The good, the bad and the ugly: pandemic priority decisions and triage
| Autor: | Bertrand Guidet, Dylan W. deLange, Andrew Rhodes, Susannah Leaver, Hans Flaatten, Michael Beil, Vernon van Heerden, Christian Jung |
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| Rok vydání: | 2020 |
| Předmět: |
Health (social science)
anaesthetics / anesthesiology Supply chain Discount points Phase (combat) Health(social science) Odds law.invention 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Arts and Humanities (miscellaneous) law Intensive care medicine Current Controversy health care for specific diseases/groups Health Policy clinical ethics 030208 emergency & critical care medicine allocation of health care resources medicine.disease Triage Intensive care unit Issues ethics and legal aspects 030228 respiratory system epidemiology Business Medical emergency |
| Zdroj: | Journal of Medical Ethics |
| ISSN: | 1473-4257 0306-6800 |
| Popis: | In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone. |
| Databáze: | OpenAIRE |
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