Home Moral guidelines EXPLANATION: What are “Crisis Care Standards? “| New

EXPLANATION: What are “Crisis Care Standards? “| New


BOISE, Idaho (AP) – As the spread of the delta variant continues unabated across much of the United States, public health officials have approved rationing of healthcare in Idaho and parts of it. from Alaska and Montana.

At least five other states – Georgia, Kentucky, Mississippi, Arkansas and Texas – are nearing capacity with more than 90% of their intensive care unit beds full, according to data from the US Department of the United States. Health and Social Services.

The decision to ration healthcare comes amid an increase in the number of unvaccinated COVID-19 patients requiring hospitalization. Standards of care in crisis enable health care providers to provide scarce resources, such as ventilators, to patients most likely to survive.

But figuring out who gets what is no easy task.


The Crisis Care Standards provide legal and ethical guidance to health care providers when they have too many patients and not enough resources to care for them all. Essentially, they explain exactly how healthcare needs to be rationed in order to save as many lives as possible in a disaster.

Some stages of healthcare rationing became common during the pandemic, with hospitals postponing elective surgeries and some doctors switching to online visits rather than seeing patients in person. But more serious steps – such as deciding which patients should be treated in a normal hospital room or intensive care unit bed, and which patients can be cared for in a hospital hall or classroom – have to do with it. been rare.

At the end of the spectrum, crisis care standards typically use scoring systems to determine which patients are receiving ventilators or other life-saving medical interventions and which are treated with pain relievers and other palliative care until such time. whether they recover or die.


States can use a combination of factors to establish “priority scores” for patients. The systems in Idaho and Montana both examine how well a patient’s major organ systems are functioning. Patients with signs of liver or kidney damage, low oxygen and blood clotting levels, and an inability to respond to pain because they are in a coma have higher scores.

Both states also score people based on the highest number of “years of life”, so if a person has cancer or some other disease that could impact their future survival, they get a score. higher.

The lower a patient’s score, the more likely they are to survive, moving them to the front of the line for ventilators or other resources.

The plans also include “tie-offs” that come into play if there aren’t enough resources for everyone on the front lines. Youth is the biggest tiebreaker, with children the top priority.

In Idaho, pregnant women who are at least 28 weeks old and have viable pregnancies come next. Both states also consider young adults before older adults, and Idaho’s fourth tiebreaker is whether the patient is performing a task that is vital to the response to the public health crisis. The final tie-break is a lottery system.

If someone on the front line gets a ventilator and doesn’t show improvement within a specified time frame, Idaho says it should be taken out so someone else can have a chance.

On Thursday, shortly after Idaho adopted statewide crisis care standards, Dr Steven Nemerson of the Saint Alphonsus Regional Medical Center in Boise said that to his knowledge, no patients from the Condition had only been removed from the resuscitation system in order to provide the equipment to someone. other. But he warned it would happen.

“It’s bad today. It’s going to get worse,” Nemerson said. “I’m afraid for all of us.


In Idaho and Montana, crisis care standards do not take into account whether a person has been vaccinated against COVID-19. Likewise, patients are not denied treatment if they are injured in a car accident because they did not wear their seat belts or have driven drunk.

“Immunization status is irrelevant to us when it comes to caring for patients. We just do what they need from us within the constraints and resources available to us, ”said Dr. Shelly Harkins, Chief Medical Officer at St. Peters. hospitals in Hélène.


People are likely to wait longer for care, not only in hospitals, but in emergency care centers that will likely treat more patients as well. Nurses will treat more patients than they normally would. Instead of hospital beds, some people can be placed on stretchers and cots. Patients will likely be discharged from the hospital home as soon as possible, relying on friends, family and home medical equipment prescriptions as they recover.

And in some cases, doctors may not try to save a patient’s life at all. Idaho’s Crisis Care Standards Plan calls for a “universal do not resuscitate order” for all adults once the state has reached the point where there are not enough ventilators for all. world.

This means that if a patient experiences cardiac arrest – where the heart suddenly stops – there will be no chest compressions, no attempt to return the heart to a normal rate, no chance to connect it to a life support device. . This is in part because resuscitation requires a lot of hospital staff, a lot of time, and is often unsuccessful. It’s also because if the patient has COVID-19, the resuscitation attempt process sends virus particles aerosolized into the air, putting staff at risk.

Montana’s plan is a little different, in that it allows individual doctors to decide whether or not to resuscitate patients on a case-by-case basis.


Talk to a health care provider in Idaho and you will likely hear the phrase “moral injury,” a term that refers to the emotional trauma that health care providers experience when they lose a patient or are faced with the problem. inability to provide life. life-saving treatment. Ideally, standard crisis care plans reduce moral injuries, but they are far from perfect.

Dr Matthew Wynia, professor of medicine and health ethics expert at the University of Colorado, said state authorities should be responsible for establishing the strategies necessary to make a fair triage decision, so that doctors and nurses are not left to their own devices such calls to a patient. bedside.

This means making sure transfer systems are in place and functioning well so that a hospital does not make tragic decisions because it has no more resources available at another facility, he said.

In the face of a critical shortage of personnel or equipment, “You really can’t say (to patients or their families), ‘Do you want to go to the emergency room? “You have to go to the patient and say, ‘We can’t do this,’ which is an incredibly difficult situation,” Wynia said.

“There’s no way to look at this and say it’s OK. It’s not OK,” he said. But it’s necessary if hospitals are under-resourced, “which is happening right now,” Wynia said.


Health experts say getting the vaccine is the best way to protect yourself against hospitalization from the coronavirus. Idaho’s hospital crisis is mainly caused by a massive increase in the number of coronavirus patients requiring hospital care, Idaho Department of Health and Welfare director Dave Jeppesen said on Thursday.

The Idaho Department of Health and Welfare also advises people to be extra careful in all aspects of daily life, wearing seat belts, taking prescribed medications, and avoiding activities outside. high risk like mountain biking until the end of the crisis.

Lindsey Tanner contributed to this report from Chicago. Iris Samuels contributed to this report from Helena, MT. Samuels is a member of the Associated Press / Report for America Statehouse News Initiative corps. Report for America is a national, nonprofit service program that places reporters in local newsrooms to cover undercover issues.


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