New York now has a standing order for a Do Not Resuscitate on Cardiac Arrest patients for EMS.

I have so many thoughts on this. So I guess it's time for my biweekly twitter thread.

First of all, the comment thread I read in the Twitter link is fucking hilarious and filled with people who have clearly never done CPR. I have. I have done it more than a mid-20 year old should have to have done it. I do it weekly, actually.

CPR is a physically exhausting job, from the compressions to access to intubation to ventilation to moving the patient, your heart does some fucking funky things.

(Pictured: telemetry of my heart during a witnessed Cardiac arrest)

You breath fast, you breath heavy, your muscles hurt, you're anxious, your moving around, you're in weird positions. You're working hard.

We are currently working all codes in these badbois and N95s, which, as you can imagine, are quite sweaty.

So, with that said, were protected, mostly. Its hard for viruses to get through our suits and masks and gloves. Yeah, it can happen, but it's low risk.

So, NY is working to eliminate that risk by keeping the virus away from a carrier population, however low the risk is.

Now, that said, patients dying of covid or with covid are at risk of spreading it via droplet. Ventilation via Bag Valve Mask can create droplets depending upon secretions in the airway. To alleviate this we have viral filters we place on our BVMs.

I see people saying that we do mouth to mouth.

We don't. I've never seen mouth to mouth resuscitation done in real life ever. There's mask barriers for it, but it's extremely ineffective.

So, that out of the way, the BVM when used correctly provides an excellent seal from airborne droplet precautions. ETT placement, or intubation, puts you at greater risk, especially with airway secretions and suctioning, but that's what mask and goggles are for.

So, risk reduced

NY is at critical shortage for beds. Arrest patients usually require an ICU bed if they are resuscitated. They usually need ventilators. They usually have a poor prognosis.

Of 347,322 cardiac arrest, 10.8% are discharged from hospital alive. In real numbers, this is 37,511 lives

If we use the base population of NY and assume a equal distribution of arrests (NY likely has a higher number for socioeconomic reasons), this means that this is 2,250 people per year saved in NY state.

Six a day.

New York has made the determination that statistically this is insignificant, and that they are better placed using the resources to resuscitate and stabilize these patients into giving other patients a better chance of coming through covid.

New York has made a difficult call here. One I would never want to make. I understand why they have made it. I think there's a lot of factors that need qualifying with this pandemic. We are in uncharted waters and we will inevitably make decisions that we will regret.

I don't think this is one of them. This is one were going to have to take a hard look at after this is over and evaluate ourselves and healthcare as a whole.

I'm not the guy to do that. This is Twitter. It's just an exhaust vent for my overactive brain to me.

I think this is a grim reality of the situation unfolding in NY. And I don't envy them.

I have a lot of thoughts and I'd need a direction to point them in, or this thread will too long.

So if you got something for me, shoot. If not, thanks for reading.

Stay safe, stay home.