Florida mull how to ration ventilators

Rebel Yell · Oct 19, 2009, 08:25 PM

http://www.sun-sentinel.com/news/nat...387,full.story

"Florida health officials are drawing up guidelines that recommend barring patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases.

The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with poor prognoses from ventilators to treat those who have better chances of surviving. That decision would be made by the hospital.

The flu causes severe respiratory illnesses in a small percentage of cases, and patients who need ventilators and are deprived of them could die without the breathing assistance the machines provide."

I hope we never see this come to fruition. Quite an ethical dilemma. What do you think?

*Pierrette* · Oct 19, 2009, 09:37 PM

Has "it" begun already?

*flightnurse2b* · Oct 19, 2009, 09:57 PM

Originally Posted by Rebel Yell

http://www.sun-sentinel.com/news/nat...387,full.story

"Florida health officials are drawing up guidelines that recommend barring patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases.

The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with poor prognoses from ventilators to treat those who have better chances of surviving. That decision would be made by the hospital.

The flu causes severe respiratory illnesses in a small percentage of cases, and patients who need ventilators and are deprived of them could die without the breathing assistance the machines provide."

I hope we never see this come to fruition. Quite an ethical dilemma. What do you think?

as a nurse who lives and works in south florida--the problem is that so many people get put on vents unnecessarily to begin with.. no one wants to let grammy die in peace, she has to have a vent, a PEG and be on dialysis and maybe by the 3rd code of the day someone in the family will say "stop!"

the TV commercials are clouded completely with 1-800-ambulance-chaser and 1-800-who-can-i-sue and we have so many risk managers at my hospital it will make your head spin!

anywho, i don't understand the reasons why we don't actually have enough vents--i think the problem is more of not enough ICU bed space and qualified nursing staff. especially since it's winter, and people come to FL for the winter, and a percent of them end up in the hospital.

i am certaintly in no place to decide who is worthy of a vent... but if hospitals have to make the choice to keep a 95 year old who has end stage cancer and a 33 year old pregnant woman with the flu on a vent, one would hope they would make the choice to end the futile attempts to keep someone who is already suffering on a ventilator... i suppose that is what this article is saying?

tewdles · Oct 19, 2009, 10:20 PM

The debate of death with dignity is (thankfully) growing. What we need is more of what we currently have...discussion. More physicians, more pharmacists, more physical therapists, more health professionals need to have thoughtful discussions about death, and dying, and the important part in between those two things. If we can improve the overall IQ and comfort level of both the professional and the lay person to consider death as part of the natural life process we will gain enormous grounds when it comes to decreasing futile care. We lost our focus...doctoring and nursing got so good at saving some people that they forgot that EVERYBODY DIES. We just need to get people to shut up with the "death panel" baloney so we can work some compassion rather than fear into the decision making process.

**Elvish** · Oct 19, 2009, 11:22 PM

If the H1N1 pandemic becomes as severe as the media makes it out to be (which I highly doubt - JMO), there is going to have to be some sort of triage process. That's nothing new and has been practiced on battlefields pretty much since time immemorial.

You save the ones whose odds of making it are better. That's not meant to sound crass or unfeeling; it's just the way of the things in an emergency situation such as described above. That's not to say one life is 'more important' than another; it's an issue of resource allocation. I pray it never has to be put to the test over H1N1.

GCTMT · Oct 20, 2009, 04:41 AM

Have you folks seen this thread on AN?

Looks like H1N1 is more serious than I thought.

**sirI** · Oct 20, 2009, 05:19 AM

Threads merged.

*Tweety* · Oct 20, 2009, 07:16 AM

Originally Posted by Pierrette

Has "it" begun already?

We're not "overwhelmed" here in this part of Florida. We have four "rule out" influenzas currently in my facility and no confirmed cases.

We have unfortunately had a couple of H1N1 related deaths so, I think it's important to think about the "what if......" scenerio with common sense and a level head not in the sand.

rph3664 · Oct 20, 2009, 08:20 AM

Originally Posted by Vito Andolini

Did the family pay the bills incurred after 60 days? If not, why not? I hate to be cold but insurance is a cold game. That's why insurance companies must be gotten out of the health care picture.

As for who gets scarce resources - who says vents are scarce? It is not anywhere possible for our great nation to be short of anything. Manufacture more. Import more. There are plenty of ventilators to go around.

Chances are, at 60 days the insurance maxed out (i.e. she had incurred $1 million or whatever the cap is), and doesn't Medicare have time limits for inpatient admissions?

caroladybelle · Oct 20, 2009, 12:07 PM

Originally Posted by Elvish

If the H1N1 pandemic becomes as severe as the media makes it out to be (which I highly doubt - JMO), there is going to have to be some sort of triage process. That's nothing new and has been practiced on battlefields pretty much since time immemorial.

You save the ones whose odds of making it are better. That's not meant to sound crass or unfeeling; it's just the way of the things in an emergency situation such as described above. That's not to say one life is 'more important' than another; it's an issue of resource allocation. I pray it never has to be put to the test over H1N1.

As was done in Katrina, and look at the legal aftermath.