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Wednesday

To Live or Die in Disaster

The Associated Press is reporting on a panel of physicians who have made recommendations regarding who would and wouldn't get health care during times of disaster or catastrophe. The list is developed with the idea that health resources will be scarce or not readily available in times of crisis and the need for a more consistent method of triaging those resources. On the surface the idea has merit. The context and list-like approach are troubling.

The report recommends that each hospital have a team assigned in times of crisis to triage health care resources...note: resources is used synonymously with treatment. The triage team would have the sole responsibility of performing triage and utilizing the triage model...not a easy job when you consider those people meeting certain criteria (high risk of death) may not receive access to those resources. According to the list, you would not recieve treatment (ie: access to health care resources) if you have a high risk of death and a slim chance of long term survival. The following list is offered to define high risk of death and a slim chance of long term survival:
People greater than 85 yeas of age
severely burned patients greater than 60 years
Those with mental impairment...Alzheimers's disease
Those with chronic disease...heart failure, lung disease, or poorly controlled diabetes...

So, if you meet the above criteria or you have one of those conditions, no care for you in a disaster. What do you think about that?

Although I totally agree that health care resources will be limited (if available at all) and a disaster situation will require health care rationing of some sort, I think this report is short sighted and not grounding in reality. Here's what I mean...

This scheme is not too distant from current triage modalities with one major exception...in triage we always base our decisions on the situation and a set of triage priorities. It is safe to say that those we choose not to work on in a triage situation are not conscious and those that are will be treated as expectant...note that I said treated here.

Was there any concern for facility safety when establishing this list? How do you expect to handle a situation when a family member is denied treatment based on this list while others are given treatment? Let's put it this way: if health care resources are going to be short, it is likely that law enforcement will be in short supply as well. It is reasonable to expect that families will show up at a hospital or treatment center as a unit...with expectations and conscious.

Lists such as the one suggested by this report may violate age discrimination or disability discrimination laws...I guess its one thing to make a decision on who gets what during a crisis...yet another thing to put groups of people on a list ahead of time.

Finally, when the public outcry and debate over this occurs (and I surprised it hasn't yet) emergency managers and medical personnel alike will be required to justify these actions and this list. That is not to say the the proposed triage model is wrong...just the way the list is presented seems to be a sticking point. The fact is that triage and health care rationing will occur by default as there is no way our current health care systems will continue to function during disaster or crisis situations. Hurricane Katrina taught us that lesson...and we haven't done much about it yet.

The best approach to the situation of health care in disaster situations is to prepare. Simple to say, far more difficult to do. In all reality, those groups mentioned on the list will receive some level of treatment in a disaster. A better plan may be to prepare community resources outside the hospital systems and place emphasis on dealing with special needs populations including shelter-in-place actions.

1 comment:

  1. Rick:

    Be sure and take a look at the New York State Department of Health's Pandemic protocols - they published a set of guidelines last year covering the triage of critical medical equipment that is actually pretty realistic. They didn't cover all of the bases, like what to do if someone volunteers to be extubated in order to free up resources, but their approach to making some of the difficult decisions was pretty well thought out.

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