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British woman revived after six-hour cardiac arrest (bbc.com)
314 points by elmar 8 months ago | hide | past | favorite | 165 comments



> In a race against time, doctors treating Mrs Schoeman turned to a specialised machine capable of removing blood, infusing it with oxygen and reintroducing it to the patient.

> Once her body temperature had reached 30C, they used a defibrillator to jump-start her heart some six hours after emergency services were contacted.

> Mrs Schoeman was released from hospital 12 days later, with only some lingering issues with the mobility and sensitivity of her hands due to the hypothermia.

> How long her heart stopped for is not clear - she may still have had some circulation, although not detectable.


Just out of curiosity - would one (say like a soldier) be able to effectively 'pre-emptively' wear a device in a backpack which has a permanent-ish lead to the circulatory system which does multiple things:

Provides a constant flow of oxygenated blood which allows for higher endurance, longer "holding of breath", and in the case of severe injury, oxygenated blood circulation to prevent death (unless there is catastrophic blood loss which moots the machine's ability)....

Recall all the famous designs of Cyborgs [and The Borg] with the tubes running into their face/head/nose - the tubes could be pumping externally oxygenated blood to the vitals which would suffer most in catastrophic physical unplanned destruction events.


It’s not practical. Patients on ECMO require anticoagulation, as do patients on cardiopulmonary bypass. This is a problem common to all systems which expose blood to foreign surfaces and pass it through pumps. Your hypothetical anticoagulated soldier with such a pump would bleed out lickety-split were they to suffer as much as a minor cut.

Also, such a system would likely require giant cannulae placed in rather inconvenient places, e.g., the neck, thigh, or chest, as in ECMO. That would limit movement significantly.


The U.S. military has already tried basically this twice.

Once back in the late 40's to for fighter pilots, and again in the 90's, a practice they called "Blood loading".

https://en.wikipedia.org/wiki/Blood_doping


Peter F Hamilton's "Fallen Dragon" had a sub-plot along these lines. Some soldiers wore exo-suits-of-muscle that had access to valves embedded in the femoral and carotid arteries. The human inside was breathing for both themselves and the suit while hooked up. The suits could be disconnected and hooked up to a external rack that did circulation and respiration when not in use.


Where would the oxygenated blood come from? How much would the soldier have to carry? How do you protect this mechanism so that it's not also damaged in whatever unplanned destruction event broke the soldier?


I asked if it was possible, you are asking me for an RFP.


You made me chuckle.


Blood has been shown to oxygenate when passing in contact with semi permeable membrane with oxygen rich environment on the other side


This would probably work best as part of some kind of a powered exoskeleton.


Dick Cheney has (had?) no heart beat: https://www.livescience.com/33035-is-it-true-that-dick-chene...

In his case, the lungs are still working, but there's no scientific reason we don't have cyborg lungs yet.


> has (had?)

Had. The article is from 2011; according to Wikipedia "On March 24, 2012, Cheney underwent a heart transplant procedure", "he remained alive without a pulse for nearly fifteen months." source: https://en.wikipedia.org/wiki/Dick_Cheney#Health_problems


/Tinfoil

I am convinced that Cheney is the reason Barnaby Jack was murdered.

Jack knew how to remotely attack pacemakers, as well as pumps and other medical devices and was to speak at BlackHat... but was neutralized just days prior...

/Tinfoil


There's a nice research article from 2016 by doctors in northern Norway about resuscitation of frozen patients:

“Nobody is dead until warm and dead”: Prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas – A retrospective study from northern Norway

J. Hilmo, T. Naesheim, M. Gilbert https://www.sciencedirect.com/science/article/pii/S030095721... (open access, CC licence)

Same hospital and team that treated Anna Bågenholm (mentioned in other comments, https://en.wikipedia.org/wiki/Anna_B%C3%A5genholm), and I guess that case is part of the study.


It’s amazing how this phenomenon has been adapted into medical technology. When my son was born he wasn’t breathing properly and his blood oxygen levels dropped to critical levels. He was rushed to hospital and the first thing they did was cool him to 34c to reduce the risk of brain damage. He made a full recovery. I dread to think what would have happened without the cooling.


Same thing happened when my son was born and he had complications resulting in loss of blood to the brain for a significant amount of time. We were told to expect mild to moderate brain damage while we just had to sit and wait as they basically did nothing but keep him cooled for about three days. It's been three years now and he very smart and extremely athletic. The doctors said the cooling is what the difference. His complications happened at the hospital so he was able to be cooled immediately.


Why not cool the patient before rushing them to hospital, if the technique is so widely applicable? It could easily be made a standard feature of emergency medical services.


Because it's hard. I helped out at a company among many that are trying to develop a system that would allow you to do this in ambulance and they started testing prototypes 10 years ago and have yet to progress from that stage.


It's not that hard... you just throw some ice packs in the groin and armpits. You won't get them fully into the TTM range in a 20 minute transport, but you can start the process.


That is extremely ineffective.

What you might want to do is to cool the brain through cooling the outside of the head as well as through the nasal cavity.

Even if you chug a giant slurpee the largest effect on the brain temperature will be the cooling of the nasal cavity on it's way down.


Packing with ice packs is a standard component of TTM, generally in conjunction with other therapies (chilled IV fluids, etc). It's also the easiest step to take in a prehospital setting, which is why we do (this is a thing I've done with maybe a dozen patients over the past few years). I'm not just making this stuff up, it's based on actual treatment protocols and algorithms.

We're talking about a naked, sedated patient (so they're already losing a lot of heat due to simple convection, and there's no heat being generated by skeletal muscle movements). The body's metabolism has slowed significantly, and it's producing anywhere near the normal level of "baseline" heat.


Do you have any links to data showing effects on brain temperature from that treatment?

Afaik interest has been low in carrying around enough ice pack capacity to make this viable, and with lacking data for it even working, whereas head-cooling packs with circulating liquid through a cooler takes little space, cools way more efficiently and required no other maintenance after insertion into the patient in the ambulance (and is moved with the patient while continously working).


Overcooling is more of a risk with I've packs than not cooling enough. It's much less of a concern in a prehospital setting though, since we're not with the patient that long. It's more of an issue in the ICU.

https://www.ncbi.nlm.nih.gov/pubmed/17114983


Sticking ice in proximity to major arteries is going to be a lot less effective without a beating heart to circulate all that newly cold blood.


This procedure is initiated after the heart has been restarted[1]. You're absolutely correct that it's pointless to do it earlier, especially since the far more important thing is getting the heart beating again.

[1] This is known as "targeted temperature management" (TTM), and is part of the standard post-ROSC (return of spontaneous circulation) algorithm in ACLS (Advanced Cardiac Life Support), if you're looking for terms to Google.


the cold won't distribute at all ?


It will but much more slowly. Think of cooling the blood as using the surface area of the arteries and veins as a heat sink to cool the body. Without that blood moving your next best heat sink is the skin so start piling on the ice.


The body itself is the heat sink. The skin is a radiator. The blood is the liquid in a liquid cooling system (moving heat from the sink to the radiator). To your point, liquid cooling systems become _much_ less effective when the liquid stops pumping.


So I guess ice and cardiac massaging are synergic.


Sounds like a good way to introduce frostbite


Those spots are not prone to frostbite, since the "coldness" gets distributed through the rest of the body very quickly (apologies for playing a little fast and loose with thermodynamics there). This is why they're used in the first place to cool the person quickly.


I don't know the exact implications, but I'd probably rather have frostbite or even lose a limb than have serious permanent brain damage.


Can you talk about the problems involved?


>easily

seems like a bold claim to me.


What would be even easier is putting the whole hospital inside the ambulance then you don't have to actually take the patient anywhere.


You'd have to make it bigger on the inside.


I appreciate the sarcasm haha


The process is called "targeted temperature management" and it's pretty common in EMS protocols. It's a part of the standard cardiac arrest "algorithm".

https://acls-algorithms.com/post-cardiac-arrest-care/


> easily

Because creating a cooling system to use on a body with a central nervous system fighting to keep it warm is just like central HVAC.


> Because creating a cooling system to use on a body with a central nervous system fighting to keep it warm

And yet, something as simple as ice cold water seems to work fine for this. You can cool e.g. even a heatstroke victim pretty quickly, without worrying too much about internal thermoregulation.


> a central nervous system fighting to keep it warm

A heat stroke victim the body is fighting to cool itself and failing. You assist. That part is easy.

Getting the body to do the opposite of what you want is the hard part. ie. Cool down below basal body temperature, stop breathing to perform thoracic surgery.


There are a lot of trials involving prehospital cooling. Some groups focus on trying to cool the entire body by putting ice packs in areas of the body with lots of blood flow near the surface. Others focus on intranasal methods for cooling just the brain.

It's exciting stuff, but it's definitely not widespread.


Maybe the training of the emergency crew is not sufficient?


Why not improve the training?


Sure, I don't know, I was asking a question. Maybe the full medicine degree would be required for that? I have no idea, that's why I asked.


Some notes:

- The headline is clickbait/false really. The six-hour cardiac arrest is pretty much made up/guessed. In fact, they don't know how long she was in cardiac arrest. The article actually goes on to state "how long her heart stopped for is not clear", so it's a bit odd to say she had a six-hour cardiac arrest.

- The six hours timeframe actually refers to the fact that a defibrillator was used 6 hours after the emergency services were called.

- It mentions that doctors are stating it's the longest cardiac arrest ever recorded in Spain. This is a very odd thing for a professional doctor to do, when they have no evidence to back that up. As a doctor, you can't just guess she was in cardiac arrest for 6 hours and record it down as being what happend. That's misleading information.


Yep agreed they're going for sensationalism. I was in cardiac arrest for 191 minutes before they got me onto the ECMO machine which was standing in for my heart and lungs. Those times though are pretty accurate because my husband was in contact with friends and emergency services so they have a lot of data about it.


Username checks out (also congratulations on making it!)


Defibrillation doesn’t jump start a stopped heart, either - article is light on accuracy...


ECMO is an amazing technology that's often used in futile situations. I don't know who the ideal candidate is for it, but a young, fit, hypothermic cardiac arrest victim is pretty high up on the list


I don't know about ideal, but it saved my 6 day old son so yeah, "amazing" is totally warranted. Years later I sometimes take a look at some of the pictures we took (cameras would be forbidden in ICU soon after) and stare in awe.


ECMO saved my daughter when she was born. She wasn't breathing due to Severe Meconium Aspiration Syndrome. After they worked on her for 4 hours they gave up and medivaced her to a nearby hospital that happened to have 2 experts in ECMO in their pediatric NICU. She was on ECMO for ~10 days (fuzzy memory). The ordeal was heartbreaking, but the result was amazing. That was almost 7 years ago and she's a healthy and happy little girl now. ECMO is amazing.


This sounds like a great story - would you be willing to share it?


As a long time game developer, I have the desire to tell it in my medium. The story is still ongoing 5 years later, but unfortunately so is the struggle, so it is very rare to find the combination of spare time, energy, and confidence to go past drafts and ideas.


That's incredible! Are the pictures online anywhere?


No, we never shared them.


Rightly so, those are yours and yours alone, it doesn't get much more private than that.


I read somewhere "you are not dead until you're warm and dead". Data point in favor.


Correct. Hypothermia and drowning (particulartly in cold water) the patient is not pronounced dead until the body has been warmed, this can be 12+ hours after the event.

Children do better.

The mammalian diving reflex prepares the body for long periods of immersion. Not to be relied upon.

https://en.wikipedia.org/wiki/Diving_reflex


It is a true reflex I practice breath holds due to the fact that I spearfish, when I started I could hold my breath for about a minute out of water and less than 2 in water. Funny part is usually you second or third hold is the longest as your body due to the reflex tends to adapt to the higher CO2 levels in it, on the second and third breath hold. I can now hold my breath in water for over 5 minutes due to CO2 desensitization. The average person with training can hold for 8 minutes without loosing consciousness if they are calm and and resist the urge to breath. I have never tried to push past 5 as it leaves a decent window and 5 minutes is a really long time underwater. I can spend 2 minutes at 100 ft with a 5 minute breath hold. I am 45 and am in average to just slightly above average shape for a 45 year old.


Part of my divemaster training included free diving training.

While I hatted it, I experienced the same thing as you did: I could hold breath for a minute out of water and 2:08 underwater. There's the preparation, getting calm and relaxed, but there's also the diving reflex playing some part there and preparing your body for longer immersion.


How cold is the water? It has to be cold, right?


No the reflex does not depend on temperature. The immersion in water is what initiates the reflex. Though it is true that cooler water prolongs the reflex. I spearfish in the Caribbean so average water temps are 70s-80s.

It is the struggling and adrenaline that causes rapid loss of consciousnesses in water, as it rapidly depletes oxygen and works against the reflex. If one calms themselves and uses deliberate movement 5 minutes is achievable in 2-3 months of training in tropical waters, by an individual in average health.

When we spearfish we don't race to the bottom or rocket to the top, we use a lazy peddling motion to slowly decent and ascend. It helps in preservation of oxygen, once on bottom we usually hover in one spot, and try to remain still while almost meditating. We only move while actively hunting a particular fish once spotted. While the reflex is active your mind can work with the reflex to help it shut systems down and focus blood to the brain which is what it is doing. Each movement reactivates a system, eating before a dive activates a system, not using the restroom before a dive can leave a system active (though the reflex generally tries to shut that down by increasing the urge as soon as you enter the water, hence the have to pee when you get in the pool reflex).


Spear fishing sounds really nice. Too bad I am VERY afraid of sharks. Yes I saw Jaws when I was a kid.


When you have been in the water long enough sharks are a natural encounter. After a while they just become part of the landscape to you. They are attracted to the struggling fish and will try to bully you for your fish but rarely are you their main attraction. When you realize that they are a lot like dogs is when your attitude starts to change with about them being around. You realize if you stand your ground give them a nudge with your spear, they generally loose interest really quickly. They avoid fighting for or with their meal. They always say it is the shark that you don't see that will get you and it is true. As long as your keep them in your sight, and confront them they will loose interest. I am no more afraid of a shark nowadays than I am a dog. You give them respect but you stand firm. I have only ever been in one really hairy situation and that was with a persistent 14 ft Tiger shark. Long story short after several nudges with my spear, and it just circling back around, I used what we call a blowfish defense on it, where you ball up and as they are coming in you stretch out your body, arms and legs quickly. That was enough to startle it and cause it to loose interest. That was the first and last time I have ever had to blowfish, All of the rest where easily persuaded that I was going to fight for my meal.


There was just a case in Norway with what looks like a mom drowning herself and her 3 children. The mom and the eldest expired, while the two youngest were brought up and are in critical condition but alive.


Unfortunately the 4 year old is also dead now. :-(


And while it is a grotesque example, it further supports the idea that the younger the child the higher chance of surviving hypothermia.


Your comment reminded me of this:

https://en.wikipedia.org/wiki/Anna_Bågenholm

The electrocardiogram connected to her showed no signs of life,[2] but Gilbert knew patients should be "warmed up before you declare them dead".[25]



When I began volunteer firefighting, curiosity led me to research the longest known CPR survival cases. Here are a few more rare and incredible tales:

https://web.archive.org/web/20191206164443/http://www.leapbe...

If you've never taken a CPR course, sign up for one! It could save a life one day.


Reminds me about a quote I heard, don't remember where, about Napoleons main medic.

Apparently he noticed that equally injured soldiers would die at different times based upon how close they were to the camp fire with those closest expiring way before those laid out the farthest from the fire.

Could be a bs story, I never actually looked into it.


So then he had badly injured soldiers sit really close to the fire?


Does this suggest that humans can be put into 'hibernation' to extend their lifespan? (Edit: I mean would be possible in future if we had a better understanding of the process?)

If I was rich enough I'd host a competition to extend the life of rats: Each year, whoever could demonstrate a technique to reliably extend the lifespan of a rat by at least 10% over the previous year's record would win a million dollars. I expect that the wining entry would involve putting the rats into controlled hypothermia.

Over the years the maximum lifespan will grow and we may even find that we can put rats into hibernation indefinitely. It would then be a question of whether we can apply the same techniques to humans.


> If I was rich enough I'd host a competition to extend the life of rats: Each year, whoever could demonstrate a technique to reliably extend the lifespan of a rat by at least 10% over the previous year's record would win a million dollars.

Something quite close to this is being done for mice. The Methuselah Foundation awards cash prizes for (1) 'the longest-living mouse' and (2) the longest-living 'rejuvenated' mouse, i.e. you have to design a treatment that works for 'old' mice, extending their life as much as possible.


Interesting - thanks. But it seems to be focused on active lifespan so maybe they would view hybernation as cheating.

Here's an article about Aubrey de Grey, the guy behind the Methuselah Foundation award: https://thenextweb.com/contributors/2018/09/19/aubrey-de-gre...


It mostly suggests that one person got very lucky and that there are likely important details that made the difference between 'dead' and 'mostly dead'.

Hypothermia due to a low environmental temperature has already been flagged as the way to come out of various otherwise fatal situations in more or less one piece. Besides that, even if no pulse can be detected that doesn't mean there isn't a pulse, and that can make all the difference just by itself.


Sure, but given enough effort perhaps we can figure out what the important details are that make the difference between 'dead' and 'mostly dead'?


There are no secrets here:

https://www.bbc.com/news/health-11389464

Just the fantasy of the life-extenders that if they figure out this one weird thing they will live forever. The body can be temporarily suspended, depending on the complexity of the creature this can be a very long time, frogs for instance can do it for weeks or even months.

https://www.latimes.com/science/sciencenow/la-sci-sn-alaskan...

The big differentiator is whether or not the water in the cells has crystallized or not, if it does it will rupture the cells and then it is game over no matter what. Other than that it is mostly a roulette game with very high stakes.

There are lots of papers on frost damage to cells, too many to list here but easily searchable.


"Does this suggest that humans can be put into 'hibernation' to extend their lifespan?"

Basically, no. Not that we know of yet anyway. This is more of a 'stars aligning' story and her being lucky not to have the bad side effects of her situation. The bad side effects happen more times than not in this sort of thing. Death or brain damage.


> demonstrate a technique to reliably extend the lifespan of a rat by at least 10%

you'd get more from calorie restriction.


Surely calorie restrictions been done with rats, so you're going to need a novel 10% improvement.


Related:

https://www.iflscience.com/health-and-medicine/child-survive...

There are a few such known examples, also some that looked good for a while but ended with a tragedy as much as a day later. I can see some parallels with the drowning case due to the hypothermia, the onset of which must have been relatively fast.



I occasionally run into people that want to deter even thinking about the idea of life saving options because of the universe/god’s plan

I met the most spiritual woman who was also in a crusade against Abrahamic religions say that

What a completely unfalsifiable version of logic when the “plan” could just as easily be the treatment

I got through the impasse by saying it just gives people choices even if the choice is already written in stone

Schrodinger’s free will


On the other hand, cooling people after return of spontaneous circulation (ROSC) does NOT seem to help in any clinically significant way:

https://www.ncbi.nlm.nih.gov/pubmed/31778636


I'm very proud of Spanish healthcare at this moment. We have a terrific team here.

Another recent example of one of our rock star doctors involving the successful reattachment of a severed hand without blood flow for 10 hours.

https://www.thinkspain.com/news-spain/30483/super-surgeon-dr...


A fascinating book to read is "King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery" by G. Wayne Miller.

Early open heart surgery was pioneered with TWO patients whose circulatory systems were connected together so that patient two could could breathe and pump blood for patient one while the heart was stopped.

Amazing (in a sort of blank-faced-blink-blink sort of way)


This article is all flash with little substance. They used a "specialized machine" and never once named it. As others have mentioned this sounds exactly like ecmo. Its obvious to me that they are really simplifying the situation for their readers.


Outside has a good narrative of hypothermia. https://www.outsideonline.com/2152131/freezing-death


So, I still don't know if you are irreversibly dead if your brain stops all activity.

I.e. is the state of your brain preserved just by the connections of the neurons? Or is the "RAM" also critical?


Lightning strikes don't wipe people's personalities. Also during epileptic seizures people's neurons fire in abnormal ways, but then return to normal afterwards. So I'd say that the RAM isn't critical; humans can boot from disk.


> humans can boot from disk

wow, this is so intriguing. i like this analogy even if i don't know how accurate it is.

we indeed have things that we forget (running out of space?) and things that take time to remember (disk latency).


We also probably have things that we forget/block/deny but are still there somewhere underneath, reachable only if we are put in the correct psychological conditions.

Like how deleting files doesn't properly wipe out the bits and with the right tools you can still recover deleted info.


Forgetting things is more like a lost pointer.


> humans can boot from disk

Now I want to read a sci-fi book with this sentence in it.


Alter Carbon:

A key concept in Netflix's cyberpunk series Altered Carbon is the 'stack', an advanced hard drive installed on the brainstem on which a person can save a copy of their consciousness. The main effect of stack technology is a form of immortality, because a stack can be installed into another body if the original body dies. But there’s another a major implication only hinted at during the first season of Altered Carbon: If you could choose your own body, would you go with the one you were born with? That's an especially important question for gender fluid or transgender people. The topic was only hinted at in the first season, but Altered Carbon creator Laeta Kalogridis told The Wrap it's something she would like to explore in greater detail.

https://en.wikipedia.org/wiki/Altered_Carbon_(TV_series)#The...


I would also be curious about the impact of the divergence of branches. Like in git forks or branches diverging

This would be the perfect research testbed for human psychology and intelligence. Do something, compare with exact but unmodified state.


ECT is notorious for "wiping" the last ~6 months of memories from patients that undergo that type of treatment.


There are some documentations of incarnation and related phenomenon, ranging from anecdotal to quite convincing. So I'd say that the disk might not be critical; humans maybe can boot from network.


Irreversible brain damage or death occurs when the brain is not getting enough oxygen.

If the brain continues its metabolism without oxygen it induces neuronal cell death.

The mechanism is called anoxic depolarization. Sodium–potassium pumps in the cell walls need to work to maintain K+ and Na+ ion gradient. When the pump runs out of energy it causes glutamate and aspartate concentrations inside the cell grow. When they grow past some critical threshold, it starts programmed cell death.

Cooling he body and brain can prevent this when the brain metabolism slows down to match the lower oxygen levels.


Electrocuting the brain like in electroshock therapy most likely wipes any electrical activity. That seems to indicate that the brain is able to recover after such an event.


>Or is the "RAM" also critical?

There are cases of people without short term memory. That to me qualifies as RAM, guess its not critical to survival.


Short term memory is more akin to cache.

The connections between the neurons is the architecture. The neurons themselves have state. If that state is wiped across the brain, I'd be surprised if the body connected to it could even still keep itself alive.

To the actual question though, neurons die/fail very quickly at their normal metabolic rate without an oxygen supply. You are certainly dead once that happens.

These procedures are all about providing some oxygen and dropping the metabolic rate to keep the neurons alive longer than they would unassisted.


What leads to brain damage, as I understand it, is lack of oxygen like all other organs and hypothermia reduces your brain activity and its consumption of oxygen but I always interpreted brain activity as an indicator of oxygen consumption and not as something that'd have a cause-effect relationship with brain damage.


Here is an interesting review of the definitions of death: https://academic.oup.com/jlb/article/3/3/743/2327864


When your brain doesn't get oxygen it will die. See https://en.wikipedia.org/wiki/Cerebral_hypoxia


It's more then that in this case. She had not vital signs at all, heart not beating and providing oxygen included.


The brain was provided oxygen, just not by her heart.


Also, perhaps during such a cold state more cells are able to stay alive despite having less oxygen to work with? Maybe due to a reduction in how much energy they use or need per unit time? Just speculating.


Cell death is a metabolic process and it can be arrested if overall metabolism is arrested, as well.


It's important to note that she had no 'detectable' vital signs. Not that she didn't have any vital signs.

Very important difference.


As someone who was once an NREMT-B in the US, we were taught that someone isn't dead, until they're cold dead. I haven't read the article yet, but I assume they kept her warm.


Not sure about that. People whose heart and lungs have stopped may survive longer if they're cold. At least that's what I heard relating to a case of a boy who was revived after spending a long time under the ice of a frozen lake/river.


You're absolutely right and I corrected myself with a comment. I don't know why but I can't delete my original comment nor can I edit it.


I lost the ability to edit my comments. I meant to say warm dead...not cold.


Exactly the opposite. You want to keep someone cold until their brain has had a chance to recover.


You're right. I corrected myself with a comment because I cannot edit my original post.

That will teach me to make comments before the caffeine has kicked in.


Many Tier 1 regional trauma centers now have the equipment to induce hypothermia on hand. Hopefully, this will become standard gear in all trauma departments


Good job it wasn't in america, she'd have woken up, seen the bill, and had another heart attack!


"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents."

https://news.ycombinator.com/newsguidelines.html

HN has had countless generic arguments about the US health care system. Turning a thread about something else into one of those is a step in the wrong direction. The major controversies eat up all the smaller topics, but the smaller topics are what actually gratify curiosity.


This is a great joke but I feel I should point out that cardiac arrests != heart attacks


Wasn't a joke.

I went to the US on business - our corporate insurance means there's a $1000 excess that we pay up front.

Went to a hospital for a minor issue. At no point was there any price list shown, at the end I was asked for $390 before been given my prescription. That was the end of it I thought, sickeningly high charge for 2 minutes with a doctor, a 10p tablet, and hours of waiting around. I asked for an itemised bill, but they couldn't give me one.

A few weeks later I get another bill through the post for another $390 (slightly different amount), complete with the entire bill. The whole bill was about $2k. The 10p tablet? $250. In fact they originally gave me a 50mg one for $9, then took it off the bill, then gave me 2x25mg ones for $250. I then had a $1100 "uninsured discount" which brought the total price down to just before $800.

The bulk of the bill was a single line that was fairly incomprehensible but seemed to cover pointless taking my blood pressure 3 times and the 2 minute consultation with a Doctor who barely spoke to me, and renting the chair for a few hours I guess.

edit: see http://imgur.com/ERjjQBil.png

The U.S. is seriously broken.


In the US, patients should go to urgent care for minor health issues that are unlikely to require a fully outfitted trauma and surgical unit. Conveniently, they’re also much easier to get to in urban areas.

Urgent care would have had something closer to a $100 markup than $2,000, because you’re only paying for a few nurses and doctors to be on call, not for having used the resources that are meant for trauma and acute crises.

That hospitals are required make up fictitious itemized explanations for their very real costs is indeed broken, but it’s a very small part of the overall issue.

If you called the hospital billing department and offered 20% of the overall bill, they would likely have immediately accepted; uninsured hospital billing has expected value on the order of 10% of outstanding balances, so if you give them more than they can get from sending you to collections, they’re usually happy to compromise much more steeply than the 60% “discount” they offered you.


You mean how the Bay Area, which is fairly urban, has precious few urgent care clinics open until 10 pm and, I believe, literally none open after 10pm? I went to one of these urgent care clinics once and got charged $650 for about 5 minutes of doctor time and a single DermaBond stick. The latter costs something like $20.

Oh yeah, I asked how much I would be charged before the doc saw me and they refused to answer.

$100 markup my arse.


In LA, Hispanic neighborhoods have 24 hour urgent cares but the doctor quality is all over the place though usually bad.

Urgent cares used to be pretty upfront. I went to an urgent care a couple of years ago, $99 advertised in the window. I go in, fill out all the paperwork and they tell me it's going to be $150. When I point to the window, she says it's expired. I start to walk out and she tells me to come back and gives me price. This is not the only time I've had to walk out over various health things, it's ridiculous. They think you won't do it because you're ill and act that getting angry over this is some sort of insane response. So now I just pretend not to have the extra money.

Anyway, I use Heal now. So happy that the VCs are funding this, hope it lasts.


You went to the doctor for a bandaid? Seriously? Could you not apply said bandaid yourself? Why would you waste a doctors time and your money for that?


I don't like the tone of your comment at all. It's very well possible for a person to end up in the hospital where the right treatment is to 'stick a bandaid on' on one end of the treatment spectrum and a much more invasive or complex procedure on the other when going in with roughly the same symptoms.

For instance, if you work a lot with tools and dirt then there is a fine line between blood poisoning and a mere scratch, they will both start out the same but you won't be able to tell what's in your bloodstream until it is too late if you're going by symptoms alone. By the time the choice is amputation above or below the knee or you've gone into septic shock you've lost the window where you might have been ok. More people die from this stuff than from heart attacks or strokes.

So in some cases, when the exact contaminant is not known it can be a good decision to go to the hospital to have something looked at, and it shouldn't cost an arm and a leg (pun unfortunately not intended) to do so.

Nobody goes to the hospital for fun except for a very few individuals that have something wrong with their heads rather than with their bodies, and that's before we get into things like people with compromised immune systems.


DermaBond is not a bandaid. I personally did not have a container of sterile saline, a pack of sterile gauze, a DermaBond cartridge, and the expertise to evaluate exactly what was needed.

And yes, I have bandaids.


Agreed and the real costs support major bloat. A friend of a friend who's previous job was a phone salesperson for a small, local sign shop got a job in the sales department for hospital software. Within months she was being flown across the country to the companies headquarters monthly and traveling around selling a product she clearly had no understanding of but was following the pitch which was taught to her. Not that she isn't a great person, but I cannot think of another industry where I've seen so many resources going to an entry level, zero experience position that could be handled locally or even remotely rather than sending this person out and paying for nicer hotel rooms than my friend who is a major airline captain stays in.


Outside of large cities, urgent care facilities operate on the standard 9-5 and are very selective when it comes to which insurance plans they take.

It's entirely possible that you're insured, but no facility within an hour's drive will take your plan, and if your kid becomes ill outside of business hours, tough luck. For liability reasons, they'll refer you to the ER anyway if you have symptoms beyond a sore throat.

The last time I had to go to an urgent care clinic in a state where no one took my insurance plan, I had to pay $700 out of pocket to talk with a doctor for 10 minutes and get prescribed a z-pack. I then paid $90 for 6 pills at the pharmacy.


In theory urgent care would be useful, but for anything non-obvious you have to go to ER. Abdominal pain? ER. Head injury? Dislocation requiring pain management? ER.

Urgent care can get you antibiotics and test for strep, and I think x-ray and set simple fractures, and stitches of course. What else is within their scope, I find it fairly limited.


> In the US, patients should go to urgent care for minor health issues that are unlikely to require a fully outfitted trauma and surgical unit

Just looked up the one near to my hotel. Closes 6PM. Not much use at 2330.


If your symptoms are acute enough that you really can’t wait until the morning, then yes, you’re going to pay for access to round the clock in person medical professionals in the US.


Irrational yes. Broken, no just optimized differently than other systems. The system is optimized to serve those who can afford it and those who are very poor and get it for free, but not those in between. It is optimized to generate profit, but also new treatments. Rich people from all over the world come here for surgery and treatment.

The pricing system is intentionally designed to be opaque so that everyone except the consumer benefits. It is not uncommon for a top surgeon to make 500-750K per year, nurses are paid well above the median and can make over 100K with overtime, hospital administrators, insurance companies... the way pricing and billing is handled protects all those interests.

Sounds like something you would want to fix, right? Well that too is complicated. Healthcare is one of the only sectors that is growing middle class jobs. A hospital is one of the only places someone with an associates degree and a certification can make 60K per year.

Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.

Start socializing medicine and all that job growth and opportunity disappears.

It is a tough problem to solve. The utter irrationality of it used to drive me nuts and still does sometimes, but I prefer it to the alternatives.


> Start socializing medicine and all that job growth and opportunity disappears.

Pegging growth to systemic inefficiency is monumentally stupid.

This is only a few steps of abstraction away from simply paying those nurses to dig holes then fill them back up, macroeconomically.


Growth occurs organically in a market system. It does not in a socialized system. I was not associating growth with inefficiency - I was associating high pay with it.


The premise of your argument falls apart if you really think about it for a minute. Switching to a single-payer model doesn't mean healthcare jobs disappear. It would kill off the insurance companies, but it would not reduce the demand for skilled healthcare workers. It seems like you are arguing that 'socializing' medicine requires that we get rid of hospitals entirely. We could still have for-profit hospitals if we drastically reduced the size of the private insurance market.

I feel like you are making a lot of assumptions about how we would fix our health care system that are unfounded.


No socialized system pays what our system pays.


Just because the industry is good at generating revenue doesn't necessarily mean that the quality of service is any better. Do you have some data to back up your claim that medical services in the United States are world leading? Are they better than what one would receive in Europe or Japan or South Korea?

Personally, I think it's unethical to keep a process inefficient even if the inefficiencies are profitable. And healthcare in the states is anything but cost-efficient.


About 5 years ago I took a health care policy class and we looked into this. In terms of outcomes, the U.S. was thoroughly mediocre, except for breast cancer and diabetes, where we were at the head of the pack (in terms of treatment) but not, say, better by a multiple.

The fact that the US has many leading medical research institutions is often abused to argue that we have the best care, but it's largely irrelevant for the overwhelming majority of delivered care and even more irrelevant for outcomes.


As I said it’s optimized differently.


> Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.

Is this supposed to be a good argument to drive desperate people into bankruptcy?


It's not a good argument, but if you want to defend the indefensible, your options are limited.


Did I ever argue against improving the system or imply these bankruptcies should happen? I just said I’d take this system over alternatives not that it couldn’t be improved.


> originally gave me a 50mg one for $9, then took it off the bill, then gave me 2x25mg ones for $250.

That sounds like straight up fraud. What the hell.


I get the point, but that's a joke. She didn't wake up and see a bill. You don't get the full blown, by the way, the anesthesiologist actually charges $20k+ for less than an hour of care bill, until a few weeks later.


Wow, that's a huge discount! Great deal! /s


One of the reasons why I don't go to the USA anymore. Past 50 the chances of something medical popping up are higher than they were in the past and I just can't afford worrying about this. The total list of why I don't go there anymore is much longer but this is definitely one item on the list. This sucks because I have more friends in the USA than I do anywhere else and I miss them.


That shouldn't stop you. Comprehensive travel insurance can be had for short and long trips for $50 - $150. Prices for US travel insurance are around the same as insurance for visiting other developed countries such as Japan or Switzerland. All the terms are clearly spelled out.

https://www.lonelyplanet.com/travel-insurance


Indeed.

Survival rates:

- Cardiac arrest (outside hospitals): < 6%

- Cardiac arrest (inside hospitals): < 25%

- Heart attack (myocardial infarction): > 90%


Yup, makes sense because although the phrase "heart attack" generally has a worse connotation, the immediate reality of a full cardiac arrest is actually much worse - the entire heart stops instead of only part of it.

"In summary, there is a difference between a heart attack and a cardiac arrest. A heart attack occurs when the blood supply to part of the heart stops and thus causes a section of the heart muscle to begin to die; whereas a cardiac arrest occurs when the heart stops beating as a whole.Jun 25, 2019" [1] https://www.news-medical.net/health/Heart-attack-and-cardiac...


Gah the word "infarction" drives me crazy since it's so close to "infraction"


This is actually what happens, seen some articles pass by where people simply could not live with the burden.


My at the time 8mo daughter was in the ER for breathing issues and had to be life-flighted to a hospital with better facilities to treat her condition. I'm thankful my insurance covered it, because the initial bill was $27,000 for the flight (excluding the hospital and ER visit costs).


Hope your daughter is doing better!


She's on a daily breathing treatment (and extra medicine and monitoring when she gets sick), but she is much better, thanks!


[flagged]


Source on your knowledge of OP’s child’s birth?


The leading cause of death among women before modern medicine was childbirth. Childbirth without medical care is incredibly dangerous.


My son would be dead if was delivered at home.


What you are saying shows terrible and dangerous ignorance. I really hope you are not a vaccine denier as well. At max you could say his complications were RECOGNIZED as such because he was at the hospital. Otherwise, by laymen, they might have gone undetected.

PS. I am a physician.


How did her brain survive with seemingly no oxygen being replenished thru circulation?


If you read the article, she was hiking in a snowy area and they believe hypothermia helped preserve her while her heart was stopped


>Audrey Schoeman developed severe hypothermia when she was caught in a snowstorm while hiking in the Spanish Pyrenees with her husband in November.


By being cold.




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