The state Health Department applied these to New York's 19 million-plus population with a 35 percent infection rate over a six-week duration.
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Re: Medical care, under dire circumstances
Originally posted by Rocky View Post
Rocky, I missed where you are getting the 1 out of every 124.Leave a comment:
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Re: Medical care, under dire circumstances
Well I created a spreadsheet but it copied across as quite a mess...
according to these statistics, figuring that 1 out of every 124 people are going to die from not having enough ventilators,
this is an estimate of what to expect in the top Metro regions in the US
these numbers were from a 2000 census...
Rank Metro area Population Deaths
1 New York--Northern New Jersey--Long Island, NY--NJ--CT--PA CMSA 21,199,865 170,967
2 Los Angeles--Riverside--Orange County, CA CMSA 16,373,645 132,046
3 Chicago--Gary--Kenosha, IL--IN--WI CMSA 9,157,540 73,851
4 Washington--Baltimore, DC--MD--VA--WV CMSA 7,608,070 61,355
5 San Francisco--Oakland--San Jose, CA CMSA 7,039,362 56,769
6 Philadelphia--Wilmington--Atlantic City, PA--NJ--DE--MD CMSA 6,188,463 49,907
7 Boston--Worcester--Lawrence, MA--NH--ME--CT CMSA 5,819,100 46,928
8 Detroit--Ann Arbor--Flint, MI CMSA 5,456,428 44,003
9 Dallas--Fort Worth, TX CMSA 5,221,801 42,111
10 Houston--Galveston--Brazoria, TX CMSA 4,669,571 37,658
11 Atlanta, GA MSA 4,112,198 33,163
12 Miami--Fort Lauderdale, FL CMSA 3,876,380 31,261
13 Seattle--Tacoma--Bremerton, WA CMSA 3,554,760 28,667
14 Phoenix--Mesa, AZ MSA 3,251,876 26,225
15 Minneapolis--St. Paul, MN--WI MSA 2,968,806 23,942
16 Cleveland--Akron, OH CMSA 2,945,831 23,757
17 San Diego, CA MSA 2,813,833 22,692
18 St. Louis, MO--IL MSA 2,603,607 20,997
19 Denver--Boulder--Greeley, CO CMSA 2,581,506 20,819
20 San Juan--Caguas--Arecibo, PR CMSA 2,450,292 19,760
21 Tampa--St. Petersburg--Clearwater, FL MSA 2,395,997 19,323
22 Pittsburgh, PA MSA 2,358,695 19,022
23 Portland--Salem, OR--WA CMSA 2,265,223 18,268
24 Cincinnati--Hamilton, OH--KY--IN CMSA 1,979,202 15,961
25 Sacramento--Yolo, CA CMSA 1,796,857 14,491
26 Kansas City, MO--KS MSA 1,776,062 14,323
27 Milwaukee--Racine, WI CMSA 1,689,572 13,626
28 Orlando, FL MSA 1,644,561 13,263
29 Indianapolis, IN MSA 1,607,486 12,964
30 San Antonio, TX MSA 1,592,383 12,842
31 Norfolk--Virginia Beach--Newport News, VA--NC MSA 1,569,541 12,658
32 Las Vegas, NV--AZ MSA 1,563,282 12,607
33 Columbus, OH MSA 1,540,157 12,421
34 Charlotte--Gastonia--Rock Hill, NC--SC MSA 1,499,293 12,091
35 New Orleans, LA MSA 1,337,726 10,788
36 Salt Lake City--Ogden, UT MSA 1,333,914 10,757
37 Greensboro--Winston-Salem--High Point, NC MSA 1,251,509 10,093
38 Austin--San Marcos, TX MSA 1,249,763 10,079
39 Nashville, TN MSA 1,231,311 9,930
40 Providence--Fall River--Warwick, RI--MA MSA 1,188,613 9,586
41 Raleigh--Durham--Chapel Hill, NC MSA 1,187,941 9,580
42 Hartford, CT MSA 1,183,110 9,541
43 Buffalo--Niagara Falls, NY MSA 1,170,111 9,436
44 Memphis, TN--AR--MS MSA 1,135,614 9,158
45 West Palm Beach--Boca Raton, FL MSA 1,131,184 9,122
46 Jacksonville, FL MSA 1,100,491 8,875
47 Rochester, NY MSA 1,098,201 8,856
48 Grand Rapids--Muskegon--Holland, MI MSA 1,088,514 8,778
49 Oklahoma City, OK MSA 1,083,346 8,737
50 Louisville, KY--IN MSA 1,025,598 8,271
51 Richmond--Petersburg, VA MSA 996,512 8,036
52 Greenville--Spartanburg--Anderson, SC MSA 962,441 7,762
53 Dayton--Springfield, OH MSA 950,558 7,666
54 Fresno, CA MSA 922,516 7,440
55 Birmingham, AL MSA 921,106 7,428
56 Honolulu, HI MSA 876,156 7,066
57 Albany--Schenectady--Troy, NY MSA 875,583 7,061
58 Tucson, AZ MSA 843,746 6,804
59 Tulsa, OK MSA 803,235 6,478
60 Syracuse, NY MSA 732,117 5,904
61 Omaha, NE--IA MSA 716,998 5,782
62 Albuquerque, NM MSA 712,738 5,748
63 Knoxville, TN MSA 687,249 5,542
64 El Paso, TX MSA 679,622 5,481
65 Bakersfield, CA MSA 661,645 5,336
66 Allentown--Bethlehem--Easton, PA MSA 637,958 5,145
67 Harrisburg--Lebanon--Carlisle, PA MSA 629,401 5,076
68 Scranton--Wilkes-Barre--Hazleton, PA MSA 624,776 5,039
69 Toledo, OH MSA 618,203 4,986
70 Baton Rouge, LA MSA 602,894 4,862
71 Youngstown--Warren, OH MSA 594,746 4,796
72 Springfield, MA MSA 591,932 4,774
73 Sarasota--Bradenton, FL MSA 589,959 4,758
74 Little Rock--North Little Rock, AR MSA 583,845 4,708
75 McAllen--Edinburg--Mission, TX MSA 569,463 4,592
76 Stockton--Lodi, CA MSA 563,598 4,545
77 Charleston--North Charleston, SC MSA 549,033 4,428
78 Wichita, KS MSA 545,220 4,397
79 Mobile, AL MSA 540,258 4,357
80 Columbia, SC MSA 536,691 4,328
81 Colorado Springs, CO MSA 516,929 4,169
82 Fort Wayne, IN MSA 502,141 4,050
83 Daytona Beach, FL MSA 493,175 3,977
84 Lakeland--Winter Haven, FL MSA 483,924 3,903
85 Johnson City--Kingsport--Bristol, TN--VA MSA 480,091 3,872
86 Lexington, KY MSA 479,198 3,865
87 Augusta--Aiken, GA--SC MSA 477,441 3,850
88 Melbourne--Titusville--Palm Bay, FL MSA 476,230 3,841
89 Lancaster, PA MSA 470,658 3,796
90 Chattanooga, TN--GA MSA 465,161 3,751
91 Des Moines, IA MSA 456,022 3,678
92 Kalamazoo--Battle Creek, MI MSA 452,851 3,652
93 Lansing--East Lansing, MI MSA 447,728 3,611
94 Modesto, CA MSA 446,997 3,605
95 Fort Myers--Cape Coral, FL MSA 440,888 3,556
96 Jackson, MS MSA 440,801 3,555
97 Boise City, ID MSA 432,345 3,487
98 Madison, WI MSA 426,526 3,440
99 Spokane, WA MSA 417,939 3,370
100 Pensacola, FL MSA 412,153 3,324
101 Canton--Massillon, OH MSA 406,934 3,282
102 Saginaw--Bay City--Midland, MI MSA 403,070 3,251
103 Salinas, CA MSA 401,762 3,240
104 Santa Barbara--Santa Maria--Lompoc, CA MSA 399,347 3,221
105 Shreveport--Bossier City, LA MSA 392,302 3,164
106 Lafayette, LA MSA 385,647 3,110
107 Beaumont--Port Arthur, TX MSA 385,090 3,106
108 York, PA MSA 381,751 3,079
109 Corpus Christi, TX MSA 380,783 3,071
110 Reading, PA MSA 373,638 3,013
111 Rockford, IL MSA 371,236 2,994
112 Provo--Orem, UT MSA 368,536 2,972
113 Visalia--Tulare--Porterville, CA MSA 368,021 2,968
114 Biloxi--Gulfport--Pascagoula, MS MSA 363,988 2,935
115 Ponce, PR MSA 361,094 2,912
116 Davenport--Moline--Rock Island, IA--IL MSA 359,062 2,896
117 Appleton--Oshkosh--Neenah, WI MSA 358,365 2,890
118 Peoria--Pekin, IL MSA 347,387 2,802
119 Huntsville, AL MSA 342,376 2,761
120 Hickory--Morganton--Lenoir, NC MSA 341,851 2,757
121 Reno, NV MSA 339,486 2,738
122 Brownsville--Harlingen--San Benito, TX MSA 335,227 2,703
123 Montgomery, AL MSA 333,055 2,686
124 Springfield, MO MSA 325,721 2,627
125 Eugene--Springfield, OR MSA 322,959 2,605
126 Macon, GA MSA 322,549 2,601
127 Fort Pierce--Port St. Lucie, FL MSA 319,426 2,576
128 Huntington--Ashland, WV--KY--OH MSA 315,538 2,545
129 Killeen--Temple, TX MSA 312,952 2,524
130 Fayetteville--Springdale--Rogers, AR MSA 311,121 2,509
131 Fayetteville, NC MSA 302,963 2,443
132 Utica--Rome, NY MSA 299,896 2,419
133 Evansville--Henderson, IN--KY MSA 296,195 2,389
134 New London--Norwich, CT--RI MSA 293,566 2,367
135 Savannah, GA MSA 293,000 2,363
136 Tallahassee, FL MSA 284,539 2,295
137 Erie, PA MSA 280,843 2,265
138 Columbus, GA--AL MSA 274,624 2,215
139 South Bend, IN MSA 265,559 2,142
140 Anchorage, AK MSA 260,283 2,099
141 Ocala, FL MSA 258,916 2,088
142 Mayaguez, PR MSA 253,347 2,043
143 Binghamton, NY MSA 252,320 2,035
144 Charleston, WV MSA 251,662 2,030
145 Fort Collins--Loveland, CO MSA 251,494 2,028
146 Naples, FL MSA 251,377 2,027
147 Lincoln, NE MSA 250,291 2,018
148 San Luis Obispo--Atascadero--Paso Robles, CA MSA 246,681 1,989
149 Duluth--Superior, MN--WI MSA 243,815 1,966
150 Portland, ME MSA 243,537 1,964
151 Lubbock, TX MSA 242,628 1,957
152 Odessa--Midland, TX MSA 237,132 1,912
153 Roanoke, VA MSA 235,932 1,903
154 Wilmington, NC MSA 233,450 1,883
155 Johnstown, PA MSA 232,621 1,876
156 Green Bay, WI MSA 226,778 1,829
157 Asheville, NC MSA 225,965 1,822
158 Yakima, WA MSA 222,581 1,795
159 Gainesville, FL MSA 217,955 1,758
160 Amarillo, TX MSA 217,858 1,757
161 Lynchburg, VA MSA 214,911 1,733
162 Waco, TX MSA 213,517 1,722
163 Merced, CA MSA 210,554 1,698
164 Longview--Marshall, TX MSA 208,780 1,684
165 Fort Smith, AR--OK MSA 207,290 1,672
166 Clarksville--Hopkinsville, TN--KY MSA 207,033 1,670
167 Chico--Paradise, CA MSA 203,171 1,638
168 Springfield, IL MSA 201,437 1,624
169 Myrtle Beach, SC MSA 196,629 1,586
170 Houma, LA MSA 194,477 1,568
171 Laredo, TX MSA 193,117 1,557
172 Richland--Kennewick--Pasco, WA MSA 191,822 1,547
173 Cedar Rapids, IA MSA 191,701 1,546
174 Lake Charles, LA MSA 183,577 1,480
175 Lafayette, IN MSA 182,821 1,474
176 Elkhart--Goshen, IN MSA 182,791 1,474
177 Medford--Ashland, OR MSA 181,269 1,462
178 Champaign--Urbana, IL MSA 179,669 1,449
179 Mansfield, OH MSA 175,818 1,418
180 Tyler, TX MSA 174,706 1,409
181 Las Cruces, NM MSA 174,682 1,409
182 Fargo--Moorhead, ND--MN MSA 174,367 1,406
183 Sioux Falls, SD MSA 172,412 1,390
184 Fort Walton Beach, FL MSA 170,498 1,375
185 Topeka, KS MSA 169,871 1,370
186 Burlington, VT MSA 169,391 1,366
187 St. Cloud, MN MSA 167,392 1,350
188 Bellingham, WA MSA 166,814 1,345
189 Tuscaloosa, AL MSA 164,875 1,330
190 Redding, CA MSA 163,256 1,317
191 Barnstable--Yarmouth, MA MSA 162,582 1,311
192 Benton Harbor, MI MSA 162,453 1,310
193 Yuma, AZ MSA 160,026 1,291
194 Charlottesville, VA MSA 159,576 1,287
195 Jackson, MI MSA 158,422 1,278
196 Joplin, MO MSA 157,322 1,269
197 Lima, OH MSA 155,084 1,251
198 Athens, GA MSA 153,444 1,237
199 Wheeling, WV--OH MSA 153,172 1,235
200 Bryan--College Station, TX MSA 152,415 1,229
201 Janesville--Beloit, WI MSA 152,307 1,228
202 Parkersburg--Marietta, WV--OH MSA 151,237 1,220
203 Bloomington--Normal, IL MSA 150,433 1,213
204 Jacksonville, NC MSA 150,355 1,213
205 Terre Haute, IN MSA 149,192 1,203
206 Eau Claire, WI MSA 148,337 1,196
207 Panama City, FL MSA 148,217 1,195
208 Santa Fe, NM MSA 147,635 1,191
209 Monroe, LA MSA 147,250 1,188
210 Aguadilla, PR MSA 146,424 1,181
211 Decatur, AL MSA 145,867 1,176
212 Rocky Mount, NC MSA 143,026 1,153
213 Florence, AL MSA 142,950 1,153
214 Punta Gorda, FL MSA 141,627 1,142
215 Pueblo, CO MSA 141,472 1,141
216 Wichita Falls, TX MSA 140,518 1,133
217 Jamestown, NY MSA 139,750 1,127
218 Yuba City, CA MSA 139,149 1,122
219 Dothan, AL MSA 137,916 1,112
220 State College, PA MSA 135,758 1,095
221 Columbia, MO MSA 135,454 1,092
222 Greenville, NC MSA 133,798 1,079
223 Steubenville--Weirton, OH--WV MSA 132,008 1,065
224 Texarkana, TX--Texarkana, AR MSA 129,749 1,046
225 Billings, MT MSA 129,352 1,043
226 Altoona, PA MSA 129,144 1,041
227 Waterloo--Cedar Falls, IA MSA 128,012 1,032
228 La Crosse, WI--MN MSA 126,838 1,023
229 Dover, DE MSA 126,697 1,022
230 Abilene, TX MSA 126,555 1,021
231 Alexandria, LA MSA 126,337 1,019
232 Wausau, WI MSA 125,834 1,015
233 Florence, SC MSA 125,761 1,014
234 Glens Falls, NY MSA 124,345 1,003
235 Rochester, MN MSA 124,277 1,002
236 Sioux City, IA--NE MSA 124,130 1,001
237 Flagstaff, AZ--UT MSA 122,366 987
238 Albany, GA MSA 120,822 974
239 Bloomington, IN MSA 120,563 972
240 Sharon, PA MSA 120,293 970
241 Williamsport, PA MSA 120,044 968
242 Muncie, IN MSA 118,769 958
243 Grand Junction, CO MSA 116,255 938
244 Auburn--Opelika, AL MSA 115,092 928
245 Lawton, OK MSA 114,996 927
246 Decatur, IL MSA 114,706 925
247 Goldsboro, NC MSA 113,329 914
248 Sheboygan, WI MSA 112,646 908
249 Anniston, AL MSA 112,249 905Leave a comment:
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Re: Medical care, under dire circumstances
This issue was being discussed on FT back in 2006. At that same time states were making vent purchases for pandemic preparedness (hopefully). Mellie was very much on top of this issue. Here are some old threads and extracts:
post #1:
Inside hospitals, shortfalls will go beyond beds. For example, Georgia predicts 20,000 of its citizens would need ventilators over the months of a severe pandemic. In the entire state, there are 1,500. Officials just bought 2,000 portable versions to truck to different hospitals as needed, but worry they won't be durable enough.
post #2:
MINNESOTA
Three major drills, including one involving 10,000 people, gave M&Ms to volunteers as practice for dispensing Tamiflu. The entire state has just 700 ventilators, and while there are plans to buy 300 more, the health department has begun talking with doctors about how they would make the difficult choices of who will get that care.
post#1:
Looking back at discussions and news articles from 2006 makes me appreciate all the H5N1 prep work that was done by various agencies. It may not be everything we want, but where would we be without it?The governor is proposing a new $400-million disaster-preparedness effort that would include about $50 million to buy face masks for medical workers, $100 million to buy ventilators, and $164 million for other medical supplies in the event of an outbreak of avian flu.
California Health and Human Services Secretary
.Leave a comment:
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Re: Medical care, under dire circumstances
That was the number for New York, nationwide would be a shortage of 271,755 x 2000 = $543,510,000 to save up to 2.5 million lives...Originally posted by tropical View Post
sounds like nothing after watching the recent bailouts...
so the answer is, if people knew how important this is, no one would question spending the money...AIG, which declined to comment, has received more than $80 billion in federal loans in successive bailouts since its near-collapse last September. In total, U.S. taxpayer aid of up to $180 billion has been extended to the insurer that once claimed global dominance.
The payments AIG is set to make next week were previously disclosed. About 40 senior managers were awarded some $9 million in performance bonuses for 2008 but payments were to be partly staggered throughout 2009, and contingent on certain targets related to AIG's restructuring.
AIG is in the midst of reducing liabilities at its financial products unit, and selling or spinning off some of its prized insurance operations in a bid to repay taxpayers.
In total, AIG last year agreed to pay in excess of $1 billion in retention payments and performance bonuses to employees across the organization, including to the financial products employees.
reuters
maybe AIG could do the right thing being an insurance company that will be crushed in a worse case scenario...
How about tossing in a half Billion $s to save as many lives as possible.Leave a comment:
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Re: Medical care, under dire circumstances
Well just to Clarify, those numbers were just for the State of New York...Originally posted by mixin View Post
Unless more were purchased, or if the 2000 actually were purchased,
we possibly have 6500 of the recommended 11,000-16,000.
It was also noted that contract solicitatian would be issued in early 2008 for the advanced development of next generation vents.
http://www.hhs.gov/asl/testify/2007/10/t20071003a.html
recalculate severe instead of 19M people, ~305M = ~2.5 Million deaths nationwide because of Ventilator shortages...In 2005, the U.S. Department of Health and Human Services estimated the toll from influenza pandemic using two scenarios. The state Health Department applied these to New York's 19 million-plus population with a 35 percent infection rate over a six-week duration. The moderate scenario reveals a 1,256 ventilator shortfall and 18,650 flu-related deaths. In the severe scenario, a 16,929 ventilator shortfall could lead to 153,301 deaths. Should H1N1 become more virulent, not only vaccines but ventilators will need to be rationed.
can you even imagine the relatives of all those people not understanding why their loved ones are being unplugged to give someone else a chance...
Imagine the parents of a dying child walking in with a suitcase full of money and laying it in front of the doctors and nurses saying it's yours if you leave our baby on for just a little longer...
who in the world would be strong enough to play God deciding who lives and who dies in a situation like this?Leave a comment:
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Re: Medical care, under dire circumstances
From the last numbers I saw, there were around 6500 vents in our stockpile as of the end of 2007. I don't know what the status is on the next-generation vents. Additionally, we have no idea how many people have been on the heart/lung machines instead of vents. I wonder how many of those we have?
----------------------------------------------------
On May 25, 2005, The Association for Respiratory Care did a study.
On the understanding there were 6,000 vents the Strategic National Stockpile, they recommended the current inventory be expanded by at least 5,000 to 10,000 more vents.
On June 5, 2006 the study was amended to include a notification from the CDC there were actually only 4000 vents in stock and another 486 were ordered but not yet received.
On October 3, 2007, testimony on the status of HHS pandemic plans state the goal is to purchase 2,000 vents in 2007.
Unless more were purchased, or if the 2000 actually were purchased,
we possibly have 6500 of the recommended 11,000-16,000.
It was also noted that contract solicitatian would be issued in early 2008 for the advanced development of next generation vents.
Leave a comment:
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Re: Medical care, under dire circumstances
#1:
"The moderate scenario reveals a 1,256 ventilator shortfall and 18,650 flu-related deaths. In the severe scenario, a 16,929 ventilator shortfall could lead to 153,301 deaths."
"Health emergency".
We live in a machined world.
Realy, why is it so mentaly blocking, to demand an surplus depot of enaugh probable needed ventilators, stocked by the "country", and payed by money from taxes?
Didn't the taxpayers want's more to have more vents which will save their and their's family lifes, than a few more concrete shores/..., or whatsoever?
We are now in a proclamed moderate scenario:
(one country projection from the source text) short for 1256 vents only;
1256 vents x 2000$ = 2.512.000 $
Could the above tax spending be prohibitive, and lead willingly to a state instaurate future deadly triages for 18.650 people?
Even the severe scenario:
16.929 vents x 2000$ = 33.858.000 $, instead of 153,301 deaths.
Could a few dozen bunch of dolar milions be enaugh to sacrifice in advance 153.301 citizens?
With all the previous gratis ireversible foraging of the Markets black holes with trilions ...
Would the citizens acclamate such decision if they are well aware now of it?Leave a comment:
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Re: Medical care, under dire circumstances
You are very welcome.
The vent decision will be a difficult one; that's why it's so important to have a non-emotional based plan now. It should be nation-wide, same for every hospital. There needs to be a plan for which patients will be transferred from one hospital to another.
And people need to know what to expect.
Can you imagine the reaction of the first grief-stricken parent who has to watch their child being pulled off the vent because he/she didn't score high enough?
I glanced at an article that was describing a new scoring system being considered that will be even faster, IIrc. I should have kept the link.Leave a comment:
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Re: Medical care, under dire circumstances
Thanks,Originally posted by mixin View Post
mixin for the link to your readable summary ! 
Decision making on ventilator allocation would be a horrible job .
Leave a comment:
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Re: Medical care, under dire circumstances
If I had a few hundred thousand dollars laying around, I'd be considering buying a few vents. IIrc, the prices run from $2,000 on up.
I don't know much about vents but from what I'm seeing, I wonder if the most advanced are the only ones that are saving some of the patients?
Of course the wealthy could buy the best AND hire the help needed to run it. Donate the vent to a hospital when it's all over and write it off on taxes.Leave a comment:
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Re: Medical care, under dire circumstances
That brings up a new area that will cause even a bigger shortage over the next few months...
I can already see drug dealers on the corners giving up on drugs and guns out there offering Ventilators...
"we've got the good stuff, and its still in a box..."
Those with money will still be able to get what they need...Leave a comment:
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Re: Medical care, under dire circumstances
For those who may not want to wade through that .pdf doc, here is the link to earlier discussion and my summary. I think this is one area of communication that really needs to be put out to the public often in the next month or two.
The thread is: Allocation of Ventilators in a Public Health Disaster http://www.flutrackers.com/forum/showthread.php?t=61803Leave a comment:
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Medical care, under dire circumstances
Medical care, under dire circumstances
First published: Sunday, July 26, 2009
When two or more patients need a ventilator, how do we decide who should receive the only one available? With the H1N1 influenza pandemic surging, we can expect this scenario.
The World Health Organization reports that "in past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks." Will vaccines mitigate the flu's impact?
With at least 50 countries ordering vaccines from GlaxoSmithKline and Novartis, hopes are high for first doses by September. But let us not be overconfident. Novartis has reported H1N1 vaccine production slow-downs because of low antigen yields. This means, according to WHO, that vaccine quantities will be insufficient by fall, and countries will receive half their needs.
University College London biochemical engineer Peter Dunnil predicts global vaccine-making capacities will not cover 10 percent of the world population.
If viral strains become more lethal, rising cases of respiratory distress will exacerbate the need for ventilators, already in short supply.
In 2005, the U.S. Department of Health and Human Services estimated the toll from influenza pandemic using two scenarios. The state Health Department applied these to New York's 19 million-plus population with a 35 percent infection rate over a six-week duration. The moderate scenario reveals a 1,256 ventilator shortfall and 18,650 flu-related deaths. In the severe scenario, a 16,929 ventilator shortfall could lead to 153,301 deaths. Should H1N1 become more virulent, not only vaccines but ventilators will need to be rationed.
The Health Department recognized this when it has asked the New York State Task Force on Life & the Law to establish ethical guidelines for distributing ventilators. The task force's planning document, "Allocation of Ventilators in an Influenza Pandemic," tackles these hard-hitting questions (http://www.health.state.ny.us/diseas...c/ventilators/).
During a pandemic, when ventilators are in short supply in acute care settings, who gets them first? The report says priority should go to the "patient with pulmonary failure who has the best chance of survival with ventilatory support, based on objective clinical criteria." This means withdrawing ventilators from patients most likely to die regardless of treatment. However, the group rejects applying an incoming patient's prospective benefit as the barometer to gauge an existing ventilator-dependent patient's prognosis.
The group recommends that physicians who are "triage officers" make this decision, not one's primary physician. The report underscores that rationing depends strictly on medical prognosis -- that is, the likelihood of survival and recovery from ventilator treatment -- and not on age or occupation.
This differs from an earlier report by the Ethics Subcommittee of the Advisory Committee to the Director, Centers for Disease Control and Prevention. According to "Ethical Guidelines in Pandemic Influenza" (http://www.cdc.gov/od/science/phethi...Guidelines.pdf), "individuals who are essential to the provision of health care, public safety and the functioning of key aspects of society should receive priority in the distribution of vaccine, antivirals, and other scarce resources" (my emphasis).
Should occupation matter? Which aims are more ethically tenable: maximal survival or restoring and sustaining public order and function? How do we measure social worth? Who decides?
Dire circumstances signal the need for altered standards of care. To what degree will the community be engaged in guidelines that will directly impact all of us?
The Health Department guidelines are not yet finalized. You can comment by e-mail to PanFlu@health.state.ny.us.
Public response, discussion, and engagement are crucial.
Michael Brannigan is the Pfaff Endowed Chair in Ethics and Moral Values at The College of Saint Rose. His e-mail address is michael.brannigan@strose.edu.
Leave a comment: