Monday, May 05, 2008


Who gets what?

I came across an interesting article on Yahoo today. It seems that people are starting to realize that in cases of a pandemic disease outbreak, there will just not be enough health care to go around. This is nothing new to those of us in health care. Most of us see this, albeit on a small scale, just about every day. Every day, we see doctors trying to balance needs for medications and/or tests against what we have in house or what the patient can afford. And any of us who have been trained on mass casualty triage models know are that sometimes you have to make a difficult decisions about who not to spend resources on. In a perfect world, there would always be enought to go around all the time, but we all know that this is just not the case.

I would like to see the whole report before I pass judgement on if I agree with these guidelines or not. There are a few things that concern me though. According to the article, these groups would not receive treatment during a pandemic:

_People older than 85.
_Those with severe trauma, which could include critical injuries from car crashes and

_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.

There just seems to be too much room for interpretation in these. How is a "severe mental impairment" defined? Would this mean that a MRDD person would be denied treatment? And 85 seems to be a rather arbitrary limit. I have had patients who were 65 with poorer chances of long term survival than some of my 90 year old patients. Simply picking a number seems a bit simplistic to me.

Of course, we will have to come up with some kind of system for situations like this. Unfortunately, almost any system is going to have to draw the line somewhere. I just hope that there are people out there a lot wiser and smarter to me working on this problem, because I know that I don't have any good answers to this question.

Sunday, May 04, 2008!

Buster, our friend BH, and I went to see Iron Man today. Definitely one of the better comic book movies recently. If you have not gone to see it yet, you have to stay through the whole credits. There is a scene after the credits that should have all of the fan-boys out there speculating wildly about the sequel.

The pictures above came from an article on MSNBC about the history of exosuits and the uses that researchers are using them for. The 2 pictures above are suits that have been or are currently being researched in Japan for use by nurses "in helping lift patients".

Now, is it just me, or does this seem a bit excessive? Firstly, the one on the left looks more like something out of a video game (Halo anyone?). And what is he holding? Is it some new machine way of starting an IV (although it does look like something you could use for starting an IO). And Just imagine the reaction of a patient when you walk into a room dressed like some creepy cosplay reject?

Can you imagine wearing one of these things for a 12 hour shift. Neither one of these contraptions looks particularly comfortable. I doubt that suit of battle armor has a handy flap either for that one time in your shift you can actually run to the bathroom. Maybe it comes with a handy foley preinstalled.....

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