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Shrestha GS, Battaglini D, Sodhi K, Schultz MJ. Medical Triage: Ethical Implications and Management Strategies. Anesthesiol Clin 2024; 42:457-472. [PMID: 39054020 DOI: 10.1016/j.anclin.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Natural or man-made medical disasters have repeatedly affected human communities. The impact on health care resources may vary depending on the magnitude of each crisis, catastrophe or pandemic, and the resources available. Medical triage protocols serve as invaluable tools to address clinical needs, particularly when resources, including supplies, equipment, and personnel, are limited. Although resources should be allocated to maximize the benefit, resource allocations need to be ethically sound. Existing triage protocols have inherent limitations.
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Affiliation(s)
- Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
| | - Denise Battaglini
- Department of Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
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Cheung W, Naganathan V, Myburgh J, Saxena MK, Fiona B, Seppelt I, Parr M, Hooker C, Kerridge I, Nguyen N, Kelly S, Skowronski G, Hammond N, Attokaran A, Chalmers D, Gandhi K, Kol M, McGuinness S, Nair P, Nayyar V, Orford N, Parke R, Shah A, Wagh A. A survey of Australian public opinion on using comorbidity to triage intensive care patients in a pandemic. AUST HEALTH REV 2024; 48:459-468. [PMID: 38763888 DOI: 10.1071/ah23265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/15/2024] [Indexed: 05/21/2024]
Abstract
Objectives This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy.
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Affiliation(s)
- Winston Cheung
- Intensive Care Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia; and Sydney Medical School - Concord, University of Sydney, Sydney, NSW, Australia; and Critical Care and Trauma Division, The George Institute for Global Health - Australia, Newtown, NSW, Australia
| | - Vasi Naganathan
- Sydney Medical School - Concord, University of Sydney, Sydney, NSW, Australia; and Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - John Myburgh
- Critical Care and Trauma Division, The George Institute for Global Health - Australia, Newtown, NSW, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; and Department of Intensive Care Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Manoj K Saxena
- Critical Care and Trauma Division, The George Institute for Global Health - Australia, Newtown, NSW, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; and Department of Intensive Care Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Blyth Fiona
- Sydney Medical School - Concord, University of Sydney, Sydney, NSW, Australia
| | - Ian Seppelt
- Critical Care and Trauma Division, The George Institute for Global Health - Australia, Newtown, NSW, Australia; and Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia; and Sydney Medical School - Nepean, University of Sydney, Sydney, NSW, Australia; and Australian School of Advanced Medicine, Macquarie University, NSW, Australia
| | - Michael Parr
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; and Department of Intensive Care, Liverpool Hospital, Sydney, NSW, Australia
| | - Claire Hooker
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Nhi Nguyen
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia; and Intensive Care NSW, NSW Agency for Clinical Innovation, NSW, Australia
| | - Sean Kelly
- Intensive Care NSW, NSW Agency for Clinical Innovation, NSW, Australia; and Intensive Care Unit, Gosford Hospital, Gosford, NSW, Australia
| | - George Skowronski
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; and Department of Intensive Care Medicine, St George Hospital, Kogarah, NSW, Australia; and Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Naomi Hammond
- Critical Care and Trauma Division, The George Institute for Global Health - Australia, Newtown, NSW, Australia
| | - Antony Attokaran
- Intensive Care Unit, Rockhampton Hospital, Rockhampton, Qld, Australia
| | - Debbie Chalmers
- Intensive Care Unit, Hawke's Bay Fallen Soldier's Memorial Hospital, Hastings, New Zealand; and Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Kalpesh Gandhi
- Department of Intensive Care, Blacktown Hospital, Blacktown, Sydney, NSW, Australia
| | - Mark Kol
- Intensive Care Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia; and Sydney Medical School - Concord, University of Sydney, Sydney, NSW, Australia
| | - Shay McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand; and Medical Research Institute of New Zealand, Wellington, New Zealand; and Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic., Australia
| | - Priya Nair
- Critical Care and Trauma Division, The George Institute for Global Health - Australia, Newtown, NSW, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; and Intensive Care Unit, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Vineet Nayyar
- Intensive Care Unit, Westmead Hospital, Westmead, NSW, Australia; and Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Neil Orford
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic., Australia; and Intensive Care Unit, University Hospital Geelong, Vic., Australia; and School of Medicine, Deakin University, Geelong, Vic., Australia; and Intensive Care Unit, St John of God Hospital, Geelong, Vic., Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand; and Medical Research Institute of New Zealand, Wellington, New Zealand; and Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic., Australia; and School of Nursing, University of Auckland, Auckland, New Zealand
| | - Asim Shah
- Intensive Care Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia; and Sydney Medical School - Concord, University of Sydney, Sydney, NSW, Australia
| | - Atul Wagh
- Intensive Care Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia; and Sydney Medical School - Concord, University of Sydney, Sydney, NSW, Australia
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Putra A, Petpichetchian W, Maneewatt K. A Survey Study of Public Health Nurses’ Knowledge in Disaster Management in Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This descriptive survey study examines the level of public health nurses’ (PHNs) knowledge regarding disaster management. The knowledge was examined according to three disaster phases, including preparedness, response, and recovery phase.
MATERIALS & METHODS: A stratified proportionate random sampling method was employed to recruit 252 PHNs of Aceh Province, Indonesia. The data were collected during November and December of 2010 by using the questionnaire developed by the researchers. They were analyzed using frequencies, percentages, means, standard deviations, and minimum and maximum scores. Additional analyses were performed to identify potential contributing factors to the PHNs' knowledge using the Spearman rank correlation (rs) and the Mann-Whitney U test.
RESULTS: The finding showed that PHNs' knowledge in disaster management was moderate (M=70.73%, SD=8.41), and nearly half of the subjects (42.5%) were categorized in this level. The lowest mean score was found in the response phase (64.75%), and four items with the lowest percentage of correct answers were also found in this phase.
CONCLUSION: The low level of knowledge for the response phase can be used to flag health policymakers and public health centers (PHC) to develop appropriate educational training and disaster drills for PHNs in collaboration with stakeholders in the community.
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Abbasi-Kangevari M, Arshi S, Hassanian-Moghaddam H, Kolahi AA. Public Opinion on Priorities Toward Fair Allocation of Ventilators During COVID-19 Pandemic: A Nationwide Survey. Front Public Health 2021; 9:753048. [PMID: 34970524 PMCID: PMC8712311 DOI: 10.3389/fpubh.2021.753048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The rapidly growing imbalance between supply and demand for ventilators during the COVID-19 pandemic has highlighted the principles for fair allocation of scarce resources. Failing to address public views and concerns on the subject could fuel distrust. The objective of this study was to determine the priorities of the Iranian public toward the fair allocation of ventilators during the COVID-19 pandemic. Methods: This anonymous community-based national study was conducted from May 28 to Aug 20, 2020, in Iran. Data were collected via the Google Forms platform, using an online self-administrative questionnaire. The questionnaire assessed participants' assigned prioritization scores for ventilators based on medical and non-medical criteria. To quantify participants' responses on prioritizing ventilator allocation among sub-groups of patients with COVID-19 who need mechanical ventilation scores ranging from -2, very low priority, to +2, very high priority were assigned to each response. Results: Responses of 2,043 participants, 1,189 women, and 1,012 men, were analyzed. The mean (SD) age was 31.1 (9.5), being 32.1 (9.3) among women, and 29.9 (9.6) among men. Among all participants, 274 (13.4%) were healthcare workers. The median of assigned priority score was zero (equal) for gender, age 41-80, nationality, religion, socioeconomic, high-profile governmental position, high-profile occupation, being celebrities, employment status, smoking status, drug abuse, end-stage status, and obesity. The median assigned priority score was +2 (very high priority) for pregnancy, and having <2 years old children. The median assigned priority score was +1 (high priority) for physicians and nurses of patients with COVID-19, patients with nobel research position, those aged <40 years, those with underlying disease, immunocompromise status, and malignancy. Age>80 was the only factor participants assigned -1 (low priority) to. Conclusions: Participants stated that socioeconomic factors, except for age>80, should not be involved in prioritizing mechanical ventilators at the time of resources scarcity. Front-line physicians and nurses of COVID-19 patients, pregnant mothers, mothers who had children under 2 years old were given high priority.
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Affiliation(s)
| | | | | | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ghanbari V, Ardalan A, Zareiyan A, Nejati A, Hanfling D, Bagheri A, Rostamnia L. Perceptions on principle of priority setting in disaster triage: A Q-method study. Int Emerg Nurs 2021; 59:101064. [PMID: 34563940 DOI: 10.1016/j.ienj.2021.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION An ethical plan is required to make decisions regarding setting the priority for assisting injured patients through triage. The aim of this study was to explore the measures used to sort patients for ethical decision-making in disaster triage. METHOD The participants were 54 clinicians and non-clinicians among the Iranian experts. Q-statements were selected from a literature review and face-to-face interviews. Data were analyzed by principal components factor analysis (PCA), Varimax, and hand-rotation techniques. RESULTS Distinct perspectives included: Saving patients with greater medical needs, survivability of patients and the community, providing effective treatment based on available capacity, maximizing health gain, supporting the human generation and productive and independent lives. Approximately 61% of the variance in decision is explained by these factors. CONCLUSION A combination of saving more people and more positive outcomes has been accepted to make an ethical decision in triage. Public engagement needs to reach a more acceptable view of patients' prioritizing factors in a scarce-resource situation.
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Affiliation(s)
- Vahid Ghanbari
- Emergency Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Ali Ardalan
- Health in Disaster and Emergencies Department, School of Public Health, Tehran University of Medical Sciences, Avecina Ave, Keshavarz Boulevard, Tehran, Iran.
| | - Armin Zareiyan
- Health in Disaster and Emergencies Department, School of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Amir Nejati
- Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Dan Hanfling
- MD; Clinical Professor of Emergency Medicine, George Washington University, Washington, DC, United States
| | - Alireza Bagheri
- Center for Medical Ethics and History of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leili Rostamnia
- Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Thorsteinsdottir B, Madsen BE. Prioritizing health care workers and first responders for access to the COVID19 vaccine is not unethical, but both fair and effective - an ethical analysis. Scand J Trauma Resusc Emerg Med 2021; 29:77. [PMID: 34088336 PMCID: PMC8177265 DOI: 10.1186/s13049-021-00886-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 01/11/2023] Open
Abstract
The Nordic countries have differed in their approach as to how much priority for COVID19 vaccine access should be given to health care workers. Two countries decided not to give health care workers highest priority, raising some controversy. The rationale was that those at highest risk of dying needed to come first. However, when it comes to protecting those at the highest risk of dying from COVID19, their needs and vulnerabilities need to be considered more broadly than just in terms of the individual protection that vaccination will afford them. Likewise, when considering whether to prioritize health care workers for the vaccine, their crucial role in keeping the health care system operational, and right to a safe work environment need to be factored in. Below we review several ethical arguments for why frontline health care workers and first responders should receive priority access to the COVID19 vaccine.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Department of Medicine, Division of Community Internal Medicine, Program in Bioethics, Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Bo Enemark Madsen
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905 USA
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Gold A, Greenberg B, Strous R, Asman O. When do caregivers ignore the veil of ignorance? An empirical study on medical triage decision-making. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:213-225. [PMID: 33398490 PMCID: PMC7781192 DOI: 10.1007/s11019-020-09992-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations ("worst-first"). This study empirically examined the influence of value-oriented considerations on medical triage decision-making. Participants were asked to prioritize medical treatment relating to four case scenarios of an emergency situation resulting from a car collision. The cases differ by situational characteristics pertaining to the at-fault driver, which were related to culpability attribution.In three case scenarios most participants gave priority to the most severely injured individual, unless the less severely injured individual was their brother. Nevertheless, in the aftermath of a vehicle-ramming terror attack most participants prioritized the less severely injured individual ("victim-first").Our findings indicate that when caregivers are presented with concrete highly conflictual triage situations their choices may be based on value-oriented considerations related to contextual characteristics of the emergency situation. Philosophical and practical ramifications of our findings are discussed.
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Affiliation(s)
- Azgad Gold
- Forensic Psychiatry Unit, Yehuda Abarbanel Mental Health Center, Bat Yam, Israel
| | - Binyamin Greenberg
- Adolescent Psychiatry Department, Beer Yaakov-Ness Ziona Mental Health Center, Beer Yaakov, Israel
| | - Rael Strous
- Psychiatry Department, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Oren Asman
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
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Ghazanchaei E, Mohebbi I, Nouri F, Aghazadeh-Attari J, Khorasani-Zavareh D. Non-communicable diseases in disasters: a protocol for a systematic review. J Inj Violence Res 2021; 13:61-68. [PMID: 33459280 PMCID: PMC8142338 DOI: 10.5249/jivr.v13i1.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 12/19/2020] [Indexed: 12/05/2022] Open
Abstract
Background: NCDs require an ongoing management for optimal outcomes, which is challenging in emergency settings, because natural disasters increase the risk of acute NCD exacerbations and lead to health systems’ inability to respond. This study aims to develop a protocol for a systematic review on non-communicable diseases in natural disaster settings. Methods: This systematic review protocol is submitted to the International Prospective Register of Systematic Reviews (Registration No. CRD42020164032). The electronic databases to be used in this study include: Medline, Scopus, Web of Science, Clinical Key, CINAHL, EBSCO, Ovid, EMBASE, ProQuest, Google Scholar, Cochrane Library (Cochrane database of systematic reviews; Cochrane central Register of controlled Trials). Records from 1997 to 2019 are subject to this investigation. Three independent researchers will review the titles, abstracts, and full texts of articles eligible for inclusion, and if not matched, they will be reviewed by a final fourth reviewer. The proposed systematic review will be reported in accordance with the reporting guideline provided in the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. We select studies based on: PICOs (Participants, Interventions, Comparators, and Outcomes). Results: This systematic review identifies any impacts of natural disasters on patients with NCDs in three stages i.e. before, during and in the aftermath of natural disasters. Conclusions: A comprehensive response to NCD management in natural disasters is an important but neglected aspect of non-communicable disease control and humanitarian response, which can significantly reduce the potential risk of morbidity and mortality associated with natural disasters.
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Affiliation(s)
- Elham Ghazanchaei
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Fatemeh Nouri
- Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Aghazadeh-Attari
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Davoud Khorasani-Zavareh
- Workplace Health Promotion Research Center, Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Burdiles P, Pommier AO. EL TRIAJE EN PANDEMIA: FUNDAMENTOS ÉTICOS PARA LA ASIGNACIÓN DE RECURSOS DE SOPORTE VITAL AVANZADO EN ESCENARIOS DE ESCASEZ. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [PMCID: PMC7849484 DOI: 10.1016/j.rmclc.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Las pandemias y otras catástrofes de alto impacto sanitario azotan periódicamente a la humanidad, aumentando desproporcionadamente la demanda por atención en servicios de urgencia, unidades de cuidados intensivos y medios de soporte vital avanzado. Este desequilibrio obliga a una compleja toma de decisiones en que se deben asignar recursos proporcionalmente escasos en relación a una gran demanda. Así, los equipos clínicos asistenciales necesitan actuar bajo criterios consensuados, que orienten sus decisiones y alivien la pesada carga moral de seleccionar pacientes para terapias, en detrimento de otros. El triaje es una estrategia que permite establecer, bajo racionalidades propias a cada escenario, objetivos y criterios que faciliten la toma de decisiones complejas para el logro del mejor resultado. Estas estrategias deben considerar el marco de valores intangibles que apreciamos y que nos identifican cultural y socialmente, como son el respeto a la vida, la igualdad, la justicia y la libertad. Sin embargo, en escenarios excepcionales como el de la actual pandemia COVID-19, en que el sistema sanitario puede no dar abasto, deberán establecerse objetivos prioritarios, como salvar la mayor cantidad de vida, del modo más humano, justo y eficiente posible. A la vez, deberán redefinirse jerarquías en los valores y principios clásicos de la práctica clínica cotidiana, adecuadas a la catástrofe sanitaria, bajo una ética propia de la salud pública, el mayor bien para la mayoría y el mejor cuidado de los que no pueden ser curados.
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Ashworth H, Soled D, Morse M. Rethinking the Principle of Justice for Marginalized Populations During COVID-19. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:611-621. [PMID: 35006052 DOI: 10.1017/jme.2021.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the face of limited resources during the COVID-19 pandemic response, public health experts and ethicists have sought to apply guiding principles in determining how those resources, including vaccines, should be allocated.
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Dos Santos MJ, Martins MS, Santana FLP, Furtado MCSPC, Miname FCBR, Pimentel RRDS, Brito ÁN, Schneider P, Dos Santos ES, da Silva LH. COVID-19: instruments for the allocation of mechanical ventilators-a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:582. [PMID: 32993736 PMCID: PMC7522926 DOI: 10.1186/s13054-020-03298-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/17/2020] [Indexed: 01/11/2023]
Abstract
After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.
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Affiliation(s)
- Marcelo José Dos Santos
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil. .,Departamento de Orientação Profissional, Escola de Enfermagem da Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 419, CEP - 05403-000 Cerqueira Cesar, São Paulo, SP, Brazil.
| | - Maristela Santini Martins
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Fabiana Lopes Pereira Santana
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Rafael Rodrigo da Silva Pimentel
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Ágata Nunes Brito
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Patrick Schneider
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Edson Silva Dos Santos
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
| | - Luciane Hupalo da Silva
- Research Group "Bioethics and Administration: Teaching and Health Care", Nursing School of University of São Paulo, São Paulo, SP, Brazil
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Abstract
Disaster medicine refers to situations in which the need to care for patients outweighs the available resources. It is imperative for anesthesiologists to be involved at a leadership level in mass casualty/disaster preparedness planning. Mass casualty disaster plans should be clear, concise, and easy to follow. Terror events and natural disasters can differ significantly in anesthesia preparedness. Resiliency is an important aspect of the recovery phase that decreases psychological damage in the aftermath of a mass casualty event.
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Affiliation(s)
- Alison R Perate
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Leonardi M, Lee H, van der Veen S, Maribo T, Cuenot M, Simon L, Paltamaa J, Maart S, Tucker C, Besstrashnova Y, Shosmin A, Cid D, Almborg AH, Anttila H, Yamada S, Frattura L, Zavaroni C, Zhuoying Q, Martinuzzi A, Martinuzzi M, Magnani FG, Snyman S, El Oumri AA, Sylvain N, Layton N, Sykes C, Saleeby PW, Winkler AS, de Camargo OK. Avoiding the Banality of Evil in Times of COVID-19: Thinking Differently with a Biopsychosocial Perspective for Future Health and Social Policies Development. ACTA ACUST UNITED AC 2020; 2:1758-1760. [PMID: 32905109 PMCID: PMC7462656 DOI: 10.1007/s42399-020-00486-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/01/2022]
Abstract
The COVID-19 pandemic provides the opportunity to re-think health policies and health systems approaches by the adoption of a biopsychosocial perspective, thus acting on environmental factors so as to increase facilitators and diminish barriers. Specifically, vulnerable people should not face discrimination because of their vulnerability in the allocation of care or life-sustaining treatments. Adoption of biopsychosocial model helps to identify key elements where to act to diminish effects of the pandemics. The pandemic showed us that barriers in health care organization affect mostly those that are vulnerable and can suffer discrimination not because of severity of diseases but just because of their vulnerability, be this age or disability and this can be avoided by biopsychosocial planning in health and social policies. It is possible to avoid the banality of evil, intended as lack of thinking on what we do when we do, by using the emergence of the emergency of COVID-19 as a Trojan horse to achieve some of the sustainable development goals such as universal health coverage and equity in access, thus acting on environmental factors is the key for global health improvement.
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Affiliation(s)
- Matilde Leonardi
- UOC Neurology, Public Health, Disability, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Sabina van der Veen
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Marie Cuenot
- School of public Health, École des hautes études en santé publique (EHESP), Rennes, France
| | - Liane Simon
- MSH Medical School Hamburg, Hamburg, Germany
| | | | - Soraya Maart
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carole Tucker
- College of Public Health, Temple University, Philadelphia, PA USA
| | - Yanina Besstrashnova
- Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, St. Petersburg, Russia
| | - Alexander Shosmin
- Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, St. Petersburg, Russia
| | - Daniel Cid
- Centre for Innovations and Development in Healthcare (CIDEAS), Santiago del Chile, Chile
| | | | - Heidi Anttila
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Lucilla Frattura
- Strategical Directorate, Classification Area, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Carlo Zavaroni
- Strategical Directorate, Classification Area, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Qiu Zhuoying
- Research Institute of Rehabilitation Information, China Rehabilitation Research Center/WHO-FIC CC China, Beijing, China
| | - Andrea Martinuzzi
- Department of Conegliano-Pieve di Soligo, IRCCS E. Medea Scientific Institute, Conegliano, Italy
| | | | - Francesca Giulia Magnani
- UOC Neurology, Public Health, Disability, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Stefanus Snyman
- Centre for Community Technologies, Nelson Mandela University, Port Elizabeth, South Africa
| | - Ahmed Amine El Oumri
- Mohammed VI University Hospital of Oujda, Faculty of Medicine of Oujda, Mohammed First University of Oujda, Oujda, Morocco
| | | | - Natasha Layton
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Victoria Australia
| | | | - Patricia Welch Saleeby
- Department of Sociology, Criminology, and Social Work, Bradley University, Peoria, IL USA
| | - Andrea Sylvia Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olaf Kraus de Camargo
- CanChild - Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario Canada
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McKinney EL, McKinney V, Swartz L. COVID-19, disability and the context of healthcare triage in South Africa: Notes in a time of pandemic. Afr J Disabil 2020; 9:766. [PMID: 32934920 PMCID: PMC7479422 DOI: 10.4102/ajod.v9i0.766] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022] Open
Abstract
During disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa's Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are 'worth' saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed.
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Affiliation(s)
- Emma L McKinney
- Interdisciplinary Centre for Sports Science and Development, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Victor McKinney
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
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Abstract
INTRODUCTION The use of triage systems is one of the most important measures in response to mass-casualty incidents (MCIs) caused by emergencies and disasters. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. Accordingly, the present study was conducted as a systematic review to explore the principles of triage systems in emergencies and disasters world-wide. METHODS The present study was conducted as a systematic review of the principles of triage in emergencies and disasters. All papers published from 2000 through 2019 were extracted from the Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar databases. The search for the articles was conducted by two trained researchers independently. RESULTS The classification and prioritization of the injured people, the speed, and the accuracy of the performance were considered as the main principles of triage. In certain circumstances, including chemical, biological, radiation, and nuclear (CBRN) incidents, certain principles must be considered in addition to the principles of the triage based on traumatic events. Usually in triage systems, the classification of the injured people is done using color labeling. The short duration of the triage and its accuracy are important for the survival of the injured individuals. The optimal use of available resources to protect the lives of more casualties is one of the important principles of triage systems and does not conflict with equity in health. CONCLUSION The design of the principles of triage in triage systems is based on scientific studies and theories in which attempts have been made to correctly classify the injured people with the maximum correctness and in the least amount of time to maintain the survival of the injured people and to achieve the most desirable level of health. It is suggested that all countries adopt a suitable and context-bond model of triage in accordance with all these principles, or to propose a new model for the triage of injured patients, particularly for hospitals in emergencies and disasters.
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Strous RD, Gold A. Ethical lessons learned and to be learned from mass casualty events by terrorism. Curr Opin Anaesthesiol 2019; 32:174-178. [PMID: 30817391 DOI: 10.1097/aco.0000000000000684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The world has seen a major upturn in international terror awareness. Medicine has had to respond. In addition to the unique physical and mental injuries caused by terror which require special clinical attention, so too terror represents a challenge for medicine from an ethics perspective. RECENT FINDINGS Several responses in the literature over the past few years have attempted to reflect where the battlefront of ethical dilemmas falls. These include issues of resource allocation, triage, bioterror, the therapeutic relationship with terrorists, dual loyalty, and challenges in the role in the promotion of virtuous behavior as a physician under difficult conditions. SUMMARY Although many challenges exist, physicians need to be prepared for ethical response to terror. With their associated unique status, providing legitimacy and specialized ability in the management and approach to terror situations, physicians are held to a higher standard and need to rise to the occasion. This is required in order to promote ethical behavior under trying conditions and ethical sensitivity of the medical profession by means of being attuned to the reality around.
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Affiliation(s)
| | - Azgad Gold
- Beer Yaakov Mental Health Center, Israel
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17
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Ethical prioritization of patients during disaster triage: A systematic review of current evidence. Int Emerg Nurs 2019; 43:126-132. [PMID: 30612846 DOI: 10.1016/j.ienj.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/17/2018] [Accepted: 10/21/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage. METHOD Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients' prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included. RESULT Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage. CONCLUSION Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers' engagement, public education, and ongoing training are required to reach a fair decision.
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Abstract
AbstractMany health service organizations deploy first responders and health care professionals to mass gatherings to assess and manage injuries and illnesses. Patient presentation rates (PPRs) to on-site health services at a mass gathering range from 0.48-170 per 10,000 participants. Transport to hospital rates (TTHRs) range from 0.035-15 per 10,000 participants. The aim of this report was to outline the current literature pertaining to mass-gathering triage and to describe the development of a mass-gathering triage tool for use in the Australian context by first responders. The tool is based on the principles of triage, previous mass-gathering triage tools, existing Australian triage systems, and Australian contextual considerations. The model is designed to be appropriate for use by first responders.CannonM, RoitmanR, RanseJ, MorphetJ. Development of a mass-gathering triage tool: an Australian perspective. Prehosp Disaster Med. 2017;32(1): 101–105.
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Wilkinson AM, Matzo M. Nursing Education for Disaster Preparedness and Response. J Contin Educ Nurs 2015; 46:1-9. [PMID: 25646952 DOI: 10.3928/00220124-20150126-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/21/2014] [Indexed: 02/28/2024]
Abstract
Catastrophic mass casualty events (MCEs), such as pandemic influenza outbreaks, earthquakes, or large-scale terrorism-related events, quickly and suddenly yield thousands of victims whose needs overwhelm local and regional health care systems, personnel, and resources. Such conditions require deploying scarce resources in a manner that is different from the more common multiple casualty event. This article presents issues associated with providing nursing care under MCE circumstances of scarce resources and the educational needs of nurses to prepare them to effectively respond in these emergencies. J Contin Educ Nurs. 2015;46(x):xxx-xxx.
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Sievers AE, Russi CS, Hankins DJ, Sztajnkrycer MD. Logistical concerns for helicopter emergency medical services response to the injured police officer. Air Med J 2014; 32:158-63. [PMID: 23632225 DOI: 10.1016/j.amj.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/16/2012] [Accepted: 08/12/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although infrequent, helicopter emergency medical services (HEMS) have been activated to transport police officers injured in the line of duty. The purpose of this study was to query current industry operating procedures in terms of law enforcement training and operations, specifically in terms of firearms restrictions and cotransport of injured officers and suspects. METHODS This is a survey-based study of air medical emergency medical services program managers in 2010. Descriptive statistics and the Fisher exact test were used to analyze the results. RESULTS Fifty-eight programs (78.4%) reported transporting officers injured in the line of duty. Sixty-three respondents (85.1%) maintained a written policy addressing the presence of weapons aboard the aircraft; 58.8% of respondents replied that this restriction applied to sworn law enforcement personnel on active duty. Nearly a quarter of programs with written firearms policies have not informed the law enforcement agencies affected by these policies. Two programs reported having cotransported an injured officer and a suspect. CONCLUSION HEMS will continue to play an important role in the care and transportation of injured officers. HEMS programs may have specific policies that impact law enforcement operations. Open communication of these policies and interagency training are critical to effective interaction during high-stress incidents.
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Affiliation(s)
- Ashley E Sievers
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55901, USA
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21
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Abstract
AbstractDocumentation of the patient encounter is a traditional component of health care practice, a requirement of various regulatory agencies and hospital oversight committees, and a necessity for reimbursement. A disaster may create unexpected challenges to documentation. If patient volume and acuity overwhelm health care providers, what is the acceptable appropriate documentation? If alterations in scope of practice and environmental or resource limitations occur, to what degree should this be documented? The conflicts arising from allocation of limited resources create unfamiliar situations in which patient competition becomes a component of the medical decision making; should that be documented, and, if so, how?In addition to these challenges, ever-present liability worries are compounded by controversies over the standards to which health care providers will be held. Little guidance is available on how or what to document. We conducted a search of the literature and found no appropriate references for disaster documentation, and no guidelines from professional organizations. We review here the challenges affecting documentation during disasters and provide a rationale for specific patient care documentation that avoids regulatory and legal pitfalls. (Disaster Med Public Health Preparedness. 2013;0:1–7)
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Cheung WK, Myburgh J, Seppelt IM, Parr MJ, Blackwell N, Demonte S, Gandhi K, Hoyling L, Nair P, Passer M, Reynolds C, Saunders NM, Saxena MK, Thanakrishnan G. A multicentre evaluation of two intensive care unit triage protocols for use in an influenza pandemic. Med J Aust 2012; 197:178-81. [PMID: 22860797 DOI: 10.5694/mja11.10926] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the increase in intensive care unit (ICU) bed availability that would result from the use of the New South Wales and Ontario Health Plan for an Influenza Pandemic (OHPIP) triage protocols. DESIGN, SETTING AND PATIENTS Prospective evaluation study conducted in eight Australian, adult, general ICUs, between September 2009 and May 2010. All patients who were admitted to the ICU, excluding those who had elective surgery, were prospectively evaluated using the two triage protocols, simulating a pandemic situation. Both protocols were originally developed to determine which patients should be excluded from accessing ICU resources during an influenza pandemic. MAIN OUTCOME MEASURE Increase in ICU bed availability. RESULTS At admission, the increases in ICU bed availability using Tiers 1, 2 and 3 of the NSW triage protocol were 3.5%, 14.7% and 22.7%, respectively, and 52.8% using the OHPIP triage protocol (P < 0.001). Re-evaluation of patients at 12 hours after admission using Tiers 1, 2 and 3 of the NSW triage protocol incrementally increased ICU bed availability by 19.2%, 16.1% and 14.1%, respectively (P < 0.001). The maximal cumulative increases in ICU bed availability using Tiers 1, 2 and 3 of the NSW triage protocol were 23.7%, 31.6% and 37.5%, respectively, at 72 hours (P < 0.001), and 65.0% using the OHPIP triage protocol, at 120 hours (P < 0.001). CONCLUSION Both triage protocols resulted in increases in ICU bed availability, but the OHPIP protocol provided the greatest increase overall. With the NSW triage protocol, ICU bed availability increased as the protocol was escalated.
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Abstract
AbstractA disaster is a situation that overwhelms the local population’s capacity to respond, thus necessitating a request for assistance from outside the impacted area. In these circumstances, needs usually outweigh resources. The objective of response is to do the greatest good for the greatest number of people (the utilitarian principle). As such, some unique ethical considerations will arise that are not seen in day-to-day practice.The adoption of medical ethics principles is important in such situations, but certain provisions must be accepted. In large-scale, complex disasters, it may be impossible to provide optimal care to each patient. This paper will discuss some of the challenges for healthcare personnel at “ground zero”, how training in preventive ethics may help, and what principles can be applied when working in disaster-affected areas or when responding to disasters.
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Koenig KL, Lim HCS, Tsai SH. Crisis Standard of Care: Refocusing Health Care Goals During Catastrophic Disasters and Emergencies. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jecm.2011.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
AbstractIntroduction: Mass-casualty triage is implemented when available resources are insufficient to meet the needs of all patients in a disaster situation. The basic principle is to do the maximum good for the most casualties with the least amount of resources. There are limited data to support the applicability of this principle in massive disasters such as the January 2010 earthquake in Haiti, in which the number of patients seeking medical attention overwhelmed the local resources.Objective: To analyze the application of a triage system developed for use in a mass-casualty setting with limited resources. The system was designed to admit only those patients who had medical conditions requiring urgent treatment that were within the capabilities of the hospital and had a good chance of survival after discharge. Priority was given to those whose treatment could be administered within a short hospital stay.Method: A retrospective, observational review of computerized registration forms of Haitian earthquake victims who sought medical care at a 72-bed field hospital within four to 14 days after the event. An analysis of the efficacy of the triage protocol that was used followed, using length of hospital stay to measure consumption of resources.Results: A total of 1,111 patients were triaged for treatment in the field hospital within 14 days of the earthquake. The median length of stay for all patients for whom data was available was 16 hours (mean = 29.7 hours). The majority of patients (n = 620, 65%) were discharged within 24 hours. Two hundred five patients underwent surgery and were discharged within a median of 39 hours (mean = 52.6 hours); of these, 124 (62%) were discharged within 48 hours. The total mortality of the treated patients was 1.5% (n = 17).Conclusions: Currently accepted triage principles for the most part are appropriate for efficiently providing medical care in a disaster area with extremely limited resources, but require extensive adaptation to local conditions.
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Bennett B, Carney T. Law, ethics and pandemic preparedness: the importance of cross-jurisdictional and cross-cultural perspectives. Aust N Z J Public Health 2010; 34:106-12. [DOI: 10.1111/j.1753-6405.2010.00492.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
General concepts about medical disasters, public health and triage are outlined. Triage is described in the context of public health emergencies and disaster settings, and the main ethical values at stake in triage are discussed. Possible conflicts between competing values are outlined. Special attention is given to possible conflicts between the protection of individual interests (typical of clinical ethics), and the pursuit of collective interests (typical of public health and triage). Hippocratic ethics is compared to utilitarian ethics and to perspectives that emphasize the principle of justice. Three ethical attitudes are suggested that may contribute to a resolution of competing values: protection of human dignity, precaution and, especially, solidarity. Personalism promotes the collective good by safeguarding and giving value to the well-being of each individual. A personalistic perspective is suggested as a way to deepen the concept of solidarity as a pillar both of clinical and public health ethics.
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Affiliation(s)
- Carlo Petrini
- Istituto Superiore di Sanità (National Institute of Health), Bioethics Unit, Office of the President, Via Giano della Bella 34, 00162, Rome, Italy.
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Lyle K, Thompson T, Graham J. Pediatric Mass Casualty: Triage and Planning for the Prehospital Provider. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Challen K, Bentley A, Bright J, Walter D. Clinical review: mass casualty triage--pandemic influenza and critical care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:212. [PMID: 17490495 PMCID: PMC2206465 DOI: 10.1186/cc5732] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process.
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Affiliation(s)
- Kirsty Challen
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
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Bibliography: current world literature. Curr Opin Anaesthesiol 2007; 20:157-63. [PMID: 17413401 DOI: 10.1097/aco.0b013e3280dd8cd1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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