Rationing Life Saving Treatments During COVID Pandemics: A Podcast with Doug White and James Frank

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By GeriPal - A Geriatrics and Palliative Care Podcast, Alex Smith, and Eric Widera. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.
You are caring for two adults with COVID-19. One who is a previously healthy 70 year old. One is 55 with multiple medical comorbidities. Both are now requiring mechanical ventilation, but there is only one ventilator left in the hospital and all attempts to transfer the patients to another hospital for care have failed. Which patient would you give the life saving treatment to and why? On today's podcast with talk with Doug White, Professor of Critical Care Medicine at the University of Pittsburgh, and James Frank, Professor of Medicine and fellowship director for the UCSF Pulmonary and Critical Care Medicine Fellowship, about this type of tragic choice that we may soon be making if we do not flatten the curse on the COVID-19 pandemic (for more on that, check out our last podcast with Lona Mody). If you don't think that would be even remotely possible, just read this quote from a NEJM article that came out yesterday: Quote: "Though the physicians I spoke with were clearly not responsible for the crisis in capacity, all seemed exquisitely uncomfortable when asked to describe how these rationing decisions were being made. My questions were met with silence — or the exhortation to focus solely on the need for prevention and social distancing. When I pressed Dr. S., for instance, about whether age-based cutoffs were being used to allocate ventilators, he eventually admitted how ashamed he was to talk about it. 'This is not a nice thing to say,' he told me. 'You will just scare a lot of people.'" In our podcast we reference a fair amount of articles and resources. Links to the following articles and resources can be found on our website at GeriPal.org : - Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions. Annals of Internal Medicine - Principles for allocation of scarce medical interventions. Lancet 2009 Definitive Care for the Critically Ill During a Disaster: A Framework forAllocation of Scarce Resources in Mass Critical Care. Chest 2008 - Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters. Chest 2019 - Meeting the challenge of pandemic influenze: ethics guidance for leaders and health care professionals in the Veterans Health Administration - Ventilator Allocation Guidelines:New York State Task Force on Life and the LawNew York State Department of Health - NYT interview with Italian ICU director in Bergamo, Italy. Truly sobering and it’s clear that many patients are dying after being triaged to no ICU/ventilation. - Flattening the curve infographic - Excellent illustration of how surge capacity will be increased as it relates to ICU staffing

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