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Link Posted: 1/26/2014 5:23:41 AM EDT
The hospitals here are all seeing big increases in ED traffic. Our run volume is going up, the EMS agency is going way up. They're at over 7k calls this year already. It's only gonna get worse.
Link Posted: 1/26/2014 5:24:52 AM EDT
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Originally Posted By Dan_Gray:
The hospitals here are all seeing big increases in ED traffic. Our run volume is going up, the EMS agency is going way up. They're at over 7k calls this year already. It's only gonna get worse.
View Quote

Thanks Obamacare!



Link Posted: 1/26/2014 5:24:55 AM EDT
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Originally Posted By Justice23:
Is a rash something you go to the ER for? It's not for me.

How about your primary care physician?

I wonder what the Cause of death was.

Posted Via AR15.Com Mobile
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In some cases, yes, you haul your ass to the ER RFN.
Link Posted: 1/26/2014 5:28:46 AM EDT


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Originally Posted By billyjoebob:





You talk real purdy
View Quote








 
 
Link Posted: 1/26/2014 5:29:34 AM EDT
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Originally Posted By fxntime:


"I have a rash" is pretty low priority in an ER room. "I can't breathe" tend to work better.

Now, ask yourself how many people in that ER had true life threatening problems and how many were there to try to score drugs, free minor medical care, or were just to stupid, cheap, or lazy to go to a urgent care facility for non life threatening problems.

Every time I have walked into an ER, I'd say maybe 1 in 10 people  had an issue where an ER visit was the correct thing to do, the rest had absolutely no immediate or urgent medical reason that couldn't be treated by a plain Dr office.
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Originally Posted By fxntime:
Originally Posted By TheRX7Project:
Originally Posted By skid2041:
Would have died anyways in a third world country. Good thing there was at least a hospital. Wonder if there is more to the story? Probably.

LOLWUT?

What good is a hospital if they don't even make an attempt at fixing you up? I can die in a chair sitting at home, no need to go to the hospital for that.


"I have a rash" is pretty low priority in an ER room. "I can't breathe" tend to work better.

Now, ask yourself how many people in that ER had true life threatening problems and how many were there to try to score drugs, free minor medical care, or were just to stupid, cheap, or lazy to go to a urgent care facility for non life threatening problems.

Every time I have walked into an ER, I'd say maybe 1 in 10 people  had an issue where an ER visit was the correct thing to do, the rest had absolutely no immediate or urgent medical reason that couldn't be treated by a plain Dr office.


Yes, but they have to pay for a Drs. visit.
Link Posted: 1/26/2014 5:30:51 AM EDT
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Originally Posted By Justice23:
Is a rash something you go to the ER for? It's not for me.

How about your primary care physician?

I wonder what the Cause of death was.

Posted Via AR15.Com Mobile
View Quote


Depends on the rash - purpuric rash, hell yes.
Link Posted: 1/26/2014 5:34:45 AM EDT
So if I'm reading ARF correctly on this, it's probably better that the hospital didn't get around to him based on his looks?
Link Posted: 1/26/2014 5:38:35 AM EDT
From the looks of him, I can't seem to find a fuck to give
Link Posted: 1/26/2014 5:38:58 AM EDT
Last 2 times I went to the ER I had to get 15 stitches in my chin and had to do some ungodly things.  

Both were admitted quickely and left as soon as I could sign my name releasing me.  Might have helped that they were 3 years ago.
Link Posted: 1/26/2014 5:42:01 AM EDT
[Last Edit: 1/26/2014 5:44:51 AM EDT by Medicfrost]
The ER I work is over 50 beds, and we are still loading patients up and down the hallway cause we are so inundated with crap like abdominal pain x 2 years and "my finger feels funny", while chest pains sit in the lobby untreated because the current system allows for it.

Ambulance abuse plays a huge role in it also.
Link Posted: 1/26/2014 5:43:28 AM EDT
Link Posted: 1/26/2014 5:45:45 AM EDT
Something tells me the rash was only a symptom of a much more serious problem.





The big question is,  is this malpractice through failure to give care when needed?



Somewhere, a lawyer is asking that question and he's getting a stiffy over it.
Link Posted: 1/26/2014 5:47:22 AM EDT
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Originally Posted By skid2041:
Would have died anyways in a third world country. Good thing there was at least a hospital. Wonder if there is more to the story? Probably.
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That needs to be our country's new motto. "America - Better than almost any third world country."
Link Posted: 1/26/2014 5:49:18 AM EDT
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Originally Posted By cmjohnson:
Something tells me the rash was only a symptom of a much more serious problem.


The big question is,  is this malpractice through failure to give care when needed?

Somewhere, a lawyer is asking that question and he's getting a stiffy over it.
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Something tells me that the rash had nothing to do with what killed him.
Link Posted: 1/26/2014 5:54:53 AM EDT
obama(no)care
Link Posted: 1/26/2014 5:54:59 AM EDT
At my hospital, a ton of people come in complaining of chest pain. After the full negative workup, they then tell us about the small cut or persistent cough. They are abusing the system and end up getting rushed back and we can't ship em out for hours. The guy who actually needs ED care then has to wait for the FSA to clear out.  I would imagine this has something to do with it.

People should use quick care more often. ED is for EMERGENCY

Link Posted: 1/26/2014 5:58:34 AM EDT
My first impression of this guy is he probably is not awake during normal orifice hours with a Doc, so he went to an ER...maybe he told the staff he had a more serious condition at the nurse's station but they went ahead and put him on the "pay no mind" list....we will get to the patient when we can. Dead men tell no tales. I cannot see anyone really at fault besides the patient, the ER is a place you should not go alone, and if you are alone it should be noted by the staff.
Link Posted: 1/26/2014 5:59:56 AM EDT
Link Posted: 1/26/2014 6:00:27 AM EDT
Isn't free health care great?
Link Posted: 1/26/2014 6:04:23 AM EDT
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Originally Posted By TheGrayMan:


That would have had a better prognosis, actually...  what my erstwhile colleague is probably referring to is meningococcemia.  At least with meningococcal meningitis, the infection is largely contained within the CNS.  With fulminant meningococcemia, the infection is a body-wide gram-negative sepsis with the same bacteria (Neisseria Meningitidis).  Meningococcal meningitis is a rapid killer... but meningococcemia is even faster... you're dead in a matter of hours.  

That and TTP are the only immediately-life-threatening "rashes" (and both would give you a similar rash, in fact) I can think of off the top of my head.  

And unfortunately for the deceased, a chief complaint of "rash" will get you a low-priority triage category... meaning you're going to wait for quite a while.  In a busy urban trauma center, you might wait all day.

And looking at the man's forearm in that second picture, I'm wondering if those aren't needle tracks.  If they are, he could have sepsis and DIC (resulting in a rash) from any number of bugs... or even endocarditis on his heart valves.  

Drugs are bad...  mmmmkay?
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Originally Posted By TheGrayMan:
Originally Posted By fxntime:
Originally Posted By oscardeuce:
Rash+ rapid death might be this:

<a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a>


Meningitis?


That would have had a better prognosis, actually...  what my erstwhile colleague is probably referring to is meningococcemia.  At least with meningococcal meningitis, the infection is largely contained within the CNS.  With fulminant meningococcemia, the infection is a body-wide gram-negative sepsis with the same bacteria (Neisseria Meningitidis).  Meningococcal meningitis is a rapid killer... but meningococcemia is even faster... you're dead in a matter of hours.  

That and TTP are the only immediately-life-threatening "rashes" (and both would give you a similar rash, in fact) I can think of off the top of my head.  

And unfortunately for the deceased, a chief complaint of "rash" will get you a low-priority triage category... meaning you're going to wait for quite a while.  In a busy urban trauma center, you might wait all day.

And looking at the man's forearm in that second picture, I'm wondering if those aren't needle tracks.  If they are, he could have sepsis and DIC (resulting in a rash) from any number of bugs... or even endocarditis on his heart valves.  

Drugs are bad...  mmmmkay?


Wow GD be smart!
A good triage nurse should have recognized this if this was the case.
Some EDs have docs in triage for this reason.
Link Posted: 1/26/2014 6:04:28 AM EDT
Link Posted: 1/26/2014 6:04:51 AM EDT
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Originally Posted By Jarhead_22:
I'm sorry that guy died, but in my experience a chinstrap beard is about a 98% reliable douchebag indicator.
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That, and the crooked hat and the Burt-n-Ernie eyebrows.    


He might have been a great guy, but...   Meh.
Link Posted: 1/26/2014 6:06:19 AM EDT
Affordable care is diminished care
Link Posted: 1/26/2014 6:06:57 AM EDT
Link Posted: 1/26/2014 6:07:23 AM EDT
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Originally Posted By P08:
I wonder how long it took them to get him into the morgue?
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No need to hurry.
Link Posted: 1/26/2014 6:09:23 AM EDT
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Originally Posted By AbleArcher:
So if I'm reading ARF correctly on this, it's probably better that the hospital didn't get around to him based on his looks?
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I think that says more about those saying it than anything else.
Link Posted: 1/26/2014 6:13:19 AM EDT
Link Posted: 1/26/2014 6:14:02 AM EDT
Meningitis doesn't usually appear with a rash.  The complaints we see with meningitis are headache, fever, stiff neck.  An ER can't even diagnose Meningitis until a spinal tap is done, which no triage nurse in America is doing.
Link Posted: 1/26/2014 6:16:11 AM EDT
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Originally Posted By Ranxerox911:


Depends on the rash - purpuric rash, hell yes.
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Originally Posted By Ranxerox911:
Originally Posted By Justice23:
Is a rash something you go to the ER for? It's not for me.

How about your primary care physician?

I wonder what the Cause of death was.

Posted Via AR15.Com Mobile


Depends on the rash - purpuric rash, hell yes.


Stolen from the Internet.

"How long has the rash been present? Is it changing noticeably? Meningococcal septicaemia will be very recent in origin and changing almost visibly.
Is the patient otherwise well? If a child has developed a purpuric, possibly meningococcal, rash but does not seem unwell, do not be lured into a false sense of security. That child may be moribund just 20 minutes later."


I guess it isn't only children.
Link Posted: 1/26/2014 6:21:05 AM EDT
Originally Posted By xylo:
Is it more work or less work, for the ER staff, if your patient just dies in the waiting room?
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More. The administration is going to crawl up their asses with a microscope. It will take months for them to investigate this and settle with the family.

An ER in New York City can have 100 people waiting to be seen. There's never enough staff, although there's usually a security guard or an orderly keeping an eye on the waiting area. The problem is that he went there with a condition that wasn't an emergency. That means they triaged him and decided that his rash could wait while they treated people who had difficulty breathing, chest pain, and other life threatening or potentially life threatening conditions.

Given the long wait and the overload on the staff, they won't worry about it when the guy with the rash doesn't answer when they call for him. They'll assume he walked out. Then they go back to people who are bleeding or trying to scam opiates out of them.

The news story says they checked on him more than once. I don't know about that, since they eventually found him dead. This has happened before, in New York City, so it's something the ER knew to expect. Not from this guy, but from people in general. The article quotes an anonymous hospital worker who says they found him, "...stiff, blue, and cold..." We don't know if this person was the chief of surgery or the SEIU wannabe who mops the floor. The statement is worthless until it is sourced.

I hope that they were watching the waiting area and the person suddenly keeled over while they weren't looking, and the family is groping for dollars. It's possible that they're telling the truth, unfortunately.
Link Posted: 1/26/2014 6:26:19 AM EDT
Link Posted: 1/26/2014 6:28:05 AM EDT
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Originally Posted By TheGrayMan:
And as for the "nobody checks on people" thing, that's ludicrous.
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I see you've never been to Woodhull Hospital.
Link Posted: 1/26/2014 6:30:03 AM EDT
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Originally Posted By Justa_TXguy:
ERs are extremely overloaded right now.
..... Snip....
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Been that way for years....I did my Medicine rotation my third year in Pod. School at the old Cook Co. Hospital...that was 2001...and they had full rooms, and the wipe off board had a space made between the rooms for the stretcher they would put there for the overflow patients...and even those were always full.

Then the next year, went to the new hospital they opened...a lot of ER rooms....helped...but still had anywhere from 24hr to 48+ hour waits for the patients that were either not triaged or only had minor complaints....

This guy was probably triaged and said "I have a rash" so was put in the 'we'll get to him after the real emergencies' category....

AFARR
Link Posted: 1/26/2014 6:31:24 AM EDT
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Originally Posted By Justa_TXguy:
ERs are extremely overloaded right now.  Ours apparently had three women miscarry in the waiting room in one weekend because they couldn't be seen.  They are admitting patients to the hallway on the medical surgical floors just to get people out of the ER so they can see people.  That's right, not even admitted to a room.  To a hallway, where people and visitors are just all walking around.

People are going to continue to die.  EMTALA is the root cause.

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Which will be exacerbated 10 fold by Obamacare...
Link Posted: 1/26/2014 6:36:56 AM EDT
Link Posted: 1/26/2014 6:41:06 AM EDT
GOVERNMENT OF MADAGASCAR CLOSES AIRPORTS TO PREVENT POSSIBLE INFECTIONS
Link Posted: 1/26/2014 6:49:39 AM EDT
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Originally Posted By TheGrayMan:

If I were a betting man, that's where I'd put my money.

And that's how business is SUPPOSED to be done; you treat the most-immediate life-threats first.  The drug-seekers, colds-and-sniffles, and drama-queens can sit their butts down and wait
Snip...
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Unfortunately after a visit or two and some talking....the Drug Seekers, Colds and Sniffles and Drama-Queens learn to say "I have chest pain", "I can't breathe", etc. as they're triaged to move them up....
My ER rotation (1 month) during my first year residency was spent in about 50% in the Asthma room (yes, even as  Podiatry resident...they stuck all the interns in there**) and most of the rest in the "Green" ER (minor stuff)...asthma's bad in the city, but a substantial percentage of the 'visitors' had no history of asthma, and once they'd get in there, suddenly, they'd have another issue (or be hungry....they actually stocked sammiches in the asthma room for patients...)...'my med needs refilled...I have this rash...my back hurts...etc'.  

AFARR

(** the asthma room was the safest place to put the new people...like me and the MD/DO interns...the nurses there ran the show...'gee doctor, do you want to...' so I learned early on to listen to the experienced nurses and go with it for the most part.     They did like us...Pod Residents and Students...for cutting and sewing though in the other part of the ER.   By the time we've hit there, we've been doing it for a while in surgery rotations, so we can give the local, drain/remove, then sew if needed and the ER attending/Senior residents didn't have to stand over us...)....
Link Posted: 1/26/2014 6:49:54 AM EDT
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Originally Posted By Extorris:

I see you've never been to Woodhull Hospital.
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Originally Posted By Extorris:
Originally Posted By TheGrayMan:
And as for the "nobody checks on people" thing, that's ludicrous.

I see you've never been to Woodhull Hospital.


DITTO for KCH (Kings County Hospital in Flatbush, Brooklyn) in the 67. I had a foot post out front of there in the 90's, good times.  In 2008 they had surveillance video of some EDP/kook stroking out in the waiting room. See Link

link to CNN article and footage
Link Posted: 1/26/2014 6:51:06 AM EDT
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Originally Posted By TheGrayMan:



When you see the petechial rash of Meningococcemia, you're actually looking at a picture of evolving DIC (Disseminated Intravascular Coagulation).  DIC is what we call a consumptive coagulopathy, where the release of bacterial toxins causes the aggregation of platelets and abnormal bleeding.  Those tiny little petechia that you're seeing in/under the skin are actually very small bruises/hemorrhages.  In some patients, those will rapidly spread/increase-in-size until they form purpura: confluent purple bruises or hemorrhagic blisters.  

These patient's are SICK...  and in many cases that rapid evolution of petechia-into-purpura is a pre-terminal event, even with antibiotics.  What you're seeing in those cases is a patient's immune and hematologic systems rapidly circling the toilet bowl.  By the time a person's sepsis has progressed to that degree, they're so far behind the eight-ball that many don't survive.
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Originally Posted By TheGrayMan:
Originally Posted By Him:

Stolen from the Internet.

"How long has the rash been present? Is it changing noticeably? Meningococcal septicaemia will be very recent in origin and changing almost visibly.
Is the patient otherwise well? If a child has developed a purpuric, possibly meningococcal, rash but does not seem unwell, do not be lured into a false sense of security. That child may be moribund just 20 minutes later."


I guess it isn't only children.



When you see the petechial rash of Meningococcemia, you're actually looking at a picture of evolving DIC (Disseminated Intravascular Coagulation).  DIC is what we call a consumptive coagulopathy, where the release of bacterial toxins causes the aggregation of platelets and abnormal bleeding.  Those tiny little petechia that you're seeing in/under the skin are actually very small bruises/hemorrhages.  In some patients, those will rapidly spread/increase-in-size until they form purpura: confluent purple bruises or hemorrhagic blisters.  

These patient's are SICK...  and in many cases that rapid evolution of petechia-into-purpura is a pre-terminal event, even with antibiotics.  What you're seeing in those cases is a patient's immune and hematologic systems rapidly circling the toilet bowl.  By the time a person's sepsis has progressed to that degree, they're so far behind the eight-ball that many don't survive.


What's the other one called, where your entire circulatory system "freezes" solid into one giant clot?
Link Posted: 1/26/2014 6:51:57 AM EDT
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Originally Posted By fxntime:


Meningitis?
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Originally Posted By fxntime:
Originally Posted By oscardeuce:
Rash+ rapid death might be this:

<a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a>


Meningitis?

anthrax
Link Posted: 1/26/2014 6:52:31 AM EDT
[Last Edit: 1/26/2014 6:52:54 AM EDT by matthardcore]
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Originally Posted By DOW:
Typical Bronx street mope, I'd love to see his list of priors...

ETA

Is Abuelita a man???



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way to make assumptions based on....well.....you tell me.

Abuelita=grandmother
Link Posted: 1/26/2014 6:57:05 AM EDT
This guy is a junkie. Anyone who can't spot it in that first pic is an idiot.
Link Posted: 1/26/2014 6:57:22 AM EDT
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Originally Posted By oscardeuce:
Rash+ rapid death might be this:

<a href="http://s487.photobucket.com/user/oscardeuce/media/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg.html" target="_blank">http://i487.photobucket.com/albums/rr232/oscardeuce/DC59387C-44F5-4DA1-AB19-0F85A675EDD1_zpsgxx5zcwq.jpg</a>
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Braile?
Link Posted: 1/26/2014 6:58:12 AM EDT
Link Posted: 1/26/2014 7:06:08 AM EDT
[Last Edit: 1/26/2014 7:07:41 AM EDT by AFARR]
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Originally Posted By TheGrayMan:


Stop shouting, will you?

And I'm unaware of such a condition.  Nobody's blood just "freezes" into one giant clot.
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Originally Posted By TheGrayMan:
Originally Posted By Him:

What's the other one called, where your entire circulatory system "freezes" solid into one giant clot?


Stop shouting, will you?

And I'm unaware of such a condition.  Nobody's blood just "freezes" into one giant clot.


Oh, please....we know you Doctor types are just covering up for the government's men in black suits in an effort to protect the Medical/Insurance consortium owned by the Illuminati and Tri-lateral Commission, managed by the Bilderbergers ....and they made a documentary about just that happening.....and it was all the government's fault....

Here it is:

Link Posted: 1/26/2014 7:06:46 AM EDT
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Originally Posted By TheGrayMan:


Stop shouting, will you?

And I'm unaware of such a condition.  Nobody's blood just "freezes" into one giant clot.
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Originally Posted By TheGrayMan:
Originally Posted By Him:

What's the other one called, where your entire circulatory system "freezes" solid into one giant clot?


Stop shouting, will you?

And I'm unaware of such a condition.  Nobody's blood just "freezes" into one giant clot.


ALL CAPS is shouting.
Link Posted: 1/26/2014 7:07:52 AM EDT
[Last Edit: 1/26/2014 7:08:26 AM EDT by Extorris]
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Originally Posted By Yankee-Carpet-Bagger:

DITTO for KCH (Kings County Hospital in Flatbush, Brooklyn) in the 67. I had a foot post out front of there in the 90's, good times.  In 2008 they had surveillance video of some EDP/kook stroking out in the waiting room. See Link
link to CNN article and footage
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Originally Posted By Yankee-Carpet-Bagger:
Originally Posted By Extorris:
Originally Posted By TheGrayMan:
And as for the "nobody checks on people" thing, that's ludicrous.

I see you've never been to Woodhull Hospital.

DITTO for KCH (Kings County Hospital in Flatbush, Brooklyn) in the 67. I had a foot post out front of there in the 90's, good times.  In 2008 they had surveillance video of some EDP/kook stroking out in the waiting room. See Link
link to CNN article and footage

KCH is wayyyy better than Woodhull especially if you need treatment for a GSW. Brookdale on the other hand.......
Link Posted: 1/26/2014 7:11:34 AM EDT
[Last Edit: 1/26/2014 7:12:34 AM EDT by TheGrayMan]
Link Posted: 1/26/2014 7:16:03 AM EDT
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Originally Posted By DWFAN:
GOVERNMENT OF MADAGASCAR CLOSES AIRPORTS TO PREVENT POSSIBLE INFECTIONS
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Okay, so it's been a while since I beat Pandemic 2 and got Kongregate's President Madagascar Assassin Badge, but I'll try to answer with what I remember.

Be Infectious, but not Deadly

You can alter your infectious disease at will. Because infected people never become uninfected, it's a totally valid strategy to infect as many people as possible and then mutate into a 100% mortality rate disease.

Be Infectious, but Invisible

You do have to be careful however, because even decidedly non-deadly diseases may spark airport / harbor closure, which may make Madagascar the human's best hideout. Don't go for the High Infection, High Visible symptoms, it's counteractive to your goal of INFECTING EVERY PATHETIC HUMAN ON EARTH. Remember - transmissions lead to closures!

Be a Virus

The benefits of fast mutation far outway the benefits of the other vectors.

Start in Madagascar

Or Canada, New Zealand, Cuba, Greenland, or West Europe. The point is, since these countries tend to be easiest to close, you may as well start there, to cut out on some headaches later. You can simply remake new games until you get one of these countries.

And finally, a TLDR from the Kongregate comments:

1.Pick Virus.
2.Start in Canada, New Zealand, Cuba, Greenland, West Europe, or Madagascar. If you do not get there restart.
3.Sell the starting symptoms, and buy sneezing (unless it is what you started with, just keep it).
4.Buy 1-1-1-0 resistances but no transmissions (they trigger closures).
5.Once four countries are infected, sell sneezing to get rid of visibility.
6.Wait until all countries are infected. If Madagascar closes its shipyards/borders or is not infected in 30 days, restart.
7.Buy all four drug resistances AND sneezing, coughing, and vomiting.
8.After a few days, unlock tiers 2-3, (do not buy tier 4 ever!) keeping whatever symptoms it gives you.
9.Buy fever, fatigue, diarrhoea, pulmonary edema, and hypersensitivity. Then save for kidney failure and ataxia.

Link Posted: 1/26/2014 7:31:26 AM EDT
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Originally Posted By safe1:


Yup.
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Originally Posted By safe1:
Originally Posted By Dan_Gray:
Originally Posted By AbleArcher:
So if I'm reading ARF correctly on this, it's probably better that the hospital didn't get around to him based on his looks?

I think that says more about those saying it than anything else.


Yup.


I think a lot of people are saying that a long term drug addict could easily have died from something other than "a rash".

Also, many addicts are frequent flier drug seekers at ER's. It makes some sense to me that the staff would become somewhat skeptical of the severity of their conditions, especially in a very crowded ER.
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