Your town has more than enough ventilators if you know where to find them. Tens to hundreds of vents are sitting in almost every neighborhood in America, but are being utilized incorrectly. Throughout the nation, there are facilities known as LTACs, which stands for long term acute care facility. These facilities are utilized for a broad array of patient care, but almost everyone falls into three categories: the first patient is someone who requires a long term ICU stay. These patients will usually recover, but they may require 30 to 120 days on a ventilator.
The second and third patients are where our resources are being wasted. The second patient is someone who has had a stroke or another catastrophic injury and has not woken up in months. The family adamantly refuses to turn off the ventilator, even though their loved one is deceased by any objective measure, due to religious reasons. The third patient had the same type of catastrophic injury but now remains hopelessly on a ventilator because their family has a dispute on disconnecting the vent, and the patient had no advanced directive or living will. The family cannot decide what to do, so their loved one just wastes away in an LTAC. All across America, there are people who are 78 years old, had a stroke four years ago and have remained on a vent in an LTAC for three years, five years, or even longer.
It is important to highlight these LTACs for two main reasons. First off, if you have a family member who has been unresponsive on a vent for years or even decades, now is the time to turn the vent off. I am genuinely sorry that you will have to let your loved one go, however in the coming weeks, a 16 year old who vapes is going to need that vent just to survive. They may have decades of fruitful life ahead of them, so please think about them. You have the power to make a life-saving resource immediately available.
Second, most government officials have no idea how many Medicare dollars are spent in these facilities each year and how easy it would be to convert them to COVID-19 battlegrounds. Our government officials should seriously entertain placing a limit on how long LTACs can keep a person unresponsive. We needn’t be cruel; we can pick an absurdly long period of time, be it 90 days or even 180 (even though after 14 days if you do not respond, your likelihood of doing so is essentially zero). At some point, the government should force the vent to be turned off. We are going to need these vents in April. They are just sitting and being wasted in LTACs all across the nation. They are already in your town, and they could be altered to actually save lives. This may seem unfair, but in the coming weeks, we are going to have to choose between the 78-year-old unresponsive stroke patient and the previously healthy 16-year-old kid.
Ian M. Kahane is an internal medicine physician.
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