Skip to main content
×
Home

Allocation of Ventilators in a Public Health Disaster

Abstract
ABSTRACT

Background: In a public health emergency, many more patients could require mechanical ventilators than can be accommodated.

Methods: To plan for such a crisis, the New York State Department of Health and the New York State Task Force on Life and the Law convened a workgroup to develop ethical and clinical guidelines for ventilator triage.

Results: The workgroup crafted an ethical framework including the following components: duty to care, duty to steward resources, duty to plan, distributive justice, and transparency. Incorporating the ethical framework, the clinical guidelines propose both withholding and withdrawing ventilators from patients with the highest probability of mortality to benefit patients with the highest likelihood of survival. Triage scores derive from the sepsis-related organ failure assessment system, which assigns points based on function in 6 basic medical domains. Triage may not be implemented by a facility without clear permission from public health authorities.

Conclusions: New York State released the draft guidelines for public comment, allowing for revision to reflect both community values and medical innovation. This ventilator triage system represents a radical shift from ordinary standards of care, and may serve as a model for allocating other scarce resources in disasters. (Disaster Med Public Health Preparedness. 2008;2:20–26)

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Allocation of Ventilators in a Public Health Disaster
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Allocation of Ventilators in a Public Health Disaster
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Allocation of Ventilators in a Public Health Disaster
      Available formats
      ×
Copyright
Corresponding author
Address correspondence and reprint requests to Dr Tia Powell, New York State Task Force on Life & the Law, 90 Church St, 15th Floor, New York, NY 10007 (e-mail: tpp03@health.state.ny.us).
References
Hide All
1.New York State Workgroup on Ventilator Allocation in an Influenza Pandemic. Allocation of Ventilators in an Influenza Pandemic: Planning Document, March 15, 2007. http://www.health.state.ny.us/diseases/communicable/influenza/pandemic/ventilators/docs/ventilator_guidance.pdf. Accessed August 24, 2007.
2.Curiel JT.Murder or mercy? Hurricane Katrina and the need for disaster training. New Engl J Med. 2006;355:20672069.
3.Drew C, Dewan S. Louisiana doctor said to have faced chaos. New York Times. July 20, 2006. http://www.nytimes.com/2006/07/20/us/20doctor.html?scp=1&sq=physician+arrested+after+Katrina+.
4.Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5. Avian influenza A (H5N1) infection in humans. New Engl J Med. 2005;353:13741385.
5.Arras JD.Rationing vaccine during an avian influenza pandemic: why it won't be easy. Yale J Biol Med. 2005;78:287300.
6.Christian MD, Hawryluck L, Wax RS, et alDevelopment of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175:13771381.
7.Ontario Health Plan for an Influenza Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge, and Triage Criteria. Critical Care During a Pandemic. April 2006. http://www.tvfr.com/dept/em/dnld/OHPIP-Critical_Car_%20During_Pandemic-final-v2_0406.pdf. Accessed December 19, 2007.
8.Ferreira FL, Bota DP, Bross A, et alSerial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:17541758.
9.Clermont G, Acker CG, Angus DC, et alRenal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int. 2002;62:986996.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 16
Total number of PDF views: 49 *
Loading metrics...

Abstract views

Total abstract views: 245 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.