Wednesday, May 14, 2008

The Allocation of Medical Resources


# 1986



CIDRAP news has another excellent report on the recent recommendations over how scarce medical resources should be allocated during a national health crisis.


CIDRAP (Center for Infectious Disease Research & Policy) is the prestigious research center and think-tank hosted by the University of Minnesota, and run by Dr. Michael  T. Osterholm. 


Their efforts are not limited to pandemic influenza, although it is for that CIDRAP is probably best known.  


They also are very active in research, analysis,  and policy recommendations on Bioterrorism  (Anthrax, Botulism, Plague, Smallpox, etc.), Biosecurity (Agriculture and food), Food safety (Irradiation, Foodborne diseases), and other biological pathogens such as SARS, BSE & vCJD, West Nile, and Monkeypox, among others.


The mainstream media has concentrated mainly on the `patient exclusion guidelines'  that doctors would have to use during a pandemic, or other health disaster.   The report, published in the May Issue of CHEST, covered far more than just these triage recommendations.


Undoubtedly the best overview I've seen of the recommendations from this panel comes from Robert Roos and Lisa Schnirring of CIDRAP news


Once again, follow the link to read the entire article.  The excerpt below just scratches the surface.






Critical care panel tackles disaster preparation, surge capacity, rationing


Robert Roos and Lisa Schnirring * Staff Writers


May 13, 2008 (CIDRAP News) – Anticipating that a terrorist attack, influenza pandemic, or natural disaster will someday exhaust regional or national critical care systems, an expert task force recently issued a comprehensive series of reports that takes stock of current capabilities and recommends a surge framework that would care for as many patients as possible but would necessarily exclude some.


The series, from the Critical Care Collaborative Initiative's January 2007 Mass Critical Care Summit, appeared recently in a May supplement issue of the journal Chest. The five articles from the 37-member task force of American and Canadian experts include an executive summary and individual papers on current capabilities, a framework to optimize surge capacity, medical resource guidance, and recommendations for allocating scarce critical care resources in a mass critical care setting.


Task force member John Hick, MD, told CIDRAP News that, although initial mainstream media focus was patient exclusion issues surrounding the task force's ventilator triage criteria, the guidelines are so far receiving good support in the medical community.


"It [the series] provides both a systems and facility-based approach to resource-poor situations," he said. "Whether the goals are reasonable or not, we'll have to see," added Hick, medical director of bioterrorism and disaster preparedness and an emergency medicine physician at Hennepin County Medical Center in Minneapolis and coauthor on three of the five articles.


Though the group covered an expansive array of controversial ethics and resource topics related to critical care in a disaster scenario, they had few disagreements on about 90% of the materials, Hick said. Not surprisingly, the critical care inclusion-exclusion generated the most discussion and required a great deal of compromise, he said.  "It's not exactly what we would do as individuals, but it's a good framework nonetheless," Hick said.


Perhaps the biggest sticking point was the group's recommendation for intensive care unit (ICU) expansion, he said, adding that the group settled on 200% because of pandemic concerns, though many advocated 100% ICU expansion as a more achievable goal.


"My only fear is that people will see that as unrealistic and not aim for what they can achieve, and I think we tried to be clear to do at least what you can," Hick said.



<BIG snip>



Devereaux A, Christian MD, Dichter JR, et al. Summary of suggestions from the Task Force for Mass Critical Care Summit, January 26-27, 2007. Chest 2008 May;133(5) Suppl:1S-7S [Full text]

Christian MD, Devereaux AV, Dichter JR, et al. Definitive care for the critically ill during a disaster: current capabilities and limitations. Chest 2008 May;133(5) Suppl:8S-17S [Full text]

Rubinson L, Hick JL, Hanfling DG, et al. Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity. Chest 2008 May;133(5) Suppl:18S-31S [Full text]

Rubinson L, Hick JL, Curtis JR, et al. Definitive care for the critically ill during a disaster: medical resources for surge capacity. Chest 2008 May;133(5) Suppl:32S-50S [Full text]

Devereaux AV, Dichter JR, Christian MD, et al. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care. Chest 2008 May;133(5) Suppl:51S-66S [Full text]


(Cont. )

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