Tuesday, March 25, 2008

Ventilator Triage During A Pandemic



# 1822



The New York Times this morning is giving some welcome coverage to a serious issue; Who gets a ventilator during a pandemic?


With somewhere over 100,000 ventilators in this country, and with between 80% and 90% in use, the number of available ventilators at any given time is probably no more than 25,000-30,000 nationwide.  


In a severe pandemic, the US government has estimated that as many as 750,000 people could require a ventilator.   Obviously, many who could benefit from a ventilator, won't have access. 


Decisions will have to be made as to who gets a ventilator, and who does not.  And harder still . . . when do we decide to remove a patient from a ventilator in order to give that resource to someone else?


These are ethical dilemmas that need to be confronted now, before a pandemic strikes. 





Guidelines for Epidemics: Who Gets a Ventilator?



Published: March 25, 2008


It may sound unthinkable — the idea of denying life support to some people in a public health disaster like an epidemic. But a new report says doctors, health care workers and the public need to start thinking about it.


PLANNING AHEAD There is no shortage of ventilators now, but what if there was?


Allocation of Ventilators in an Influenza Pandemic: Planning Document (PDF)


The report, by New York State health officials, grows out of the work of a group formed in 2006 to plan for the possibility of an influenza pandemic. The group focused on the breathing machines called ventilators.



Right now, there are enough ventilators to go around. But in an epidemic, there could be a severe shortage of machines and, more important, doctors and nurses to run them. At that point, the new report says, doctors and hospitals would have no choice but to start taking some people off the machines so that others could live.



Removal “is absolutely the crux of the problem,” said a lead author of the study, Dr. Tia Powell, who has spent much of her career studying medical ethics. “There are people who might survive who won’t get a chance at a ventilator if someone who is likely to die even with a vent is using it.”



Before an epidemic strikes, the report says, the public should confront the issue to ensure that any such triage decisions reflect community views, as well as ethical and clinical standards.

1 comment:

Dreamer said...

Donald McNeil wrote a similar article about 2 years ago. About the time I first saw his article (about a year ago) I thought I would try to do something about this problem if I could. Usually we can not rely on governments and bureaucracies to properly plan and prepare for high impact but low (in the immediate term) probability events such as a pandemic (or New Orleans flooding). It does not have a good political payback. My solution is a more grassroots approach.

During the polio epidemic, ordinary people built ventilators to save the lives of children afflicted with paralysis to save those lives when they ran out of commercially made iron lungs. Popular Mechanics even published plans to build them in their edition of January 1952. Modern ventilators may seem to be incredibly complex devices, but to an engineer they are just a collection of valves, sensors and a control system. Even commercially made ventilators from 1952 had very basic control systems. In 2008 we can use a modern industrial controller (PLC) to control ordinary valves, and construct a ventilator that is reliable and can perform many of the functions with the safety alarm systems that many commercially available ventilators have. Most of the hard stuff is in the software that is easily and cheaply reproduced once it is developed.

The Pandemic Ventilator Project (www.panvent.blogspot.com) is working on a design that will allow people to build ventilators even after a pandemic begins using PLCs, ordinary solenoid valves, piping and plastic bags. Please have a look at the site. Every time this issue comes up, I hear the same story, "there will be a massive shortage, we need more ventilators, they are too expensive, nobody buys them".

The situation has not fundamentally changed in the 2 years since McNeil's article. There was a shortage then, there is a shortage now. I think my project is a rational way to at least partially solve this problem. It is however, small,unfunded, and little known. It has not gotten the attention of any of the major planning groups.