[aeauooo]

Originally Posted by 10MG-IV

New Orleans Hurricane Katrina Dr Poa, Nurses Landry and Budo. Ask them. No good deed goes unpunished. They stayed for their patients. http://www.memorialnursessupportfund.com/index.html

I live in New Orleans. You can take a small degree of solace from the fact that Charles Foti lost his seat as attorney general in the next election. He was not very popular, and I like to think that was in part due to his prosecution Budo, Landry, and Pou.

That's why I voted againt him!

[al_29]

Originally Posted by llg

The only people who might be taken aback by them are people who have never given it any thought.

Actually, I've thought about issues like these several times, even before I started school, and while I understand the logic behind implementing these types of measures, it still doesn't feel right. I know, my first-year idealism is showing, and I've already been informed several times by instructors that I'd just have to "deal with it" (referring to this survival-of-the-fittest method of doling out medical care), but I hope I never, ever fail to be taken aback by issues like these.

[Elvish]

My brother has learned this in USMC boot camp.

I learned it in nursing school. Somebody with only a minor wound can wait. Somebody whose brains and intestines are both hanging out might not get anything at all. Who are you going to save? Obviously, the ones most likely to make it. No sense in depleting already-stretched resources for someone who's not likely to make it. This pains me to think about because this includes my 92yo stepfather and 3 of my 4 grandparents.

I don't mean that to sound crass, but in the event of a pandemic, there have to be some rules about who gets txed first, last, and/or not at all, or there will be chaos. There will probably be chaos anyway. I am hoping this will cause folks who don't do what we do for a living to think about things.

[al_29]

I do understand where all of you are coming from on this (especially with all of the experience all of you have had); it's just hard to see it put out there like that.

[ocankhe]

It is not only those most likely to survive are treated first but health care workers get a higher priority also. Theory being the pandemic will go on for some time and we would need all the HCW we can. Again this is standard battle field triage.

[CHATSDALE]

TRIAGE sort into three groups
1. those who can be saved with immediate intervention, ex: severe bleeding
2. those who can be saved but intervention can be postponed until others are cared for ex: broken bones
3. those whose chances of being saved are slim/none or which will take up resources and time that would be taken away from caring for group one

triage in a disaster takes some strong minded, intelligent assessments
i don't envy them

[psalm]

I have heard that the flu or pneumonia is a quick way to die for an already debilated pt. Has that been your experience? I feel for my pts. in their 80s and 90s who come in so miserable with the above diagnoses and wonder if it would be kinder for nature to take its course, if that was the wish of the pt. Thoughts or comments?

[quezen]

Psalm, I have heard that pneumonia was called "the old mans friend", back in the day of no modern medicine.
The conversation generated by this topic is so necessary, as IIg said and 10MG( I think I just got it!) pointed out with that link to the story about Dr. Poa and the accused nurses.
The specifics about emergency triage for civilian mass causality scenarios that 'aleah' talked about are encouraging. Can you imagine the potential for intimidation in such a scenario, political and otherwise! You can bet your B/P cuff that it would come down to someones 70 yr grandmother against a 40 yr healthy amputee, and other such unsavory decisions. I hope the plan provides for heavily armed security support.
I was trained in military triage in the Army, that stuff about expectant, immediate, and urgent is drilled into everyone. Especially now, the goal is to have all soldiers be 'Combat Life Savers', as well as soldiers trained in their military job. That said, the military does generally use combat injury type scenario's to illustrate those categories. It is not too hard to see that someone who sustained a whole body burn in a tank fire, or someone with their brains or intestines cascading out is 'Expectant', i. e.-expected to die. ('Do not treat, does not mean do not provide comfort-the instruction is to leave a medic with these patients to administer morphine, benzoes, do as much as possible to ease the pain.) I guess I never really thought about what would constitute an 'Expectant' patient in a civialian mass cal like a Pandemic.
Yes SharonH, you are so right, get these SOP's legally in place, the sooner the better, and make at least a nodding acquaintance with them a required continuing ed course for (re) licensure! If I would be at work or go to work in such a mass cal situation, protect me from the political fallout and wrath of the aftermath. Please!

[CHATSDALE]

the case in new orleans with dr poe and the two nurses was not a typical triage case...this did not go to trial because there was no evidence to support the charges, AG Foti was telling half truths and exaggerations
the SOP on pandemic or a case like the situation in burma where help is not hours but days away needs to be brought up in first year in nursing school and reinforced over and over again so that nurses will act without guilt and save the savable

[twistedpupchaser]

While I agree with everyone about the neccessity of triage in a pandemic situation I am realistic and cynical enough to know it will never work in the real world as stated in the article.

An 88 year old with Emphysema and acute renal failure, (just as an example) will be treated before a 20 year old with no medical conditions if she is rich or related to the right people. The rich and powerful are garanteed treatment before everyone else.

I know I am cynical but I can see it happening, cash or political power being bought to bear on the medical facilities to treat the powerfull first.