Amid growing fears that the United States could face a shortage of ventilators for coronavirus patients, state officials and hospitals are quietly preparing to make excruciating decisions about how they would ration lifesaving care.The plans may not be necessary, as officials are scrambling to secure more ventilators, which can make the difference between life and death for coronavirus patients in critical condition who are struggling to breathe. Social distancing and other mitigation efforts to slow the virus' spread could prevent hospitals from being overwhelmed. But hospitals are already huddling with state health officials to hammer out their policies to determine which coronavirus patients would get ventilators if they run short — essentially deciding whose lives to save first.In Maryland, state officials are in discussions with the biggest hospital systems in the region about how to factor in age, pre-existing health conditions, overall life expectancy and other criteria to determine which patients would have priority if there are not enough ventilators, said Dr. David Marcozzi, who is directing the coronavirus response for the University of Maryland Medical System, which has 14 hospitals."These are conversations that no one wants to have. But we need to have these conversations just in case," said Marcozzi, who has been appointed to the state's coronavirus response team. "We need to put steps in place to ensure the public's confidence that those difficult decisions will be made with the greatest care."States are revisiting recommendations that many began developing in the aftermath of Hurricane Katrina 15 years ago, when medical providers hastened the deaths of some patients after their hospital lost power. The goal is to provide hospitals with consistent, transparent guidance for patient care when lifesaving resources are scarce — part of a framework known as "crisis standards of care," which prioritize the survival of the group over the survival of the individual patient during disasters. Minnesota's patient care guidelines also include a detailed breakdown of the factors used to determine whether a ventilator will be withheld or removed from patients, including their response to the treatment, likelihood of death and underlying conditions, such as severe chronic lung disease, congestive heart failure and cirrhosis. The state also details strategies for palliative care to relieve pain, explaining that "it may be the only care that is able to be provided due to the patient's prognosis and available resources."New York's ventilator guidance does not specify the medical conditions that would exclude patients from being ventilated. Instead, it recommends that hospitals create a list of such conditions based on “immediate or near-immediate mortality even with aggressive therapy”; rate patients based on their likelihood of survival; and use trials to determine how much they are medically benefiting from a ventilator.Download the NBC News app for full coverage of the coronavirus outbreakAge should be used only as a tiebreaker, the New York state panel said, and health care workers and first responders should not get priority over others. By contrast, Michigan's guidelines specify that hospitals could choose to prioritize workers performing "essential social functions" — including doctors and nurses treating patients, as well as police, military members and firefighters — to receive scarce resources like ventilators and ICU beds.Disaster planning experts stress that it is crucial to create such guidance ahead of time — and to separate the decision-making process from the doctors on the front lines of caregiving."Without prior planning, you're going to have these life-or-death decisions made by clinical staff not trained in this, who are exhausted and overworked," Powell said.Disaster response experts stress that there is still time for the public and officials to act to avoid forcing hospitals to make such painful choices."It all depends on how effective our social controls are — how much can we flatten the curve?" Hick said, referring to the social distancing measures the public can take to slow the virus. "Some cities are on their way to crisis. We're holding our breath."
Source : aol.com/news
Source : aol.com/news