From the Sacramento Bee:
Older, sicker patients could be allowed to die in order to save the lives of patients more likely to survive a massive disaster, bioterror attack or influenza pandemic in California.
It’s not how nurses and doctors are accustomed to doing things, nor how Californians expect to be treated. But it is part of a sweeping statewide plan being praised for its breadth, even as it rankles providers who will have to carry it out.
The new “surge capacity guidelines” released by the state Department of Public Health, depict a post-disaster health care environment that looks and feels nothing like the system most Californians depend on.
It provides for scenarios in which patients could be herded into school gymnasiums for life-saving care or animal doctors could stitch up the human wounded and set their broken bones.
The 1,900-page document lays the practical – and ethical – groundwork for local and county health departments, hospitals, emergency responders and any able-bodied health care worker likely to be called upon in a catastrophe.
Striking in its specificity and its frank focus on the need to suspend or flex established laws and to ration health care, the plan is being hailed as a model for the rest of the nation.
You really need to read the whole thing to get a sense of how the plan would simultaneously limit patient protections and provide freer access to care.
Cross-posted at The Gimp Parade
It’s called triage: evaluate who will survive with care, who will survive without care, and who will die even with care. In circumstances where resources are limited, resources are allocated in that order.
As RonF said, military surgeons have been doing this since at least Ancient Greece.
Very true. But this plan is for the general population of California. The triage principles appear to be the same, but the scale of application (for one thing) would be something very new.
I had written a longer post, but then I thought of a shorter one.
Kay: WWII.
There is nothing new under the sun. Let’s hope this document becomes promulgated, studied, modeled, widely adopted, and never ever used.
Older, sicker patients could be allowed to die in order to save the lives of patients more likely to survive a massive disaster, bioterror attack or influenza pandemic in California.
Now there’s an unfounded assumption. In the last flu pandmic (1918), it was the younger, apparently healthier people who were most likely to die while older people and young children were more likely to survive. Which makes me worried about the plan in general. Is it flexible enough to allow true triage?
even as it rankles providers who will have to carry it out.
Also a bad sign. It’s not going to go anywhere if the people who have to actually implement hate the whole thing.
This sounds like a plan for triage in a crisis/disaster situation, not a general health care plan.
In the last flu pandemic it was the young who were congregating in large numbers under stressful conditions (WW I), providing an ideal situation for transmission of the virus from one person to another. And standards for hygiene in such situations wasn’t what it is now.
Ron: True, but of people who contracted influenza, younger people were also more likely to die. It is possible that older people were more likely to contract an attenuated virus or lower innoculate level because they tended to catch it at home, from their younger relatives. Of course, since I just made that explanation up, it could be entirely wrong as well.
Be that as it may, you are abs0lutely correct that the next flu (or other virus) pandemic will be different. I mentioned the last influenza pandemic to point out that assuming that younger patients would be the ones most likely to survive and therefore the ones most deserving (from a maximizing survival point of view) of treatment. One could imagine a situation in which, say, 10% of people over 60 or under 2 survive with aggressive treatment but only 0.001% of people aged 2-60. In that case, it would be best to concentrate on the younger and older people, wouldn’t it? Technically, this plan would not allow that. In practice, I suspect that the plan would be abandoned very, very quickly in such a situation though.
animal doctors could stitch up the human wounded and set their broken bones.
And this is a bad thing? Would you prefer that the animal doctors passed out cookies instead? Stitching and setting bones are mechanical animal tissue repair whether it’s on humans or any other mammals.
“Animal” doctors?!? Well last time I checked, Homo sapiens is in Kingdom Animalia. Furthermore, getting a DVM is a lot more demanding than getting an MD.
I would also think that treating patients who can’t tell you what’s wrong woudl be difficult as well.
When someone decides to start rationing general health care that way, not only will sanity have finally prevailed, but the working class may finally have an advantage over the retired class, instead of the working class being expected to pay all the expenses of the retired class, as is now the case.
In context, I’m guessing what you mean by “working class” is the age segment most likely to work, approximately 20-65. You think that as it stands now, this segment has not a single advantage whatsoever over senior citizens? Really?
If this were [checks Wikipedia to get it exactly right] 1935 you might have some sort of case to make. But since it’s not, you are fail.
“True, but of people who contracted influenza, younger people were also more likely to die.”
I thought the official explanation for this was that the healthier influenza victims were being killed by the vigorous reaction of their own immune systems.