A task force of members from the military, government agencies, major universities and medical groups has drafted recommendations on which patients should receive lifesaving care should a pandemic or other disaster occur. The guidelines reflects the somber reality that not everyone who needs treatment would receive it, and that some, if not all, will die as a result.
The task force included members of the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.
Dr. Asha Devereaux, a critical care specialist in San Diego and the report’s lead writer, told the Associated Press that the proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another health care disaster hits. The idea, task force members said, is to ensure scarce resources, such as ventilators, medicine and medical professionals, are used in a consistent, objective way.
“If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,” the report said.
The task force wrote that hospitals should designate a triage team with the Godlike task of deciding who will and who won’t receive treatment. Those refused care would be at a high risk of death with a slim chance of long-term survival. However, the report gave specific details about who should be denied treatment, a list that includes:
- 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.
Dr. Kevin Yeskey, a task force member and director of the preparedness and emergency operations office at the Department of Health and Human Services, told the Associated Press the report would be among many the agency reviews as part of preparedness efforts.
Lawrence Gostin of Georgetown University, a public health law expert, called the report important but also “a political minefield and a legal minefield.”
“The recommendations would probably violate federal laws against age discrimination and disability discrimination,” said Gostin, who was not on the task force.
“If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability,” he said.
“There are some real ethical concerns here,” he said, while also acknowledging that health care rationing would be necessary in a mass disaster.
James Bentley, a senior vice president at American Hospital Association, told the AP that the report would provide input to hospitals as they put in place their own preparedness plans, even if they don’t follow all the guidelines. Bentley added that the draft resembles the battlefield approach of allocating limited health care resources to those most likely to survive.
He said the report was “the most detailed one I have seen from a professional group.”
“While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary,” Bentley said.
Devereaux said compiling the list “was emotionally difficult for everyone,” partly because members believe it is only a matter of time before such a catastrophic pandemic occurs.
“You never know,” Devereaux said.
“SARS took a lot of folks by surprise. We didn’t even know it existed.”
The task force recommendations appear in a report in the May edition of Chest, the medical journal of the American College of Chest Physicians.
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