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1/Somebody needs to start caring about poor urban & rural hospitals. If you think that we have top world medicine in this country then you r blind. While top hospitals get a lot of resources, smaller hospitals practice third world country level medicine in the pandemic
2/In many small hospitals there are no critical care, nephrology, gastroenterology docs on staff. There ER docs, hospitalists & maybe cardiology (real story). Hospitalists have to practice outside of their scope & they learn on the go.
3/These hospitals used to tranafer critical patients to bigger centers. But bigger centers do not accept transfers. I keep getting texts from my hospitalists friends who r frustrated. They call bigger hospitals for transfers but pts dont get accepted. And more are waiting in ERs.
4/Even if hospitalists can handle the critical situations, they need critical care nurses, respiratory therapists, all other ancillary support. We need to help these docs & these hospitals to care for patients.
5/Media outlets keep inviting top hospital docs for their opinions. Instead should be calling ppl that work in poor resource places - ER docs, hospitalists that function as ICU+nephro+GI, nurses who r forced to do critical care, RTs.
6/These are the data:
30% of rural communities have no ICU beds (Penn data)
48% ICUs do not have intensivists (SCCM report)
death rate is 
x3 in hospitals w <50 ICU beds (JAMA)
30% of rural communities have no ICU beds (Penn data)48% ICUs do not have intensivists (SCCM report)death rate is x3 in hospitals w <50 ICU beds (JAMA)
7/In low resources hospitals we cant even talk about meticulous vent management, proning, other evidence based interventions. Those are not possible without trained staff. I have seen a struggle when non ICU nurses didnt know how to use feeding pumps, infusion pumps.
