin to provide coverage.”

Vallejo said not much has changed. He says he and his colleagues were run ragged.

“You have nurses crying in the middle of their shift — it’s horrible,” he said.

Despite Corizon’s contract with the state guaranteeing 90 percent staffing fulfillment, Vallejo claims his unit was usually only 50 percent staffed with health care personnel.

He says the turnover was like nothing he has ever seen.

“Corizon is just hiring bodies, trying to get their numbers up,” he said.

Vallejo kept internal employee logs that he claims show several units at the Eyman prison were continually understaffed.

Editor’s Note: KJZZ reports that the Arizona Department of Corrections (ADC) did not respond to multiple requests for comment regarding the accusations contained in this article. Corizon Health spokesperson Martha Harbin said Jose Vallejo was “terminated from his position for failure to perform required duties” but provided no other response to his allegations.

‘Dangerous Situations’

Vallejo says a registered nurse should have been at the prison complex at all times, but often there was no one working with that level of certification. Many times, he says, licensed vocational nurses were forced to make decisions that should have been handled by someone with more experience.

“We’re making a call that someone else should be making,” Vallejo said. “We’re making calls that someone with more education should be doing.”

Vallejo says this led to many dangerous situations.

*“We’re putting people’s lives on the line,” he said. “When we’re passing medications to so many inmates, it creates room for medication errors.”

Vallejo says this included inadvertently giving inmates the wrong medication, “which can ultimately kill them, depending on what you’re giving them. I mean you have blood pressure medications, heart medications – critical stuff.”

Vallejo says inmates with chronic illnesses suffered the most.

“There was a lot of times, due to lack of staff, that diabetic inmates weren’t getting their insulin until 9 or 10 o’clock in the morning,” Vallejo said. “That’s pretty dangerous considering we turn around and give it to them again at 3 p.m.

“So they’re not even hitting their peak when we’re turning around and giving them more.”

In addition to serving thousands of patients’ daily needs, Vallejo says there were constant emergencies.

He claims during one shift he worked in early November, there were 28 Incident Command System (ICS) responses. An ICS is an emergency situation at the prison requiring an all-hands-on-deck type of response from health care providers and Department of Corrections staff.

“It was everything from inmates cutting themselves to cell extractions to chest pains,” he said.

Vallejo said the health care staff wasn’t alone in dealing with staffing shortages.

“The Department of Corrections staff is hurting just as much as we are,” he said.

“There [are] times when you have one correctional officer running an entire wing of several hundred inmates. So you don’t even have eyes on you like you’re supposed to 24/7.”

Vallejo says one night at SMU-1, the inmates set the building on fire.

“We had fire trucks out there, ambulances sending people to the hospital.”

He claims several patients and Department of Corrections staff were injured. He says the inmates were rebelling because they had not been receiving their medication.

“They warned us that they were going to go off,” Vallejo said. “But nobody listened, and they ended up setting the unit on fire.”

Nurses were expected to perform the work required of a full roster of employees.

Vallejo says despite the short staffing, nurses were expected to perform the work required of a full roster of employees. He claims Corizon supervisors repeatedly ordered him and his colleagues to improperly distribute medicine to patients.

“She wanted one of us to pop ’em, while the other two went and handed them out,” he said.

Vallejo says instructing one nurse to “pop” pills from their blister packs while directing another nurse to distribute them is against guidelines established by the state board of nursing.

“We told her we weren’t going to do it. It’s illegal. We can’t pass medicines that somebody else has poured. But they didn’t care.”

Empty Oxygen Tanks, Broken EKG Machines

Vallejo alleges a lack of resources contributed to a dangerously deficient level of care.

“We have cancer patients not getting cancer treatment like they should be,” he said. “There are follow-ups by providers that aren’t happening. They’re just being overlooked.”

Dr. Jan Watson, who also formerly worked for Corizon as a health care provider at the Eyman prison, made similar accusations about poor access to specialty care to KJZZ in December 2017.

Watson ended up testifying in federal court along with another Corizon whistleblower, Dr. Angela Fischer, who expressed similar concerns.

“I had one male patient that was so bloated he looked like he was nine months’ pregnant,” Vallejo said. “He was jaundiced so badly, he had pretty much yellowish skin.”

Vallejo says he fought with administrators for three months before they agreed to send the patient to another facility that could provide proper care.

“He should have had a lot better care,” Vallejo said. “He needed dialysis. He needed different types of CAT scans and we just weren’t equipped to handle that.”

Vallejo says he treated another patient whose blood platelet levels were dropping rapidly. He says he asked administrators for help with the patient for a year before it was discovered he had developed cancer.

“There was a time when we had an emergency and we didn’t even have working oxygen tanks that were full — they were all empty,” he said. “Other times, we’re having to run to another unit on the other side of the complex to get an EKG machine because ours isn’t working.”

Vallejo says “man down” situations were a constant occurrence. But a specific bag, reserved for such emergencies, was never properly maintained.

“People would break the secure tags on ‘man down bags’ to get supplies in an emergency and then wouldn’t replace them,” he said. “You have things in there that are expired and don’t even belong in there.”

DOC Monitoring Bureau

The Arizona Department of Corrections created a monitoring bureau “to follow the medical care and treatment of inmates” after the state privatized prison health care in 2012. The bureau performs audits on the health care facilities at state-run prisons, currently operated by Corizon Health.

Vallejo claims he witnessed and took part in numerous practices, directed by Corizon Health administrators, that were conducted to deceive the state monitoring bureau and avoid potential fines.

“When it’s time for audits, Corizon administrators will ask us to make sure all the books are signed and tell us to ‘fill in the blanks,’” Vallejo said. He says there are several logs maintained by Corizon for monitoring things like narcotics inventories and temperatures in the inmates’ cells.

“Our narcotic books are supposed to be signed every shift,” he said. “All the temperatures are supposed to be within normal limits.” But these books, he said, were often left blank.

“I’ve been asked to fill in the blanks on multiple occasions,” Vallejo said. “Narcotics are supposed to be counted and signed for at the beginning of the shift and at the end of the shift. But there’s a lot of times where they aren’t. So two or three months later, they’ll ask whoever is around to sign off on the books, so they’re not getting dinged for it.”

Vallejo says there was a specific room at his unit where his supervisors would pile up the books full of empty blanks and a Corizon administrator would order Vallejo and his colleagues to fill them in.

“If a state auditor shows up, they’ll call every unit and let them know they’re there and instruct the nurses to make sure everything is signed out, make sure everything is out of sight, and make sure everything is ‘tidy,’” Vallejo said.

Vallejo: I was ordered to improperly sign narcotics books.

Vallejo admits to improperly signing several of the narcotic books under order from his supervisors.

“It sucks because they’re putting us in a predicament where either we sign it — or if we don’t — we’d end up getting some sort of retaliation.”

Vallejo says he is certain that Corizon administrators knew when the audits were coming, and prepared for them. “They know before they show up. So they try to start fixing everything and hide what they can,” he said.

“Every nurse that works there has been told at one point or another to fill in a blank, or sign something off, or back-date something, or chart on something that they might not even have been there to chart on,” Vallejo said. “It’s common practice.”

Vallejo claims that in addition to falsely signing forms and backdating patient visits that didn’t occur, Corizon administrators ordered nurses to hide expired medicines from the state auditors.

Expired Meds Hidden From Auditors

“We were asked to make sure expired medications were out of sight so the auditor doesn’t see them,” he said.

“We had medications in the med room that should have been discontinued,” he said.

“When they find out the auditors are coming, they’ll go and stick the expired meds in the pharmacy room and pretty much just lock them up until the auditors are gone. And once they leave, they’ll bring them back out.”

Vallejo says when clinics at the prison would run out of medications, which he says occurred frequently, Corizon administrators would instruct nurses to give patients the expired medications.

Vallejo said he expressed his concerns about all of these allegations to the Corizon Health facility administrator, assistant administrator, assistant directors of nursing and the regional director of nursing. He claims nothing happened in response.

Vallejo saved emails from his superiors that show they were aware of the staffing shortages and the impact it was having on patient care.

Vallejo says he asked Arizona Department of Corrections officials for help as well, to no avail.

“Anytime we try to go to ADC, they have us go up our chain of command at Corizon,” he said. “It got the the point where I started telling inmates to write grievances because we weren’t getting anywhere with management.”

In November 2018, Vallejo and his colleagues sent emails to Corizon Health administrators describing how dire the staffing situation had become.

Vallejo says two weeks after the November email to supervisors stating the nurses would no longer distribute medicines without proper staffing, he was told by his supervisors they were going to report him for abandoning his patients. Vallejo says on Dec. 3, 2018, ADC officers escorted him from the property at Eyman.

‘I Hope Somebody Opens Their Eyes’

Days later, Vallejo contacted KJZZ to tell his story.

“I just hope somebody opens their eyes,” Vallejo said. “I hope something is done about it, because there is a lot of potential there. You have a lot of great nurses there, but we don’t have the resources or the help that we need.”

“Nothing is being done,” Vallejo said, “and nothing will be done unless it’s brought to the light. The only route that anyone can take now is bringing it out to where people can read about it and taxpayers can know what they’re paying for.”

Vallejo believes if Corizon would fill the contracted health care positions and provide better training for new employees, turnover would decrease and the quality of patient care would improve dramatically.

He says he’s heard from former coworkers since his departure who were told by Corizon administrators that if they took a stand like Vallejo did, they would face the same fate.

Vallejo says he continues to worry about the patients he left behind at Eyman.

“They are not asking for anything out of the norm,” he said. “They’re just asking for the medications they need. They’re asking to be seen when they’re supposed to be seen. They’re asking for simple stuff. It’s not anything drastic, just basic necessities that we don’t have the resources for.”

“Somebody needs to do something,” Vallejo said, “or else more patients are going to die.”

The Arizona Department of Corrections recently announced it has selected a new health care vendor, Centurion Managed Care, to take over the state prison health care contract from Corizon Health on July 1, 2019.

Additional Reading:

Corizon Health Loses Arizona Prison Health Care Contract

Scabies Outbreaks Confirmed At 2 Arizona Prisons In 4 Months

Jimmy Jenkins, a staff reporter for KJZZ, Arizona Public Radio, is a 2018 John Jay Justice Reporting Fellow. A fuller version of his reporting, as well as links to his broadcasts, are available here.

Private Health Provider Endangered Arizona Inmates: Whistleblower syndicated from https://immigrationattorneyto.wordpress.com/

[technato]

Zipline Expands Its Medical Delivery Drones Across East Africa

Doctors order by app and wait for medical supplies to drop from the sky

Illustration: MCKIBILLO

Illustration: MCKIBILLO

While Amazon and United Parcel Service pour considerable resources into finding ways of using drones to deliver such things as shoes and dog treats, Zipline has been saving lives in Rwanda since October 2016 with drones that deliver blood. Zipline’s autonomous fixed-wing drones now form an integral part of Rwanda’s medical-supply infrastructure, transporting blood products from a central distribution center to hospitals across the country. And in 2018, Zipline’s East African operations will expand to include Tanzania, a much larger country.

Delivering critical medical supplies in this region typically involves someone spending hours (or even days) driving a cooler full of life-saving medicine or blood along windy dirt roads. Such deliveries can become dangerous or even impossible to make if roads and bridges get washed out.

Zipline’s drones avoid such problems entirely, slashing delivery times to minutes. The drones, called Zips, fly blood packs from a distribution center in Muhanga, Rwanda, to 21 hospitals located within 75 kilometers. In an emergency, a doctor can use WhatsApp Messenger to request blood, which gets packed into a Zip that’s fired into the air with a catapult. Using GPS navigation (and in coordination with Rwandan air traffic control), the drone heads for its target. When the Zip reaches its destination, typically within an hour of the initial request, the doctor gets a WhatsApp message to come outside, and the Zip drops the blood pack in a padded container with its own little parachute. The Zip then heads back home for an arresting-hook-assisted landing onto a soft mat, and it’s ready to fly again after a quick battery swap.

Zipline’s system in Rwanda solves two problems. The first, as Zipline founder Keenan Wyrobek explains, is the short shelf life of whole blood, which makes planning what types and amounts to keep on hand at each hospital difficult. As a result, some hospitals don’t have the packs they require, while other packs go unused. Central stocking with immediate distribution via drone is the solution.

Photo: Zipline

Needed Now: Zipline’s drones can deliver their blood products where they’re needed, normally in less than an hour from the time the order is placed.

This system also helps in an emergency. Zipline CEO Keller Rinaudo describes what happened to a 24-year-old woman who gave birth via C-⁠section at a hospital. There were complications after the birth, and the woman began to hemorrhage. The doctors immediately gave her two packs of blood. “But she bled out in 10 minutes,” Rinaudo says. “She was in real danger.” The doctors had no more packs of her blood type, so they placed an emergency order with Zipline. A procession of drones (each 12-kilogram Zip has a payload of just 1.5 kg) ended up delivering seven units of red blood cells, two units of plasma, and two units of platelets. “All of that was transfused into this woman—that’s more blood than you have in your body normally—and they stabilized her,” he says.

Zips are able to make such lifesaving flights at night, through heavy rain, or in high winds. And Zipline is already developing a new generation of Zips with even longer ranges and larger payloads and the ability to make more deliveries per day.

According to Rinaudo, “the technology is the easy part.” The hard parts are making sure all regulatory issues are resolved, finding and training a local team to operate the distribution centers, spreading word to doctors and health care workers about the service, and communicating with people who see the drones whizzing overhead. “We want them to understand how this technology benefits them,” Rinaudo says. So far, the benefits are significant: Zipline’s partners estimate that over its operating life each Zip will save eight lives.

“Rwanda has shown such remarkable success that a lot of other countries want to follow in its footsteps. The problems we’re solving in Rwanda aren’t Rwanda problems, they’re global problems—rural health care is a challenge everywhere”

Adam Klaptocz, founder of WeRobotics (which establishes drone innovation labs in developing countries), is impressed by what he characterizes as Zipline’s “brute force” approach. With a realistic focus on one-way delivery of blood products, “they can do it well—and they operate—which is more than most drone companies,” he says.

In Rwanda, Zipline’s goal is to be the primary blood distributor for most of the region’s hospitals. After Zipline opens a second distribution center it has planned there, Zips will be able cover the entire country, making hundreds of deliveries each day. In Tanzania, Zipline will deliver a wider range of medical products. The company expects to establish four Tanzanian distribution centers, with enough drones to make 2,000 deliveries per day to more than 1,000 health facilities.

Rinaudo says that Zipline is likely to begin operations in a few other countries in 2018 as well, although he’s not yet ready to specify which ones. “Rwanda has shown such remarkable success that a lot of other countries want to follow in its footsteps,” says Rinaudo. “The problems we’re solving in Rwanda aren’t Rwanda problems, they’re global problems—rural health care is a challenge everywhere.”

This article appears in the January 2018 print issue as “Medical Delivery Drones Take Flight in East Africa.”​

Zipline Expands Its Medical Delivery Drones Across East Africa syndicated from http://ift.tt/2Bq2FuP