Ottawa Guidelines for Who Gets Access to Scarce Treatment Resources

[indigo girl]

http://www.theglobeandmail.com/news/politics/ottawa-prepares-for-pandemic-with-new-rules-for-treatment/article1215870/

A look at some sobering information in this article that makes me wonder what the US plans are or, if we even have any.

Fast tracking students and calling professionals out of retirement is mentioned. Argentina is already doing this now.

For the first time in decades, doctors across the country will be given rules to help determine which patients get access to life-saving treatments in the event an influenza pandemic hits the country hard this fall. Drafting these rules signals how seriously Canadian health authorities take the H1N1 virus, which they fear could become deadlier and more widespread during flu season.

Experts say there is a strong likelihood that a vaccine will be in place by November to stop an H1N1 pandemic from taking down large segments of the population. But the effectiveness of preventive medicine is by no means a certainty. Production of a vaccine has already hit a snag, with manufacturers reporting a disappointingly low yield when the virus is grown in eggs, according to the World Health Organization.

To be prepared in the event a pandemic does take hold, the federal and provincial governments are developing a plan which stipulates, among many other things, that guidelines be developed to assist doctors in making tough choices about the allocation of scarce treatments. “There may come a point where there is definitely an overcrowding situation where triaging has to occur if you have limited resources,” Theresa Tam, director general of infection disease and emergency preparedness for the Public Health Agency of Canada, told The Globe and Mail in an interview.

Some of the work to develop the rules around triage has already been done, said Dr. Tam. It is primarily the job of the provinces, but the federal government is assisting by providing information. “We knew that we had to pull together a multidisciplinary group” to analyze the potential situations, she said, “because you have legal issues, clinical issues, ethical issues that have to come together.”

With most diseases, it is the elderly and the infirm who are worst affected. But the H1N1 virus has a predilection for people in their prime. On Friday, public health officials issued a warning telling pregnant women that it is hitting them with peculiar ferocity.

“We may be faced with two young persons who may be competing for the same health-care resources, and those are some of the questions that we will be facilitating discussions on,” Dr. Tam said.

Respiratory technicians say there are not enough members of their profession currently practising in this country to care for patients during an influenza pandemic. Nor, they say, are there enough critical-care nurses. The public-health agency is looking at ways to bring health professionals out of retirement, getting students fast-tracked into the work force, and allowing credentials to be accepted across jurisdictions.

Some doctors have also suggested that the problem of finding enough ventilators will pale in comparison to finding enough isolation rooms. In fact, said Dr. Tam, isolation rooms are unlikely to be needed because hospitals could simply close off entire wards or wings and devote them to influenza patients. Under that scenario, it is the number of ventilators that has many health experts worried.

There is no official tally of the machines in Canada, and Dr. Tam said there is no point in counting those that are not attached to critical-care beds because a ventilator needs trained personnel to operate it. By using a number of different mathematical models, she and her staff have concluded that there are about 3,500 to 4,500 ventilators in Canada that could be used in a pandemic.

Some doctors say their H1N1 patients require oscillating ventilators that push air into patients' lungs in short, rapid bursts rather than the long, slow breaths afforded by the regular machines.

The public-health agency is purchasing 370 of the regular ventilators to add to the federal stockpile of 130 that can be distributed to the provinces as needed. Dr. Tam said the regulators will be selected with ease of transportation and operation in mind. The agency expects to spend about $10,000 per machine.

The Respiratory Therapy Society of Ontario questions that choice. “Any true critical-care ventilator capable of managing the pulmonary insult that the H1N1 virus has produced comes at a minimal cost of approximately $40,000,” the society said in an e-mail. “The devices that are around the $10,000 range are typically used for transport or management of patients who require ventilatory support, but do not suffer from any pulmonary compromise. As a result, these devices are not capable of properly oxygenating (provision of oxygen to the blood) or ventilating (removing carbon dioxide from the blood) critically ill patients.”

Reformatted.

(hat tip flutrackers/hornblower)

[oramar]

Oh we were just talking about this were we not! We have to get this info to high ranking officials in the CDC and Washington DC. WE have NO NHS to making decisions like this. We are trusting a highly decentralized healthcare system in the US that is only focused on the next quarter profits to see this coming and deal with it. They have put profit before our lives before and why would they suddenly get interested in the public welfare now. I recognize it is very piecemeal. Some are doing a very good job of getting ready, others are in such deep financial difficulties that they can't even meet their payrolls let alone invest in pandemic preparation. I know the federal government just released a lot of money for pandemic preparation and I hope some of it is going to things like buying equipment and training nurses. The CDC keeps talking about vaccines as our only hope, they better start thinking about plan B. All these people who think universal health care is the same as socialism are about to get a wake up call. Wait till they go to the ER with their dying child and they can't even get through the door because the place is surrounded by panic stricken, sick and dying patients and their families. If you think I am over reacting just read what the above article says about the fears the Canadian NHS has. They sound even more worried than me and NHS is very conservative about there planning.