Senseimatt91

Not bad as they used to be, but reopening seems to have led to a number of people abusing their newly found freedom and doing stupid things such as going to the disco and stuff... And we're back up with the new cases, risking a second lockdown. Also, median age of new cases seems to be younger (at least for now) so we're raising an eyebrow for this as well. Intensive Care workers are shivering at the thought of going back to the previous situation, so everybody just stay at home :D

We have a totally different system so I'll have to explain that first (sorry if it's a little long, but it is necessary for context).

1) We don't have EMTs/paramedics, HUGE difference; 2) In many regions, especially from central Italy to the south, we don't have just one public society for territorial emergencies, but rather one public sided by a number of private societies sub-contracting different areas; 3) We have many different types of "ambulances" basing on the combination of the operators employed: driver, nurse, rescuer (usually drivers are also rescuers, except for the Red Cross and a few other societies), doctor (which may be a generic doctor or an anesthetist), volunteers who are more or less equal to rescuers. We also have helicopters (pilot+technician+nurse+anesthetist), medical cars (doctor+nurse and sometimes a driver, otherwise it'll be the nurse's duty) and regular ambulances (various combinations); 4) Usually BLS, ACLS and basic PTC (or equivalents) are the only requirements. Some societies will also require other certification such as PALS, but the requirements will change from region to region. Of course, less standardization means more likely issues in terms of quality assurance.

Generally speaking, the level is average with a huge variability between regions also depending on their funding (which is higher in northern Italy). We have smaller distances to travel so we usually can afford a "scoop and run" approach but at least in my experience the operators involved in territorial emergency are fairly capable at doing their "dirty work". Main problem here is that ambulance operators are not often motivated, as it's hard work and being employed in private societies will often mean you will get paid not much. Working on ambulances is a job often done by newly-graduate doctors, so that can be an issue.

May I ask for your experience too? (Hope I answered your question, otherwise please tell me and I'll gladly say more).

There is a number of reasons and it also depends on things like the procedure involved, so the best thing I can tell you is to discuss it thoroughly with the anesthesia provider and ask them directly what their choice is and why. What do you mean by "basic anesthesia"? Depending on the procedure, stopping your breathing may be in fact necessary and, even if it is not the case, it very rarely is a dangerous occurrence but rather a fairly common side effect of sedative drugs :)

Perception of the "end", and the way it is lived, is extremely different from subject to subject and particularly hard to investigate for the most obvious reasons: I've seen people die of very different deaths and not necessarily did the reason match with their feelings and emotions at the time, sometimes terrible diseases carried little to no burden and viceversa. Also, a lot depends on spiritual factors: does the person think they will go to heaven or that they will simply hit the "off" button? I'll go a little dark and existential as well: don't be afraid of death, just make sure you don't get there without having lived properly both in terms of health and of emotions and experiences. At which point, hopefully, you might even get to decide how it feels :)

I did know some people who had NDEs, plus another couple who got this close to dying but were saved just before (especially one whose airways were cleared of an obstruction just before losing consciousness): most of them reported feeling at peace and outside of their own body, as if they were fluctuating and watching the scene from above or another point of view. This being said, it is less common for providers like us to hear this from our patients because of their mental status while they are in ICU: they often are disoriented and it usually takes a lot of time for the brain to get back "in shape" enough to actually be able to report it. This kind of memory is usually elaborated at a second time, after discharge from ICU.