Are There Enough Skilled Medical Workers To Run Ventilators?
DAVID GREENE, HOST:
All right. So about 2% of people with the coronavirus are expected to develop respiratory problems so severe they'll need to be put on ventilators. There is a shortage of those ventilators in some European countries, and this is raising fears about shortages here in the United States. And there's another problem that gets less attention - that's the need for medical workers with the skills to run those ventilators. Here's more from NPR's Joseph Shapiro.
JOSEPH SHAPIRO, BYLINE: A ventilator is a lifesaving machine that helps someone breathe. A tube runs from the machine to a person's windpipe. The ventilator blows oxygen into the lungs. It requires a trained medical team - a respiratory therapist, a nurse and a doctor - usually a pulmonologist.
STEVEN SIMPSON: There are over 30,000 trained and certified pulmonologists in the United States. But just like with other medical specialties, most of them are concentrated into urban and some suburban areas.
SHAPIRO: Pulmonologist Steven Simpson is the incoming president of the American College of Chest Physicians. He spoke while driving to his hospital in Kansas City, where there is already one COVID-19 patient on a ventilator.
SIMPSON: The patients who are deteriorating into full-blown respiratory failure seem to do that relatively quickly, in a matter of a few hours.
SHAPIRO: So a hospital, maybe in a small town or a suburb, without the right staff will need to make decisions - and quickly - about a patient.
SIMPSON: It can be important to get them transferred to a larger center before they develop full-blown respiratory failure.
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UNIDENTIFIED PERSON: And volume control ventilation and pressure control ventilation, room air and 100% oxygen-zero and 20 of PEEP at the same rate and tidal line (ph).
SHAPIRO: A ventilator is a complex, computerized machine. This is from a webinar on how to use ventilators that are kept in the federal Strategic National Stockpile. It's a training for respiratory therapists.
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UNIDENTIFIED PERSON: And you turn O2-conserve off, and the bias flows goes away. Now, that does slightly affect the triggering. It's not a big issue in adult patients, but it could be an issue for you in pediatric patients.
TOM KALLSTROM: So you're a caregiver, and, in some ways, you are kind of a mechanic.
SHAPIRO: Tom Kallstrom runs the American Association for Respiratory Care.
KALLSTROM: Primarily, the ventilation is done by the respiratory therapist. The respiratory therapist is the one that will oftentimes intubate the person - putting the tube in their airways - manage the ventilator, assess, make adjustments and, when the time is correct, extubate - or pull the tube out of the patient.
SHAPIRO: There are about 150,000 respiratory therapists. They, too, are often concentrated in large cities. The Federal Bureau of Labor Statistics says we already need more - about 21% more - in the next several years just to care for the growing number of people, often elderly people, with chronic lung disease. In a pandemic, Kallstrom said retired therapists can be pulled back, students about to graduate from two- or four-year training can start.
Some therapists have proposed ways to modify a ventilator - a machine designed for one patient - to connect it to four. But Kallstrom's group studied that and says it's not safe. The best solution, that's what the nation is doing - social distancing, self-quarantine so that fewer people get infected at once and so those ventilators - and the staff to run them - are needed over a spread-out period of time.
Joseph Shapiro, NPR News.
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