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Lazarus Long Profile picture
@LazarusLong13
Nov 12, 2021 • 16 tweets • 9 min read • Read on X
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A thread on ambulance ventilation.

And why you are going to see more staffing EMS staffing shortages - resulting in you laying forever next to your wrecked car.

Waiting to be picked up by CoVid+ EMT's in surgical masks.
Study is here - click the PDF button....or just ride along in this clown car.
researchgate.net/publication/33…

Looks like in the USA, there are no standards for ventilation in ambulances.

Used to be 30 ACH..which would be amazing.
In the UK, they recommend not using the recirculating air during AGP's, during pandemics.

assets.publishing.service.gov.uk/government/upl…

Currently, surgical masks as long as within 6 feet of the CoVid+. No recirculating.
gov.uk/government/pub…

All based on WHO guidance. (Foreshadow.)
The default ventilation of the ambulance is 5 ACH, IF the exhaust blower was on.

They replaced the default ventilation tho with the below HEPA filter, so they could get accurate measurements, avoiding external aerosols, and reset quickly.

Quite clever.
americanlaboratorytrading.com/lab-equipment-…
Here's the rest:

"For each test, four optical particle counters
(OPCs) were placed in locations representing possible positions for a seated EMS worker treating the
patient. OPCs were placed in the positions labeled OPC 1-4 when the cot was at 0° or 30°, and positions ..."
Before going on, let's touch on the 5 ACH that all of you will be hit with in surgical masks.

Even with surgical masks on, we have certainly seen a huge number of outbreaks in hospitals with 6 ACH (better) ventilation
and continuous surgical masking.

For example, Alberta Health Services, @AHS_media, which is the embodiment of the @WHO's IPC guidance.

Stands to reason as Dr. Conly rules over AHS AND the WHO with a very clean fist.

Back to our clown car, Lindsley (yep, the famous one) found that a single cough resulted at least some worker exposure.

Given that Delta is everywhere, and we now know it takes under 3 virii to successfully infect?

Not good.

Might not be a bad idea to buy a @FixTheMask brace
in case you have to go to the hospital or even ride in an ambulance.

Or make the 3 rubber band version and keep it in your wallet or purse:


Why would there still be exposure?

"Air circulation pattern in the ambulance patient compartment generated by...
the ventilation
system. The jet of air created by the air inlet causes a clockwise recirculation pattern to form which
circulates aerosol particles throughout the compartment. Even if the cough is directed toward the rear
of the ambulance, aerosol particles are carried
toward the front by the recirculation. Thus, a worker
anywhere in the ambulance is exposed to the cough aerosol particles."

Thus, you will be exposed to the same.

But does it have to be this way?

No. Or I should say, N100.

The same solution as in this thread that was
slightly viral about 25 years of no infection in the Texas TB hospital:


And the same solution being used today by NYC's EMS:
nydailynews.com/new-york/ny-fd…
But the story does not end there.
Did you know that someone tried putting a HEPA filter into an ambulance?

cdc.gov/niosh/hhe/repo…

"The effective
air change rates ranged from about 43 to 46 ACH in
the HEPA ambulance, and from 26 to 32 ACH in the
non–HEPA ambulance."

This provides further proof that
portable air cleaners such as the Corsi/Rosenthal Box are additive to any current air cleaning infrastructure.

And...they help remove aerosols much faster.

The message is the same because this is NOT rocket science.

Vax.
N100.
HEPA if you can afford it.
CR Box if you can't
A very cool simulation model study confirming what Dr. Noakes shared below. Thank you!

1 - An ambulance transport with a patient actively emitting a virus.
2 - A subsequent transport with an uninfected patient <- very interesting setup here.

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More from @LazarusLong13

Lazarus Long Profile picture
Jun 10
Please explain how a study measuring physical improvement in a Cognitive and Behavioral study can have unmeasured Graded Exercise Therapy - and be considered as well-controlled. Not confounded.

So, I emailed Dr. Ebell and asked how that was nitpicking. Image
Image
I also agreed with the comments at the bottom of the study, linked below.

If you change analysis protocols post hoc? That's not nitpicking in my book. But maybe that is nitpicking?

jamanetwork.com/journals/jaman…
Science is ALL about nitpicking. You ARE SUPPOSED to be very detailed, so you can be replicated, right? Alan is funny.

Anyway, amusing to spot the lobbying group for the Lightning Process on their advisory board.

Tch tch. Or is that nitpicking. ;) ? Image
Read 7 tweets
Lazarus Long Profile picture
Jun 1
A thread on airborne Ebola - the rest is accurate.

Let me emphasize that I agree far more than disagree with her, in general.

Declaring a thing debunked without actually debunking it, with facts, is not debunking.

So, let me debunk this. Image
Dr. Kuppila has excellent credentials, and has earned her laurels.

If we accepted the debunking of airborne Ebola on the basis of credentials, we would have given into the fallacy of appeal to authority.

:) not today.

She worked in an Ebola Treatment Unit in Sierra Leone,
coming back in December 2014, and now resides in Dallas per her very interesting StatNews article:



She did not get infected. We could have survivorship bias here - fortunately.

This is a reference to possible surgical mask usage by her.

You see, the web.archive.org/web/2026052103…Image
Read 22 tweets
Lazarus Long Profile picture
May 28
Ebola - it's not all about respiratory aerosols.

DYK that you, and me, and everybody are Pig Pen from Charlie Brown?

We shed our entire outer layer of skin every 2-4 weeks, about 500 million cells daily.

Your corneocytes (outermost cells) lift off of your body with the
gentlest of micro-air currents. Like a leaf picked up off the ground for the briefest of moments in fall.

They act like 12 micron aerosols in float time, but 25% of total skin flakes are sub 5 microns...and you know what that means. Deep deposition - or shallow as
sub 5 likes to also deposit in the nose.

It's funny...I embrace push-back in debate. Tightens up my game.

Imagine if those skin flakes now have Ebola on them?

Two studies show that Ebola literally oozes through the skin - both ways. In and out.

Not shown in vivo, but
Read 10 tweets
Lazarus Long Profile picture
May 23
The WHO forbids contact tracers from masking or gloving up.

"Do not conduct home visits wearing personal protective equipment like masks, gloves, or
gowns."

It gets worse. Do not conduct home visits wearing personal protective equipment like masks, gloves, or gowns.
They have a handy how to reduce risk of catching ebola at home.

It even has 5 masks listed on it.

But not for the other family members.

"7. If the patient has vomit, diarrhoea or bleeding, a mask or a dry towel wrapped around the face can be used to protect the nose and mouth Image
7. If the patient has vomit, diarrhoea or bleeding, a mask or a dry towel wrapped around the face can be used to protect the nose and mouth when touching the patient or items soiled with blood or body fluids. A waterproof gown, eye protection, gloves and rubber boots should also be worn in these circumstances.
Here are the 5 face masks. Image
Read 9 tweets
Lazarus Long Profile picture
May 22
The "epidemiology" of Ebola tells us that it's not airborne. You've heard this over and over.

What drives it? The questions on the contact tracing form.

Quick 🧵. Image
COVID - the WHO and CDC said it wasn't airborne via aerosols, right?

The CDC said it was spread person to person via close contact - within about 6 feet.



And you remember it took FOREVER to get changed.

The contact tracing form was web.archive.org/web/2020032817…Image
Image
arranged around close contact. These are the questions driving the stats of how many and how are infected.



So, the CDC will only hear back what it's asking. This was the epidemiology of COVID - until it wasn't. web.archive.org/web/2020052514…Image
Read 16 tweets
Lazarus Long Profile picture
May 20
Speaking of silly, can we agree that the WHO has Ebola experts?

Let's talk about PPE, and a bias towards "less PPE is better." Image
The WHO EBOLA IPC guidance:


Foreshadow on PPE

"...due to the desirability of an off-
the-face design, and not for protection from aerosols, respirators may be used instead of medical masks"who.int/publications/i…
If you can stay 3 feet away while screening? No medical mask needed. Image
Image
Read 12 tweets

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