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.

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