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N.S health-care disaster plan in works
Last Updated: Thursday, February 11, 2010 | 8:39 AM ET
CBC News
In a major crisis, doctors would deny ICU beds to patients with the greatest chance of dying. (CBC)
A team of health experts has drafted a plan to ration critical care for a worst-case scenario, in which a deadly pandemic overwhelms Nova Scotia's health-care system.
The triage plan would be triggered during an unprecedented health crisis, when 80 per cent of the intensive-care beds in Nova Scotia hospitals were full and demand continued to outstrip resources.
Under the proposed guidelines, patients who were deemed to have only a 10 to 20 per cent chance of survival would be denied intensive care to make way for those with a greater chance. They could appeal, but would have to do so within 30 minutes.
For doctors, in essence, the philosophy shifts from dealing with the sickest patients first to providing care to the greatest number who would benefit the most.
Some patients would die as a result, said Dr. Ward Patrick, a member of the government task force that developed the plan.
"None of us want to do this," he told CBC News. "We're much happier providing care for patients than we are denying care to patients."
Patrick is in charge of critical care at the QEII Health Sciences Centre in Halifax. He spent nine months working on a plan he hopes he never has to implement. However, he said, having a clear set of rules will help everyone.
"The alternative is much worse. Going into a pandemic when it's this bad with no predefined criteria and making decisions arbitrarily will be much worse," he told CBC News.
The draft plan is designed to come into force if Nova Scotia were hit with a much deadlier and more widespread crisis than the recent H1N1 pandemic. Seven people in the province have died from the virus as of Jan. 28, according to the Public Health Agency of Canada.
There are about 250 intensive-care unit beds in Nova Scotia, though hospitals can add another 150 if they have the staff. But since four health workers are needed per bed and many could be sick during a crisis, it's unclear how many extra beds could be made available.
Whatever the number, someone in the ICU who is on a ventilator, for example, would be moved out of the unit to make way for another patient who meets the new criteria.
Patrick admits the new pandemic triage system would be difficult on patients denied ICU care, as well as their families.
"The immediate reaction to this will probably be, 'This can't be,'" he said.
"But over time I think if people are given an opportunity to understand the kind of ethical underpinnings for this, to understand the kind of pain that went into actually putting this together, then I think they will start to have some comfort."
Patrick said patients removed from the ICU would still get care outside of the specialized unit.
Right to appeal
He said anyone who found themselves in this situation would have the right to appeal, something he said makes Nova Scotia's pandemic plan unique in Canada.
Under the plan, a patient or family would have to file an appeal within 30 minutes of being denied access to an ICU, and the hospital would review the file and render a decision within an hour. Speed is vital so that a patient doesn't languish in an emergency room waiting for a decision, Patrick said.
The provincial Health Department plans to post the draft plan on its website and seek feedback. There could be changes made after that.
In Ontario, officials added a specific age restriction to their pandemic triage plan after hearing from the public. It now states that anyone over the age of 85 would be denied an ICU bed during a crisis.
Read more: http://www.cbc.ca/health/story/2010/02/11/ns-icu-pandemic-beds.html#ixzz0fFfMSICy
Last Updated: Thursday, February 11, 2010 | 8:39 AM ET
CBC News
In a major crisis, doctors would deny ICU beds to patients with the greatest chance of dying. (CBC)
A team of health experts has drafted a plan to ration critical care for a worst-case scenario, in which a deadly pandemic overwhelms Nova Scotia's health-care system.
The triage plan would be triggered during an unprecedented health crisis, when 80 per cent of the intensive-care beds in Nova Scotia hospitals were full and demand continued to outstrip resources.
Under the proposed guidelines, patients who were deemed to have only a 10 to 20 per cent chance of survival would be denied intensive care to make way for those with a greater chance. They could appeal, but would have to do so within 30 minutes.
For doctors, in essence, the philosophy shifts from dealing with the sickest patients first to providing care to the greatest number who would benefit the most.
Some patients would die as a result, said Dr. Ward Patrick, a member of the government task force that developed the plan.
"None of us want to do this," he told CBC News. "We're much happier providing care for patients than we are denying care to patients."
Patrick is in charge of critical care at the QEII Health Sciences Centre in Halifax. He spent nine months working on a plan he hopes he never has to implement. However, he said, having a clear set of rules will help everyone.
"The alternative is much worse. Going into a pandemic when it's this bad with no predefined criteria and making decisions arbitrarily will be much worse," he told CBC News.
The draft plan is designed to come into force if Nova Scotia were hit with a much deadlier and more widespread crisis than the recent H1N1 pandemic. Seven people in the province have died from the virus as of Jan. 28, according to the Public Health Agency of Canada.
There are about 250 intensive-care unit beds in Nova Scotia, though hospitals can add another 150 if they have the staff. But since four health workers are needed per bed and many could be sick during a crisis, it's unclear how many extra beds could be made available.
Whatever the number, someone in the ICU who is on a ventilator, for example, would be moved out of the unit to make way for another patient who meets the new criteria.
Patrick admits the new pandemic triage system would be difficult on patients denied ICU care, as well as their families.
"The immediate reaction to this will probably be, 'This can't be,'" he said.
"But over time I think if people are given an opportunity to understand the kind of ethical underpinnings for this, to understand the kind of pain that went into actually putting this together, then I think they will start to have some comfort."
Patrick said patients removed from the ICU would still get care outside of the specialized unit.
Right to appeal
He said anyone who found themselves in this situation would have the right to appeal, something he said makes Nova Scotia's pandemic plan unique in Canada.
Under the plan, a patient or family would have to file an appeal within 30 minutes of being denied access to an ICU, and the hospital would review the file and render a decision within an hour. Speed is vital so that a patient doesn't languish in an emergency room waiting for a decision, Patrick said.
The provincial Health Department plans to post the draft plan on its website and seek feedback. There could be changes made after that.
In Ontario, officials added a specific age restriction to their pandemic triage plan after hearing from the public. It now states that anyone over the age of 85 would be denied an ICU bed during a crisis.
Read more: http://www.cbc.ca/health/story/2010/02/11/ns-icu-pandemic-beds.html#ixzz0fFfMSICy