As the number of coronavirus cases increases, hospitals are adopting systems to rank patients for treatment. health

Governor Andro Cuomo said in a coronavirus briefing on Thursday that if current hospital admission and intubation rates continue in New York, stockpiling ventilation remains “about six days.”

“If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies. That’s a straightforward equation here,” Kuomo said.

With the surge of coronavirus patients, demand for ventilators is soaring in intensive care units across the country. Typically, adult patients only stay in the ICU and on the ventilator for three to four days. Connecticut doctor explainedHowever, Covid-19 patients need up to 2-3 weeks, and demand is increasing dramatically.

Mr Trugg said the hospital was working throughout the weekend to develop policies to determine who would receive intensive care during a public health emergency. He said one of the better frameworks to follow was developed by Dr. Douglas White. Critical Care Medicine Professor At the University of Pittsburgh and the University of Pittsburgh Medical Center (UMPC).

This is basically a point to calculate the likelihood of a patient to benefit from ICU care based on two considerations: 1) saving the most lives and 2) saving the most lives. System.

The lower the patient’s score, the higher the care priority. On the 8-point scale of the system, the first 4 points indicate the likelihood that the patient will survive hospitalization and the last 4 points will be associated with a life expectancy of less than 1 year or less than 1 year, assuming that the patient has survived hospitalization Assess if there is a medical condition 5 years.

In the event of a tie, White’s framework instructs the physician to consider the life cycle, giving priority to young patients.

“These are necessarily dire choices and only bad ones,” White said. “But the only thing worse than developing a clear allocation framework is not developing it, because decisions made during the crisis are biased and arbitrary.”

Mr White said that his framework is intended to be comprehensive and non-discriminatory for people with disabilities.

“It is important to clarify that typical judgments about quality of life do not affect these decisions, and that no one will be disqualified from treatment because of the disability,” White said. Stated.

White identified existing recommendations for allocating critical care resources in 2007, and those recommendations often simply bar large groups’ access to critical care during public health crises He noted that he was based on “exclusion criteria.”

“Age, severe cognitive dysfunction, and chronic heart and lung disease were all used as exclusion criteria, which seemed unethical to me. We send the wrong message, “White said.

He said that this could lead to perceptions of inequity during public health emergencies where trust is essential. In contrast, the framework developed by White and his team ensures that no one will be disqualified from emergency care from the start.

“Everyone who is usually subject to intensive care is subject to public health emergencies,” White said.

He said that hundreds of hospitals across the country have adopted a white framework. First set of hospitals including Johns Hopkins And Medstar joined after 2009 Articles about the systemSaid White.

However, since early March this year, his emails have been flooded with guidance requests from hospitals. The UPMC confirmed that 40 hospitals have since adopted the framework, and Pennsylvania has also provided interim guidance to public hospitals based on his framework, Mr White said. Was. The Pennsylvania Department of Health did not provide details on the basis of the interim guidelines, but said that the final guidelines would be published shortly.

When hospitals across the country try to figure out how to distribute insufficient supplies in an emergency-their arguments are sometimes public anger, as was the case when a letter to a patient on the Henry Ford Health System was proposed cause Leaked last week -Some state guidelines, until recently, exclude certain types of people from critical care in such situations.

Alabama 2010 emergency operation planFor example, “persons with severe or severe mental retardation” and “moderate to severe dementia” state that “respiratory support is unlikely.”

These guidelines are February 2020However, the new guidance does not mention how to triage patients in the event of ventilator shortage. The Alabama Department of Public Health did not confirm that the exclusion criteria were still being used.

In the 2014 document, Indiana similarly listed Exclusion criteria for ventilators during epidemics of respiratory illness, including dependence on severe burns or dialysis. The state told CNN reporters that these were “not part of the current response plan.” Link to new plan. As in Alabama, there is a lack of guidance on how to triage patients for ventilator access.

After considering the new Alabama guidelines, White said that there was little solution.

“Therefore, their guidance on crisis management standards currently does not basically provide physicians with guidance on what to do in the face of ventilator shortages, and of course has its own issues of variability and prejudice Are piled up, “White wrote in an email.

Two other states, Tennessee and Kansas, had guidelines to exclude some people from care in the event of a pandemic emergency, but on Friday after a CNN reporter contacted them. The guide has been taken offline.

“The document you are referring to is an old document that is not intended for COVID-19 compliance. We are working to update the guidelines,” wrote a spokesman for the Ministry of Health.

At Harvard, Trouge recently supported the white framework, New England Medical Journal And that Boston Globe To help hospitals, physicians, and the public prepare for the decisions and consequences they will soon face.

Mr White argued that such foresight by experts is important, and that doctors facing pandemics do not have to struggle with such disastrous ethical issues on a case-by-case basis. White believes that the Triage Committee should consist of non-front-line physicians to “increase objectivity, avoid conflicts of commitment, and minimize moral distress.”

Dr. Ira Byock is a palliative care physician in Los Angeles, Human Caring Laboratory Based in Providence Trinity Care Hospice, California, he said that doctors’ normal clinical ethics would change during the public health crisis.

“For the first time in our experience, we need to balance the well-being of the community with the well-being of individual patients.

But even with the ethical guidance provided by frameworks such as White, Trug said that responsibilities meant that American physicians would not be able to navigate the future.

“ In the next few days, doctors may have to make decisions that they had never thought before, and for some people the mental burden will be completely nullified, ” said Trugue. Was.