U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge

[babylonsister]

U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge

March 21, 20209:07 PM ET
Sacha Pfeiffer


As COVID-19 spreads rapidly through the United States, many American doctors could soon be making the decisions that overwhelmed health care workers in Italy are already facing: Which patients get life-saving treatment and which ones do not?

Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically, an ethics committee made up of not just medical professionals, but often also social workers, pastors and patient advocates. Sometimes in partnership with hospital triage committees, they create guidelines for prioritizing patient care if there's a resource shortage.

As the number of coronavirus cases rises in the U.S., hospitals have a new urgency in revisiting and updating those guidelines.

They vary from hospital to hospital, but their overall goal is usually to save the most lives. So hospitals consider a combination of factors: age, life expectancy, how severe a patient's illness is, how likely treatment is to help, and whether a patient has additional illnesses that could shorten their life span, such as cancer or heart disease. Hospitals can then use those factors to develop scoring systems or clinical scores to prioritize care.

snip//

Another potential factor is "social usefulness," a concept that might favor, for example, a sick nurse because that person could go on to save other lives.

more...

https://www.npr.org/2020/03/21/819645036/u-s-hospitals-prepare-guidelines-for-who-gets-care-amid-coronavirus-surge?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social&fbclid=IwAR1y6Wnqk2w-wDBqo5uPMCicQiqURyeBq9jyhuqk54Mr8HHuhnZaIfNwKro

[rampartc]

1. "social usefulness" is an interesting concept

nurses and firemen etc should get the ventilators.

[babylonsister]

2. I would think that'd be a tough call to make.

Ability to determine who lives and who dies?

[rampartc]

3. doctors knew the job was dangerous when they took it.

[OhioChick]

5. How so...

Compared to Nurses, EMTs, Fire, etc.?

Everyone's job is dangerous and no one saw this coming.

[rampartc]

10. i suppose i was answering the "decide life or death" question

doctors have been making that decision since hippocrates.

and definitely, my respect for nurses emts etc is immeasurable.

[Igel]

12. I suspect that since supplies and tech have become more abundant,

this has changed significantly.

In 1918 you'd have doctors that couldn't do much about the Spanish flu. But on the battlefield, you certainly could and doctors made that decision--health, injury, that sort of thing.

I suspect that more recently it's been either gut emotion or accident that's made the determination. You see a child versus an adult, you pick the child, not because the child's more useful or has a greater need, but because it's a child. Otherwise, you help the one you're working on and since you can only work on one at a time, you do your best for others until you have the one you're with stable. Along the way you may lose some, but you just sort of go from person to person.

[rampartc]

15. "women and children first" birkenhead drill

[elias7]

6. Actually, I disagree

I think most of us were strong in science, yet possessed a strong sense of social duty and service. Using our knowledge and training to help our fellow people. I gravitated to emergency medicine because I was able to think and act effectively in a crisis, use my learning and experience to guide people through that process.

We learned there were some dangers along the way - violence from patients, infectious risks, emotional trauma, but we are taught how to protect ourselves. In terms of infection, we have specific precautions we take for various types of potential exposure to keep ourselves safe.

When I hear of a potential pandemic 2-3 months ago - yes, it was foreseeable - and my own government completely fails in its preparations to protect the public with a coherent plan and protect its medical personnel with adequate resources and safety equipment, I’m sorry, but I find your implication that I knew what I was getting into was dangerous to be utter snark

[OhioChick]

7. +1000 n/t

[babylonsister]

9. +++++++++ nt

[rampartc]

11. please see my reply to the ohiochick above, doc

i meant no disrespect.

[elias7]

17. Maybe you meant "difficult" rather than dangerous

I think I’m going to be faced with some of the most difficult decisions of my life, if I’m alive to do it that is.

FWIW, our experience (nurses and docs - it’ll be a team effort for these types of choices) is what will get us through, we make these choices and decisions along this spectrum all the time, guiding people on when they should think about not pursuing resuscitative efforts for a family member who has dismal prognosis, encouraging efforts in those cases we think might be reversible, when to consider pulling the plug, choosing who gets prioritized for CT scans, ambulance transfers, based on acuity, salvagability, etc. Just never had to make choices on this scale...

I will not shirk that responsibility. That is part of the job I chose. I did not choose to go into a gunfight with a plastic fork, however.

[Igel]

13. Most of the medical students I know where like that.

Nursing candidates, too.

Some of the medical students had a strong sense of monetary need and income, and more than one nursing candidate said that there'd always be a job and she liked that.

[Ex Lurker]

18. How far do you take it?

Social usefulness is not necessarily an objective parameter and depends in large part upon personal biases. The nurse example is easy and probably most people would agree. What about business owner vs welfare recipient? Criminal vs law abiding citizen? Teacher vs instagram influencer? Democrat vs Republican? This is a door we probably don't want to open very widely if at all.

[elias7]

4. This is a really difficult piece

Discussing DNR status (do not resuscitate) with patients and families in advance is like trying bringing an abstraction into a practical realm.

Dealing with impending respiratory failure, overwhelming sepsis or brain injury in the moment is different, as death may be imminent, and the physician’s role is to gauge the likelihood of meaningful survival and guide the family (and patient) through a difficult process of how aggressive or not aggressive to be.

But having to stratify emergent care when patient load exceeds resources and personnel is a whole new concept for us health care workers. If I’ve got one ventilator left and three patients in need, I am being asked to choose who is going to have the chance to live and who is not. I live in a small town and work in a small hospital; these are people I or my wife knows, or friends of friends, or people with community standing, or people with families. Even vented, many will not survive. What do we use to guide our instantaneous choices? Age? Co-morbidities? Social responsibilities or “usefulness”? Degree of loss to the community? There is no right or wrong, just painful decisions that must be made quickly and which we will have to live with for the rest of our lives.

[babylonsister]

8. I can't even imagine

how difficult this will be. I never considered small towns, neighbors having to make this determination on neighbors. No right or wrong, but must be done. Heart-wrenching.

[elias7]

16. 😢

[GeorgeGist]

14. Voted for Trump?