Monday, May 05, 2008

Triage In A Pandemic

 

# 1948

 

The big story this morning, carried by the AP (Associated Press) and printed in scores of papers, is the newly released guidelines on triage in a pandemic or MCE (Mass Casualty Event) that appears in the May edition of Chest, the medical journal of the American College of Chest Physicians.

 

We've talked about triage before, and I've stressed the need for guidelines that doctors can follow during a pandemic.   The May edition of Chest does not appear to be available online yet, but here are the highlights from the AP report. 

 

 

 

Triage plan details whom to let die during a pandemic

Treatment blueprint gives severely hurt, elderly lower priority

Lindsey Tanner, Associated Press

Monday, May 5, 2008

 

 

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding whom to let die.

 

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

 

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.

 

<snip>

 

To prepare, hospitals should designate a triage team with the Godlike duty of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific and include:

 

-- People older than 85.

-- Those with severe trauma, which could include critical injuries from car crashes and shootings.

-- Severely burned patients older than 60.

-- Those with severe mental impairment, which could include advanced Alzheimer's disease.

-- Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

 

 

The guidelines listed above would effectively eliminate a large number of patients from the treatment pool in a pandemic or MCE.  Having guidelines spelled out, and endorsed by major universities, medical centers, and government agencies is an important step in our pandemic preparedness. 

 

The question, of course, is what happens when these patients are no longer included in the `treatable cases' and yet the demand for ventilators, antivirals, and hospital beds still exceeds our capacity to provide them?

 

The grim reality is, in a severe pandemic the demand for these life saving resources could be several times greater than our health care system can handle. The reduction in patients using these triage rules will relieve some of the load, but probably not enough to ensure that no other triage decisions will have to be made.

 

While I applaud the creation of this triage list, and appreciate the difficult decisions that its creators had to make, I suspect we will need further guidance in the face of  a severe pandemic. 

2 comments:

Joel said...

Thanks for posting this. Now I'm hunting to try and find the full guidelines. Your closing point - that this is a start and that we need to be ready for when the need surpasses these guidelines - is all too true.

Anonymous said...

Full guidelines are at
http://www.chestjournal.org/content/vol133/5_suppl/