Figuring Out How to Ration Ventilators if Swine Flu Gets Really Bad http://blogs.wsj.com/health/2009/09/23/figuring-out-how-to-ration-ventilators-if-swine-flu-gets-really-bad/tab/print/
Let's make this clear up front: There's no sign that the H1N1 flu, which has thus far been widespread but relatively mild, is becoming significantly more severe. But if the bug were to mutate to become much, much more deadly, the need for ventilators would far outstrip the supply. That could create very difficult dilemmas, including whether to take dying patients off of ventilators in order to free the machines up for patients who have a better chance of surviving. State and federal officials have been working out plans for just how to handle those sorts of situations, largely out of sight of the public, ProPublica reports this evening. Last year, well before the current outbreak, the state of New York published proposed criteria for allocating ventilators in case of a severe pandemic. Among other things, those criteria would automatically exclude certain patients, such as those with terminal cancer or late-stage heart failure, if demand for ventilators exceeded supply. At the time, we asked one of the authors of the guidelines why public health officials don't just buy more ventilators. She said there are some stockpiles for emergencies, but ventilators require highly trained staff to operate them, and staff would be extremely limited in a severe pandemic. "If you're sick enough to have that kind of intensive care, we can't just stick you in a hallway and give you a ventilator," she told us. New York state officials have recently discussed the plan with doctors, hospital officials and other experts, but the public has largely been excluded, the ProPublica article says. And the Veterans Administration and other states have drafted their own protocols, based in part on the New York plan. Kenneth Prager, who is professor of medicine and director of clinical ethics at Columbia University Medical Center in New York, said the broader public hasn't had input into the state's plan. "Maybe society will say, 'We don't agree with your plan,'" he told ProPublica. Still, he said the state's plan is ethically appropriate. "If we don't use triage, people will die who would otherwise have been saved" because of ventilators "being used to prolong the dying process of patients with virtually no chance of surviving." The state Department of Health put out two press releases in 2007 seeking public comment on a draft version of the guidelines. Seeking more public input in recent months was not a high priority because "we don't think we're going to get to the point where we're going to need to allocate ventilators," Claudia Hutton, the department's director of public affairs, told the Health Blog. --~--~---------~--~----~------------~-------~--~----~ You received this message because you are subscribed to Mark Crispin Miller's "News From Underground" newsgroup. To unsubscribe, send a blank email to [email protected] OR go to http://groups.google.com/group/newsfromunderground and click on the "Unsubscribe or change membership" link in the yellow bar at the top of the page, then click the "Unsubscribe" button on the next page. For more News From Underground, visit http://markcrispinmiller.com -~----------~----~----~----~------~----~------~--~---
