Solving Life-And-Death Dilemmas During Disasters

Main Category: Aid / Disasters
Article Date: 11 Mar 2008 - 1:00 PDT

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During a public health emergency when the number of patients exceeds the available medical resources, how do health care facilities determine who receives treatment? New York state developed new model guidelines for addressing this ethical and clinical dilemma when allocating limited ventilators, the topic of a new study published in the latest issue of the American Medical Association's (AMA) Disaster Medicine and Public Health Preparedness journal.

The study, "Allocation of Ventilators in a Public Health Disaster," outlines eight steps established by experts in medicine, policymaking, law, and ethics to prepare for and to make decisions during a disaster when more patients require ventilators than can be accommodated. The guidelines include requiring decisions be made jointly by multiple health care providers to ensure just allocation of ventilators and access to ventilators based solely on medical factors at the time of a disaster.

"An absence of guidelines leaves allocation decisions to exhausted frontline providers and amounts to a failure of responsibility to both patients and providers," said lead author Tia Powell, MD, executive director of New York State Task Force on Life and the Law. "These guidelines for allocating ventilators rely upon both ethical and clinical standards to offer the best possible care under gravely compromised conditions and represent a radical shift from ordinary standards of care."

In a time of crisis, professional ethics cannot be set aside. As part of the guidelines, an ethical framework was established to create a foundation for allocating ventilators.

"Incorporating the ethical framework, the guidelines propose both withholding and withdrawing ventilators from patients with the highest probability of mortality to benefit patients with the highest likelihood of survival," said Dr. Powell.

The guidelines are released for public comment to allow for revisions that will reflect both community values and medical innovation. Although these guidelines focus on ventilator allocation, the process can serve as a template for the development of other polices regarding the allocation of scarce resources in public health emergencies.

Additional articles in the March issue of the AMA disaster journal include:

- "Chronic Disease and Related Conditions at Emergency-Treatment Facilities After Hurricane Katrina - New Orleans Area, Louisiana"

- "Trial of Prophylactic Inhaled Steroids to Prevent or Reduce Pulmonary Function Decline, Pulmonary Symptoms in Airway Hyperactivity in Firefighters at the World Trade Center Site" (Presented at CHEST 2007)

- "Implementing the Cities Readiness Initiative: Lessons Learned from Boston"

To obtain complete online access to the journal, contact AMA Media Relations at (312) 464-4813 and provide appropriate press credentials. The AMA's Disaster Medicine and Public Health Preparedness journal maintains editorial independence and the statements and opinions in the journal, including the articles referenced above, are not those of the AMA or Lippincott Williams & Wilkins. The next issue of the journal is scheduled for publication in June 2008.

About AMA's Disaster Medicine and Public Health Preparedness Journal

The AMA Disaster Medicine and Public Health Preparedness journal was created to promote public health preparedness and the science of disaster medicine. It is the first comprehensive, peer-reviewed publication emphasizing public health preparedness and disaster response. The journal is published for the AMA by leading health care publisher Lippincott Williams & Wilkins An online version can be found on the web at http://www.dmphp.org

American Medical Association