Source: Yahoo News

CHICAGO - Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.



Read more: http://news.yahoo.com/s/ap/20080505/ap_on_he_me/pandemic_rationing_care

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Horrifying, if you ask me.

care and emergency rooms would be denied to certian people who would have otherwise survived. Even poeple with diabetes that is poorly controlled would be denied medical treatment.

They give the medical staffs at hospitals "God" like ruling on who gets to live.

It supposedly violates many laws including age discrimination. But they don't seem to care. This is supposedly not only for pandemics but when emergency resources are overwhelmed - which is your typical emergency room visit. But lets hope they're serious that this is just a study on who they would pick and not something they will invoke say, now.

Ah, they also note the poor would get less medical care because they have an unfair amount of worse off people.

:scared:

Medical care is still not at the level it should be.

I am betting that they looked at the despair and tradgedy that the remaining hospitals and their staff suffered during Katrina. I am betting they looked at 9/11 too.

Poof.

with a broken leg?

These rules are being made to prevent staff from making these decisions on their own.

Medical triage is a fact, and it is best if it is planned out ahead of time. Ask any ER doctor.

And yes, it is horrifying - but appropriate. The idea is to help as many as you can with limited resources.

of course not under these proposed guidelines.

How nazi of them.

This triage approach has been around for many years. The thing is, you don't want to waste limited resources treating people who would die anyway - or people with minor problems who would live if treatment is delayed.

Going by first come first served in a crisis would result in needless deaths.

The "richest" country in the world, and we're ready to throw our diabetics on the "to go" pile? I realize that everything is finite, however, I can't help but think that if we hadn't flushed $3 trillion down the Iraqi toilet, we wouldn't be having to decide these things...

Maybe that's why there's a push on for a national ID database with medical records:
"OK, what about this guy?"
"No. 192837465...name's 'KansDem.' Looks like he had a heart attack and was diagnosed with diabetes in 2003."
"Oh, well...it's the 'Adios Pile' for him!"
"Here, KansDem, just lie back and think of nicer times. Oh, and here's a Pepsi™ for while you wait!"

In the meantime, maybe they should tattoo numbers on all our arms ... could use a coding system like the one they use on fruits & veggies, identifying organic, GMO, etc. It'd make it easier for them to sort us all out ...

What the hell has this country become?

Get it? Triage would be in effect in a

CRISIS ONLY

See, in a

CRISIS

the huge numbers of sick and injured would overwhelm our medical facilities. That's why we would have limited resources. Get it?

Perhaps our "limited resources" wouldn't be so "limited?" Ya' think?

We are borrowing the money for the Iraq and Afganistan wars. If it was not for war, no way would either the House, or the Senate ever consider borrowing $3 trillion for such a mundane activity as medical facilities.

the billions of dollars that we are giving to Israel for their War Machine too.

tens of thousands of doctors standing by and literally millions of hospital beds ready to go in case of a major disaster? That doesn't make sense.

No amount of money would allow us to be prepared to handle any imaginable disaster.

......upwards to 90% (or some other unfathomable number) of your salary that it would take to keep unlimited medical resources on hand at all times so that there be no need for triage at any given time?

Get real. :crazy:

Maybe you want to change that to pandemic situations because otherwise, you could happily dismiss the elderly during the next big freeway multi-car crash.

At most, we would have double the ventilators (we're would you suggest we store them) and still we won't have the facilities or personnel.

We don't have unlimited resources to deal with a pandemic...it's that simple. First come, first served might work
in a backwoods ER, but if 10% of the population has life-threatening disease, another protocol is necessary in the
immediate run.

My first visit to the emergency room as a patient I sat around for a few hours while the staff treated some people who came in after me. Of course, they had a heart attack and premature labor while I just had a large gash in my foot, so I wasn't overly upset.

Do you work in the healthcare field? Have you ever been trained in trauma triage? I doubt it. This is standard for triage. This is not eugenics, it's reality when there will be one ventilator for 100 potential patients.

But in a pandemic the results are the same, the strong survive and the weak die!!!!

such as the darker skinned folks go to the back of the line.

Oh, wait, that's the system we have NOW.

A guy coming in having a heart attack is going to be seen sooner than a guy with a closed tibial fracture.

at all, the guy with a foot gash takes precedence as he's young and hurt playing football - if it were a pandemic situation that is.

Not even in the pandemic protocol.

David

Because to supply adequate medical care in this country would smack of Socialism? This isn't MASH. This is the US which sure finds the money to spend on weapons and wars and who's military budget is bigger than all the other countries combined. This isn't the beginning of the 19th Century with the killer flu. We've advanced 100 years in science.

See, they're conditioning us to believe in scarcity and to believe that there isn't enough of anything to go around. That's all manufactured.

Think of all the hospitals that have closed, all the hospitals that are completely full or almost full on any given day, all the ERs that have to divert patients. We don't have enough beds.

Then think of how each small community hospital, usually understaffed in doctors and nurses already, would have to have a stockpile of Cipro and other drugs to deal with any major epidemic, ICU beds and ventilators, and a big blood bank. They don't have those now, so what makes you think they'd have them in a crisis?

If healthcare were nationalized, we could move resources from where there is too much to where there is too little. Because of our base being the market system, though, we can't do that much at all. Just try talking a hospital administrator into giving up a doctor bringing in $2 million in billing a year to go to a small community hospital, especially if it's still in the area his hospital covers. It gets nasty right quick.

even if we got the most perfect system ever, we don't have the resources (the ventilators specifically) for the coming pandemic. We just don't. And we won't, even if the government takes over healthcare as they should. That's the sucky thing, as bad as the Bush administration has acted, this is the one thing that just doesn't have a solution, it's just something we get to go through, with all the attendant horror.

Not enough respiratory therapists. Not enough unit docs. Not enough unit beds. Hubby's really worried about our area--we just don't have the resources to deal with the usual flu season now, and that's disgusting.

because the vaccine cocktail was wrong this year.

Every year on planet earth, we build 16 MILLION shitty cars killing us all with pollutants in the air, and that is by expecting people to buy them. Are these ventilators more complicated or less than cars?

I cannot understand why if we chose to, we couldn't make all we wanted. Or why we can't get more people trained, except for the artificial quota system that limits medical personnel to pump up profits for HMOs and other care-denying innovations.

Frankly, and here goes the tinfoil, I wouldn't be surprised if a major pandemic aimed at the elderly was used to solve the SS "problem" (they stole the surplus and don't want to give it back).

The whole thing is simply used to lower expectations. Millions of WIIs can be built, millions of iPods, and much more junk, and we can't get other more important things?

It's the system, not the training or technology. Time to junk the system.

And hospitals to house all those patients.

To build enough to be completely prepared to treat a TRUE pandemic (ie the 1918 flu scenario, millions in need of emergency care), we'd be looking at thousands of new hospitals across the US. Most of them would sit empty and unused until the flu hit, which could be next year, or a decade from now. Then we'd have to figure out what to do with all the staff required to run these hospitals during downtime when their services weren't needed. All of this just isn't feasible. All the cars, IPods, and Wii's that are built are purchased and used frequently, while a pandemic flu is something that only hits once every few decades.

I couldn't have said it better myself.

The reason I try to insert reason into these crazy conversations is because I want people to start thinking about what they can personally do to try to save themselves. No guarantees but the more prepared, the more likely a person is to make it through the next pandemic and bitching about what our government isn't doing, when it really isn't feasible for our government to do such things, really just makes people stupid. We aren't cows (though we often act that stupid) so we don't have herders who can take care of us.

Sure, the people with the comparatively cursory training in the medical field would be *much* less qualified than we'd ordinarily want our medical professionals to be (I'd envision a scenario where the equivalent of "weekend warriors" would step in to serve as nurses, RTs, etc., while more experienced professionals such as nurses would be permitted in a crisis to diagnose and prescribe). I wouldn't want one of them anywhere near me in ordinary times. But the ability to call trained amateurs in to assist with less critical patients and complex cases during such a crisis might save lives.

on the fly and we can create endless hospital space and so on.

There's no such thing as too much medical care when I can look at dozens of children in my own classrooms in the high school I teach in who have obvious untreated medical conditions and injuries which are dealt with at home, including homemade butterfly clamps when stitches are really required and so on.


What does it take for medical training? Some two years, some four, some more. So, start training today.
Why can't we opt for more medical care for our tax dollars and less interest on debt and less expense on war to kill people and $18 billion per year less in subsidies to huge oil companies (yes, we pay some of the most profitable companies on the planet subsidies).

I don't think people are cattle. I think we're entitled to get services for the taxes we pay. Actually, picking out a line of death is treating people like cattle. And so is trying to convince me that we cannot do any more than was done a century ago no matter what we know or do. This sort of learned helplessness is designed to put money into corporate pockets without any expectation of service.

Truth is, and any medical person knows it, we SPEND more money on health per person than any other country, but we don't get more SERVICE than any other country. That's because of all the non-medical parasites who suck profit at every step, including insurance, holding, HMO, PPO and all the other alphabet soup designed to separate you from your dollars while denying you care.

The Spanish Flu killed between 2% and 5% of the human population less than a century ago, and any competent doctor will tell you flat out that it WILL happen again. We lost over 650,000 people in the United States, and more than 1 in 4 people suffered from it. Today, that would be like having 75 MILLION people sick. There is just no way to train enough people to handle that, especially considering that many of your TRAINEES will get sick too. That same flu, in the world today, would kill over 300 million people globally.

You would literally need to have an army of doctors and nurses on standby, and stadiums filled with medical equipment, to handle those kinds of numbers. And for what, an event that happens maybe once every century or two? What do they all do the rest of the time? More importantly, who pays for that? The kind of money required for that kind of infrastructure would dwarf any health care system ever proposed for this country, or any other for that matter. You could shut down the military completely, and the money saved MIGHT pay for it. Probably not though, since you're going to need a couple million new doctors, and they're going to demand far larger paychecks than those we give our soldiers.

There are simply some things that cannot be prepared or planned for. Medical pandemics, nuclear bombs detonating in large cities, that sort of thing. When and if they happen, you simply deal as best you can.

That said, all the money in the world won't create enough ventilators if the H5N1 is the virus that comes calling and it is currently the most likely candidate. Even if we had all the ventilators in the world, we won't have enough. Triage will happen and many, many people will die without ever seeing the inside of a hospital, not that that will be any sort of treat for those who do. They will be stacked like cordwood in the hospital being taken care of by people who haven't slept for days and don't have any supplies with which to treat them. It will make what happened in the New Orleans' hospitals look like a fucking walk in the park.

Advanced in science? Yes, somewhat. Now, we get to know a few years early what is going to take us down. But make no mistake, H5N1 (the most likely candidate) as it currently is, is so effective at taking down healthy individuals that our healthcare system, for all of it's advances, will not make it past week three of a pandemic. That's what we know ahead of time. Yay, science! We also know that the most likely culprit is a similar flu to the one that caused such decimation in the early 20th century. We know that the vaccine we're already preparing has little chance of being good enough and that even with stockpiling, that we won't have enough antivirals to even cover our healthcare workers. We know that we will not be able to mount an effective response past the third week. All of this we know and you guys are getting outraged because someone pulled back the cover and exposed it.

Sorry kids. This is reality and I know it horrifies you to think that we, the healthcare providers will be using triage techniques during the coming crisis, but it is the reality and you'd best either get used to it or continue pretending that it won't happen.

He often talks about it.

and it's a frustrating talk because there just aren't perfect solutions.

I became really angry (still am) when people started dismissing the H5N1 as a fearmongering game by this administration and therefore people stopped being concerned with it. It didn't go away, the interest from the public went away.

It may have been fearmongering by the media, but my husband was happy that people were finally admitting that it is a huge problem and needs to be talked out and prepared for. Then, the media went on to the next fad, and now everyone's left thinking it's really no big deal.

Especially here, where people are usually uber informed. I'm assuming you and yours have stocked up on respirator masks, yes? He'll especially need them if he's going to go out there and fight the fight. As an internist, he will definitely end up on the front line in his community.

There's a great kit we could buy, too, with pretty much anything you'd need for an emergency, but he won't get that, either. Humph. I think I'm going to look it up and start putting money away for one here at home. We get flyers in the mail for it, and whenever we do, I prod him again. It's a thousand bucks, but I look at this and think it's pretty good.
http://www.statkit.com/images/pdfs/900fax.pdf

I assume it would happen in a pandemic, just like it does in a war zone. What bothers me is that it is officially sanctioned now, by our government. The elderly and the weak will die quickly, but unless I'm really really ignorant, when was the last time anyone went without emergency care or any care because they had to wait for an old person to die?

Whenever I hear of these 'culling' methods being sanctioned by any government I know for certain that people like Steven Hawkins would be the first to go. Not that he should get more care than the next person, but he should at least get equal care.

edited for spelling

and they are making the standards national (although these look to be the same standards that have always been used with triage). This is one time when it isn't a case of the government making their agenda known, this is just the reality of triage during any mass casualty situation.

Many other governments are handling the prep better than we are but you can be sure they're also putting into place emergency policies just like this. If they aren't, then they really aren't doing a better job than us. They know as well as we do, that they will not be able to treat more than 10 % of the victims and they will choose the fittest as well. Excruciatingly painful in the microcosm, necessary in the macrocosm.

Believe me, if I were the 90 year old, I wouldn't WANT the treatment if it were coming at the expense of the young. That's all this document is. A summarization of how the lines would be drawn.

Keep in mind that, because of age, any treatment on that 90 year old is probably going to be less effective and suffer from additional complications anyway. That 10 year old, with the bonus of youth and an aggressive immune system, is more likely to survive treatment from the get-go. That's why the 10 year old gets it, and the 90 year old doesn't.

My point is that in this country both the 90 year old and the 10 year old should be treated. I'm questioning the assumption that there isn't enough to go around. That's plain ridiculous! Do you believe that every single part of the US will be suffering from a pandemic? This country is huge!

And if by some catastrophe it turns out that every town, every city and every corner of this country is having people fall like flies then who's left to make the triage decisions, or aren't doctors and nurses going to get the deadly diseases?

more medical equipment, if we wanted to. there used to be more beds per capita because folks were kept in hospital longer for almost everything. "we" just made the choice to lose beds, & ration healthcare - for profit - even in non-profits.

There would be no need for rationing medical care if our society did not worship violence and war.

Should we be hit with a severe flu that will require ventilators, we will be in better condition than most. We have plenty of technology - we just don't have the will to share under normal circumstances.

The scenarios described in the above article can't be considered normal, however.

We will not have even a tenth of what we will need, in terms of equipment, supplies, room or staff to handle more than a couple of weeks of a true pandemic, especially H5N1. If we had the perfect, socialized medicine, we might make it 4 weeks (probably not, though) and then these hard choices will have to be made. I expect that one of the really hard choices that will impact me more personally is that they will probably take all of the NICU ventilators, reprogram them for adults and our kids will just have to sink or swim. Yet another hard choice and yet, given the environment I work in, these are the rich folks kids and still, those choices will be made.

The long answer is a little bit more complex.

Right now Pharmaceutical companies make an ungodly amount of money off of the sick and ailing...enough to wipe out the national debt in 1 year.

The US spends 3 trillion (with a big T) on medical every year in spite of the fact that our "modern medicine" is the leading cause of death in the US.

One might ask themselves "Wait a sec...if we (the US) spend that much on medical expenses, why aren't Americans healthier?"

The pharmaceutical companies don’t want you to be healthier...they want you to take your new little pink, purple and polka-dot pill with the nifty sounding name that is a compound or two different from the old pink, purple and polka-dot pill that used to be cheaper.

Pharmaceutical companies don’t make as much money on creating drugs that hospitals typically need more of.

The AMA (American medical Association) put out a magazine a year or two back where a number of highly respected Doctors stated in their research findings "Modern Medical practices are the leading cause of death in the US".

Nice to know our money is going to good use eh?

That's obvious, no? The infrastructure's built around "normalcy"—a normal, more or less predictable level of illness, injury, etc. Otherwise you'd have equipment sitting around unused, doctors with no patients, etc., which would be incredibly wasteful and expensive. In the case of a pandemic, in which millions of people might become critically ill in a very short period of time, rationing of care (triage) is inevitable. The trick is to do it effectively and as humanely as possible.

My city has approximately 200 ventilators, that is plenty for normal use with about a hundred to spare. Depending on the severity of a flu pandemic the estimations are that my city alone would need between 750 and 2,500 ventilators. The health department, fire department, rescue squad all bought ventilators to use in the event of a pandemic but how much tax money should you spend on something that may not happen or be as severe as the estimates predict.

david

The economical benefits would be undeniable. :sarcasm:

It doesn't help, and for once, this isn't something that can be placed at the feet of this incompetent administration (though they have certainly gone out of their way not to care about the eventuality of it). When, not if, a pandemic comes, many, many people will die and there is nothing any specific entity can do about it. There are a few things you can do to prepare but instead, you mock. Really not helpful.

If our tax revenue and resources were being utilized to create a better, more equitable society instead of the perpetuation of a corrupt and rotten system designed to enrich corporate and political elites, there would be no need for consideration of the scenario outlined in the OP.

There are far too many enablers of the status quo on a progressive website.

Open your eyes.

Look up H5N1, get educated about how it kills and what will be needed to combat it and then come back and tell me to open my eyes. I've done the research, you clearly haven't. This isn't going to be a fight between the haves and havenots.

look at katrina - the poor died, the poor were dispossessed. the rich suburbanites' property was blockaded so the poor couldn't reach them.

Can't expect utopia, but we can do a helluva lot better than "just the way it is," shrug.

If the well-being of our society were the undercurrent in all our endeavors, we could do MUCH better.

and what can and can't be done at home. If we could do that, some (though not all) of the disastrous sequelae could be mediated. But people went from being terrified to not even listening - and neither place is the least bit productive.

As if they're not totally capable of stooping to something like this.:rofl:

it's just a republishing of triage tactics to keep us all terrified and on edge. come on, anyone who's ever seen an episode of ER was already familiar with all this.

...but some animals are more equal than others.

Same with terrorist events. There's no way to prevent them, but there are ways to mitigate the damage when they do happen.

<snip>
The Influenza Pandemic of 1918

The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.


The Grim Reaper by Louis Raemaekers

In the fall of 1918 the Great War in Europe was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, in pockets across the globe, something erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children. It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 1918 would go down as unforgettable year of suffering and death and yet of peace. As noted in the Journal of the American Medical Association final edition of 1918:


"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked, the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918). <MORE>

http://virus.stanford.edu/uda/

And it will be just as futile an effort if it's the government rather than mother nature who whoomps us.

Talking about setting up national triage standards before we're knee deep in the feces hitting the oscillator is one of the important things. Another is to get the public to understand that they must begin learning what they can about self and family care as most will be completely isolated and unable to get into a hospital. Frankly, I think most of the ones who end up getting into the hospital will find that that is it's own kind of hell if we have a full on pandemic.

Hubby's worried about it, since, as an internist, he'd be on the front lines, so to speak.

It is a when, not an if, and it isn't a nefarious plot, it is just the natural cycle and the only thing that our advanced science has been able to give us is a heads up on the fact that it's coming and that it will most likely be H5N1, not that that is proving to be all that useful.

We were told point blank that medical workers, firefighters, and police would get vaccines, etc, first. He also recommended that everyone keep at least a two month supply of food and water at home, because in all likelihood we'd be stuck at home in a worst-case scenario, which would include martial law. He even let us know that they had a mass grave site identified.

Partly as a hedge against higher food prices, but also in case of pandemic or other major disruption of services/supplies. It's not quite building a bomb shelter, but it's in the neighborhood.

When is more like it and I've been to a couple of those symposiums. I keep the requisite food and 50 gallons of water as well as broad spectrum antibiotics and the best first aid kit a nurse can put together. If it looks eminent, we will try to go to ground, but my hospital knows where I live and I wouldn't be the least bit surprised to find an armed man coming to take me to the hospital to care for the dying but I will make sure my family knows how to take care of themselves.

but, in the event of a pandemic, would tell people to f off????

I'm not inclined to give my life in a fruitless struggle to save people when I have a handful in my own household who need saving. Yeah, I'm more pragmatic and less dutiful than you may expect a nurse to be, but there it is. If I was positive that my family could survive without me, I would go. OTOH, I'm fairly sure the National Guard would compel me to go, so don't worry, I'm sure I'll be there.

My wife is a nurse, but works in a private practice office. I often wonder if her name is on some list and she would get "called in."

I do understand where you are coming from, though.

Every doctor who has admitting privileges (which is everyone) has to give the hospital every phone number and pager number they have. In a Code Black situation, they have a system in place to page/call everyone to tell them to report to the hospital. I would assume that they'd do the same to any nurse who's ever worked there and probably ask every doctor in town to send in his MAs, RNs, NPs and PAs, too.

their children and family and really have no loyalty to go...

Remember the Doctor and Nurses who were loyal and came in for Katrina

they had to go to court for possible murder charges


Nurses and Doctors are not employees of the state so they have the option of coming in if they want

Its not like this situation hasn't been addressed
but I guess what I'm saying is there will be some who will come in and some who will not

If they were government workers they would be under the Universal Health law and work for the single payer system

but they don't so it would be purely volunteer

The hospital administrators left all of them to die. Horrifying. Hubby talked about how that could happen here at the time, and it was really scary.

If so, you lack the requisite imagination, you know what I'm saying?

So, they will have a back up plan to help us get to the hospital, if you know what I mean. Under martial law, there won't be any choice about the matter. If they can find us, we will be there.

That's why I tell Hubby he'd have to go in anyway and that I'm planning on him being gone. He hates the thought of it, though.

Similar subscription-type services are already in place in Florida (Hurricane relief) and Southern California (privatized firefighting).

"AIG's (American International Group Inc.) Wildfire Protection Unit, part of its Private Client Group, is offered only to homeowners in California's most affluent ZIP Codes -- including Malibu, Beverly Hills, Newport Beach and Menlo Park -- and a dozen Colorado resort communities. It covers about 2,000 policyholders, who pay premiums of at least $10,000 a year and own homes with a value of at least $1 million.

Link: http://www.latimes.com/business/la-fi-richfire26oct26,0,3352683.story?track=mostviewed-storylevel

Quote from same article (From Naomi Klein, author of the Shock Doctrine): "What we have is a dangerous confluence of events: underfunded states, increasingly inefficient disaster response, a loss of faith in the public sphere . . . and a growing part of the economy that sees disaster as a promising new market," said Naomi Klein, whose new book, "The Shock Doctrine: The Rise of Disaster Capitalism," looks at, among other things, the response to Hurricane Katrina.

If it were the government doing the triage, it would be a possibility, but healthcare workers won't do that. But we will triage.

and to stay there until I collapse or die, but they won't interfere with the work there. They don't have the knowledge base.

insurance and cash will be out the window. The hospital is the last place you will want to be. Keep a good first aid kit and some extra groceries at home and prepare to nurse your family. There is no way any hospital system will be able to stay up and running. A hospital is more than beds and doctors and nurses. There is the laundry, kitchen, and security people for example. I doubt many of them are going to show up for work in a pandemic especially one with a high fatality rate.

Horrifying indeed.

They don't support universal health care so they should sacrifice themselves for god and country

They have no survival skills outside the office environment. In fact, considering their parasitical effect on productivity, they should go even if there isn't a pandemic! That includes brokers, advertising agencies, political handlers, insurance companies, investment banks, most of wall street, and all of Washington DC. political personages.

the secretaries, school teachers, your municipal, county and state government workers. They too are paper pushers and have very little to offer society outside of their offices. They likewise have not survival skills.

Lawyers, artists, writers, dancers, English majors, professional (including college) athletes, musicians, politicians, sculptors, kill them all, why wait?

Better yet, keep them alive and penned up. We with survival skills can always use them as cattle. Make jerky, and soylent green.



:sarcasm:

This caught my eye. I wonder how they define "poorly controlled."

Does that mean if my blood sugar is high when they bring me in, I'm dead? Or will they do the average glucose over three months?

That seems to be the going definition. Hubby tried to control his patients' blood sugar much more aggressively than that, but he's had patients with numbers in the five and six hundreds before who then try to tell him that they're testing themselves every day. They're probably talking about those kinds of patients.

HgbA1C is unlikely to be easily available. The lab will be utilized for other things. You're assuming that someone will even be coming for you. If you don't land in the first wave, there won't be any room in the hospitals.

Doesn't make sense. Doesn't even make sense they'll be doing blood tests on everyone in a crisis/triage situation.

It will be glucometer spot checks, if at all.

So if you just happen to be high at that particular moment, you're a goner.

A1Cs can be done almost as quickly as finger sticks now, but that is still only the past three months. Blood sugar is not the only predictor of who will suffer complications. Some well-controlled people get them, some poorly-controlled people do not.

They should just say they're gonna let us die, rather than acting like they are going to choose between us (what about choosing between type I and type IIs?). I think they just don't want to say it.

shelters & learned how to duck & cover.

folks.

but i in no way trust these fascists to come up with a reasonable prioritization.

as with everything they do, they'd apply it to their advantage, letting democrats die and campaign contributors thrive.

reality.

When faced with a situation where there are more needs than personnel and material can possibly fulfill, harsh, painful and apparently heartless decisions must be made.

If you look at some of the criteria:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

the odds are against these folks surviving, regardless of the level of treatment. In addition the level of treatment necessary to sustain life would drain away resources and personnel from patients who have a much higher likelihood of survival.

It's a numbers game: sacrifice 10,000 to save 100,000, while horrifying when it's an intellectual argument, it gains a lot of traction when it's reality.

and every battlefield has to deal with it, and every emergency room.

Emergency rooms take the sickest first, but if there is a disaster - of any kind - and the emergency room is inundated with victims, they are triaged. If a 90-year-old and a 5-year-old are side by side in the ER, who do we want them to save. If a 5-year-old with mortal injuries is lying next to a 5-year-old with a chance, they will work on the 5-year-old with a chance. This, of course, is only if the ER is completely overwhelmed.

It is horrifying, but what other options are there? If you always give preference to treating the very sickest whose chances of survival are minimal, you let others die who might have survived and the sickest most likely will die also.

and it will be the medical people who are doing the triage, not the government.

all you want, it's shaky ground upon which this theory stands. First of all, I do not accept the fact that we HAVE to have either a pandemic or terrorist attacks. We MAY have either or both but to say that we will have either one is really making quite a strong statement. Secondly, how do we ever decide to let people die? How do we make a call to let someone not receive treatment that has for just for instance been in a serious car accident or been burned, when we supposedly have the most advanced medical technology in the world? How about if we concentrate on how to care for everyone even if it means (oh the horror of it all) working with our neighbors to the south and north of us? Didn't they make decisions similar to this in Nazi Germany?:scared:

...August 29, 2005

<snip>
As of August 2, 2006, the official number of deceased victims from Louisiana was 1,464.<17> The first deaths were reported shortly before midnight on August 28, 2005, as three nursing home patients died during an evacuation to Baton Rouge, most likely due to dehydration.

On September 4, Mayor Nagin speculated that the death toll could rise as high as ten thousand after the clean-up was completed. Some survivors and evacuees reported seeing dead bodies lying in city streets and floating in still-flooded sections, especially in the east of the city. The advanced state of decomposition of many corpses, some of which were left in the water or sun for days before being collected, hindered efforts by coroners to identify many of the dead.

There were six deaths confirmed at the Superdome. Four of these were from natural causes, one was the result of a drug overdose, and one was a suicide. At the Convention Center, four bodies were recovered. One out of these four is believed to be the result of a homicide.<18> Body collection throughout the city began on approximately September 9. Prior to that date, the locations of corpses were recorded, but most were not retrieved.
<MORE>

http://en.wikipedia.org/wiki/Effect_of_Hurricane_Katrina_on_New_Orleans

selection has already began, because there are fifty million Americans currently not insured in this nation at this moment. Those fifty million people are unable to afford medical now, much less during a crisis (although I qualify this as a on-going) crisis. :think:
P.S.Also, in regards to Katrina-just who dropped the ball there (could it possibly be the guv-mint)?

A pandemic will happen, they have through the millennia and they will continue to occur. One main difference is that we have some advanced warning this time. As well, during a pandemic, the whole world will be dealing with it and there won't be any neighbors to the south or the north to help us out. In fact, by week three, you won't be able to even receive help from your neighboring city. Everything will shut down. The hospitals will be the canaries in the coal mine but it will not stop there.

This is not a case of eugenics or of genocide. Your comparison, well possibly satisfying to you, is not correct.

your first point is a matter of speculation as to whether it will happen or not
but the second, How do we make a call to let someone not receive treatment, is the whole crux of the matter and boils down to allocating resources. If facilities are overwhelmed and people can not possibly be treated; decisions must be made, no way around that

I already know that when a pandemic next hits (notice I didn't say if, it isn't an if, it's a when), we will not have sufficient ventilators to save everyone. It's a cold, hard reality that triage will have to happen. They are looking at the eventuality prior to the coming pandemic. It's what must be done. There have also been discussions about compelling healthcare workers to work during the next pandemic because they've already discovered that many of us are planning to refuse. I suppose because I'm one of the ones who will have a gun put to my head to force me to place my life in danger to care for these people, I should be doubly enraged, but I'm not. In a pandemic, what's done is what is necessary. I'm really sorry that some of us are going to be triaged out of the equation before we ever start and that some of us will be put in extra harms way when the pandemic comes, but that is the reality. You all are just going to have to get used to it. I have. I've had a lot of time to contemplate it, even after the rest of you decided that the warnings about the coming pandemic were fearmongering tactics (they aren't, btw) and that you could therefore discount it. The rest of us that are in the know are out here, planning for the fucking eventuality. I'm sorry that we can't make it go perfectly or even better, make it go away, but we can't, and even if we had universal health care with complete fairness, huge numbers of people WILL NOT GET CARE during the coming pandemic.

Horrifying? Fuck yeah, it's horrifying. The most horrifying thing is that there is no way, no how, even if we had a perfect healthcare system (and you know we don't) that hundreds of thousands of people wouldn't end up dying in their own homes with no care whatsoever. I'm really sorry that it hurts to see this stuff but I'm glad they're looking at it. We all need to look at it and figure out what we're going to do for ourselves, because the healthcare system will implode by about week three of a serious pandemic (most likely H5N1, but there are other candidates) and that serious pandemic will come.

He waffles on whether to go in on a code black or not. We have young kids, and he doesn't like the idea of leaving me alone to cope while he puts himself at risk, but we're in a smaller community with not enough doctors. He'd be needed. I've come to terms with the idea that he'd be gone--I've dealt with that before through med school and residency. I don't think he's come to terms with it, though.

There are nowhere near the number of ventilators here. Heck, we don't have enough unit beds on a regular day as it is. We don't have enough unit doctors, nurses, beds, or equipment for the usual flu season (Hubby had to turf patients further away a couple of times this year), so people will definitely die in any kind of epidemic in our area.

Cause nobody would be so frothy. Oh wait. Someone might.

Also, when it comes to medicine, I tend to defer to his judgement, since he's the one who works in that field day in, day out, and is actually on-call right now and has to go back into the hospital tonight to cover his patients.

And considering I got higher grades in college and helped him study in med school, I can think quite well on my own, thanks. My area's not medicine, though, so I tend to respect his opinion on that more than mine.

wasn't it? Geez, some people.

Edited to add: I've come to respect your hubby through your discussions here and I don't have automatic respect for doctors. I've seen them up close and personal and too many of them don't think any better than the average freeper. Your's otoh, seems very thoughtful

It's not the first time I've had to deal with snark like that. I guess because I quote Hubby a lot and the fact that I'm a stay-at-home mom make some people think less of me for some reason.

The more I read here, the more I wonder if my husband really is an exception. I know many doctors who are amazing people and hard-working, wonderful doctors, but I've had bad doctors, too. Heck, eight doctors missed my chronic appendicitis (even Hubby), but he was the one who talked me and my doctor into the CT that caught my kidney tumor, so I guess we're even. ;) He just got home from going back into the hospital to check on a couple of patients he was worried about. Usually it's that or a family conference.

Oh, and I've told him that if I ever hear a bad report on him from a nurse, he loses the golf clubs for month. :evilgrin: I have nurse friends who keep me apprised of how he's doing, though I hear nothing but good things, even from friends of mine who are patients of his. I keep my ear out, though. I think the big difference is that Hubby was a nurses' aid in nursing homes for six years, starting in high school, to pay for college and get a start in medicine. He knows what it's like on the other side of the bed.

I can't imagine someone having a first name where everyone recognizes it as a doctor - but that's back to your thinking(?) style to arrive at that.

Let me guess he calls you "wifey" even to strangers. And let me guess, they throw up everytime he's starts just like my first inclination when I read your posts because as a feminist reading "hubby says..." everytime you answer makes you look like a twat without a brain.

Having a bad day?

"Hubby says...", over and over again.

My hubby is a physician too and I am a retired nurse. What she says is accurate and I am familiar with the fact that her hubby is a physician. I know that she is a kind astute person from her posts.
My husband plans to work during a pandemic. We have stockpiled supplies to that end. Most hospitals run on a just in time basis re supplies like the grocery stores.

They will run out of masks and gowns in a heartbeat and the govt has already said they don't think the trucking industry will end up intact as far as resupply. Add to that that most of our medical supplies and medications are made overseas these days and I doubt in a global event like this much will be coming in. If you read any nursing boards that discuss it, a good portion of nurses are not planning to work a pandemic and I can't blame them. Canada was floating a law that would require nurses to come in. I have no doubt that this country would conscript them too.

My sister who is in the emergency planning field in the military has been gaming the situation and giving briefings all over the country. There simply is not the capacity to handle an event this size.
Sec Levitt has already said, we will be on our own and I take him at his word. It will be a giant clusterfuck with grocery stores unable to resupply, high absenteeism in critical infrastructure like water treatment plants and electric companies.

And article today re the subject.
Risk of bird flu pandemic probably growing
By Stephanie Nebehay, GENEVA (Reuters) 6/05/2008 14:05

Risk of bird flu pandemic probably growing Risk of bird flu pandemic probably growing


The risk of a human influenza pandemic remains real and is probably growing as the bird flu virus becomes entrenched in poultry in more countries, health officials warned on Tuesday.

Some 150 experts are attending a meeting hosted by the World Health Organization (WHO) to update its guidance to countries on how to boost their defences against a deadly global epidemic.

The H5N1 avian flu virus has infected flocks in much of Asia, Africa and parts of Europe. Experts fear it could mutate into a form that passes easily from person to person, sparking an influenza pandemic that could kill millions.

"The risk of a pandemic remains and is probably expanding," said Dr. Supamit Chunsuttiwat, a disease control expert at Thailand's health ministry who is chairing the four-day meeting.


Supamit noted the highly pathogenic H5N1 virus persisted on three continents and had caused human cases in Indonesia, Egypt and China this year.

"We are concerned that the spread through migratory birds hasn't stopped. Once the virus is established in birds, it is difficult to get rid of the virus and the risk (to humans) remains unless countries develop good control of transmission in birds," he told Reuters
more at link
http://www.mirror.co.uk/news/latest/2008/05/06/risk-of-bird-flu-pandemic-probably-growing-89520-20407654/
similar articles


AP
Pandemic flu threat remains substantial, health experts say
http://news.yahoo.com/s/ap/20080506/ap_on_he_me/who_pandemic_preparedness
Risk of bird flu pandemic probably growing: experts
http://today.reuters.co.uk/news/articlenews.aspx?type=healthNews&storyid=2008-05-06T131526Z_01_L06159431_RTRIDST_0_HEALTH-BIRDFLU-WHO-DC.XML

It spreads quickly and easily, and if it ever mutates to not kill its host super-quickly, we pretty much screwed. I've seen many articles in the journals that flood our house, and none of them sound positive at all. It's just a matter of time.

I think I need to reassess my "storm box" (since we live in a tornado area, that's what we call it). Maybe more water, some masks and gloves. What else?

and make sure you have enough water for tow months at 2 gallons per person per day. The large rain barrels work best. I put away rice and beans. Boring but will keep us alive. Two months may be a short estimate, I'm not sure but that is certainly a head up compared to anyone else. Also, you'll need fire supplies to cook with and possibly to stay warm with as this will likely happen during the winter season. Right around this time every year is when I breathe a sigh of relief and start cycling my supplies out. I still watch the WHO carefully throughout the summer but I stand down quite a bit until the Fall. The only reason I'm even talking about this right now is because people got outraged about a perfectly reasonable triage discussion, as I knew they would, and it seemed like a possible teaching instance. A few of them are pretty unteachable but I'm not directing this at them.

I need to figure out a better water system. I like the rain barrel idea, actually, and will look into how to set one up. I could easily do two, maybe even three. I could use it to water the garden planters, too. And I need to get the better masks (have some in the first aid kit, but they're not the respirator kind.

They are the only one's that can filter out viral particles.

with some good info on preparation for a pandemic
http://www.getpandemicready.org/

I got tired of typing out husband, and DH makes me think of baseball.

We're in a smaller area, and so, yes, people would be able track him down pretty easily. Granted, I'm not making it much harder with this, but I figure every level of work I give someone makes them less likely to do it.

So, you think I'm not a feminist? I'm just curious. Is a stay-at-home mom who somehow ended up with quite the traditional life somehow less of a feminist or not a feminist at all or incapable of being anything but a "twat without a brain"? It sounds like you're the one with biases that need to be examined, then.

"My boyfriend says"? You wouldn't start worrying about how independent I am in the thinking arena?

you are attacking an obviously intelligent person by virtue of her referring to her spouse who is in the field under discussion in this thread. People here know knitter4democracy and allow the shorthand as an expedience and appreciate the input, which is clearly more informed than your own...

then it became apparent that even when it didn't need to be hubby says, he's the person she attributes to what she's saying.

At that point, why not let him type for himself.

I think you may have some issues in the thinking area if you can't see a pattern that becomes unnecessary there.

I feel that attribution is a wonderful thing. When one makes a point and references it to someone with day in/day out healthcare experience, you know they're probably not talking out of their hat.


If you'd like my response to the OP, please see post #180

I do take issue with your insinuation that medical staffs play God, and that they don't seem to care. I imagine you don't personally know any physicians or nurses or EMT's to run your opinions by. Perhaps if your boyfriend was in the medical field you could reference him...

Or even home all that much at night and wants to spend time here?

I use DU to stay connected to the adult world and keep up on what's going on. My husband has no such need, considering he covers two offices and two hospitals and has a large patient base. He asks me what I've read up on here, and we talk about it late at night after he's home and the kids are in bed, but if he has a few minutes to himself, he'd rather golf or do other things than spend time arguing with people on-line. Since I used to be a teacher, I miss the arguing and so spend time here and on knitting sites.

I learned in high school to cite my sources. My husband is my source, and considering this thread is on medical issues, I think it's right to cite him for clarity. What's wrong about that?

:hug: You're sweet.

If a particular topic regarding his field of expertise should come up, I would be prefacing a lot of statements with "hubby says," as well.

Although, I'm much more imformed on outsourcing and H1B visas, for instance, regarding his chosen profession because I'm more politically involved and better read in that area. And I know for a fact that he has referenced me "Fed_up mother sent me this article to read, and I'm sending it to all of you. She says...."

I always assume a woman can think for herself. Having taught high school, I've found that most women are fine with thinking for themselves. The vast majority, in fact. I just like to cite my sources, and apparently, you don't.

Always have. I'm on two other boards and "Mr. 'other name'" would sound ridiculous considering my other chosen name. I suppose I could refer to him as fed-up father on this board, but hubby is just so much faster to type. :)

necessity of triage in emergencies, do any of us trust it with the current crowd in charge - or , for that matter, to general corporatist state that is evolving?

Actually, getting this late to the discussion, I am surprised that no one noted this from the article:

"If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability,"

I am not opposed to triage, and I certainly don't agree with first-come, first-served, and the list - at least as I read it - seems painful but understandable in a dire emergency. But the why aren't we preparing for such an event in any meaningful way, aside from deciding who doesn't get health care? As Winebrat upthread mentioned, there will be privatized systems for those able to afford them, and while some might argue that they are paying for a different system and therefore aren't a strain on the limited resources, the medical personnell, medical supplies and facilities that go into running a private system are going to be a further drain on public resources.

We need to have this discussion, given the likelihood of something like this occurring ( some of my father's earliest memories were of the Great Flu Pandemic), but we need to have this in the context of real discussion on developing a real national health care system in this country.

There just won't. If I went down during a pandemic, I wouldn't even attempt to go to the hospital. It will be bedlam in those hallowed halls.

this thread. You know what you are talking about. Normally accurate information reassures me, not so much in this case. I take it a lot of us are pretty well screwed when it hits.

Stockpile beans and rice and water (rain barrels are good for that - 2 gallons of water per person per day). Get enough respirator masks for each member of your family and make sure they fit correctly and everyone knows how and when to use them (never be in public without them!). Learn proper handwashing technique. Go to ground when it hits and if anyone in your family gets sick, quarantine them, do what you can for them but do not be without your respirator around them. Have basic first aid supplies in place and easily found. Have flashlights for when the lights go out as they soon will.

See, it isn't just that the hospitals will be overwhelmed, all the systems will come down to some extent, but if you've put some things in place, you have a better chance of making it through.

That is why I talk on these threads. I want people to set up a personal emergency system while they still can - when it comes, it will be too late.

They already exist to some extent -- not to deal with pandemic but natural disaster. But give them a chance and they'll expand to stockpile all the ventilators and beds and penicillin they can and build their secret clinics while their wealthy clientele gladly pay the annual premiums.

"But the why aren't we preparing for such an event in any meaningful way, aside from deciding who doesn't get health care? <snip>We need to have this discussion, given the likelihood of something like this occurring ( some of my father's earliest memories were of the Great Flu Pandemic), but we need to have this in the context of real discussion on developing a real national health care system in this country."

As much money as we spend on health care in this country, the fact is we are still, even after 9/11 and Hurricane Katrina, woefully unprepared for a national health catastrophe. The problem is complex, but I welcome anything that sheds the glaring light of day on just how messed up our health care system is here in the US. People talk about having "champagne tastes on a beer budget". Our private insurance based health care system is "beer" on a champagne budget. Never have so many gotten so little for so much!

It is the "chronic disease and disability" that can be dealt with more effectively with universal health care and poverty elimination.

I support the idea of triage, if its done in a fair and morally defensible way. I could live with the ones described in this article. Unfortunately, given today's healthcare environment, patients would be triaged by ability to pay. For example, a severe burn victim with a great healthplan would be treated before an uninsured trauma patient. An 85-YO with dementia with a very wealthy family would always get care - if only by private docs charging top dollar.

Sure, if the hospital execs have their way, money will be a factor, but in the event of a pandemic, none of the healthcare providers will listen to them.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and

government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health

and Human Services.


Let's hope our next administration convenes a new "task force" and new health care decisions.

Realizing total nuclear war is unavoidable, the muckitie-mucks of the government and military decide who goes into the underground tunnels to escape annihilation. It is noted that each male should have several young, attractive wives in order to re-establish the species.

They all pick themselves.

I saw this movie it was "The Stand".:hide:

if you have limited resources, you want to use them on people with the highest chance of benefiting from those resources.

this is for an extreme situation, not everyday life.

This is SOP during an emergency, and happens quite frequently in battlefield hospitals.

The Bush Administration is frought with crimes against man & nature, but we mustn't throw blame where it isn't warranted or we will look foolish & damage our cause.

and no one ever imagined they would use airplanes as missiles

:eyes:

I'm not a bush apologist, if you're implying that.

bush was absolutely responsible for Katrina becoming the massive tragedy that it was, and remains to be.

And *someone* did more than just imagine those planes.

bush, personally, is responsible for the aftermath of that tragedy also.

Not only did he not "foresee" it, despite all the evidence available to his advisors, he failed to respond in an appropriate manner. He then used the tragedy to further his imperial ambitions. I doubt that I could actually envision the actual number of people that bastard has killed, nor imagine the scope of the suffering he's caused.

Slight as the chance is to see him pay for his crimes, if we allow ourselves to be stampeded into condemnation over a correct decision, we lose credibility. The concept of triage, as horrific as it sounds to the casual observer, is and has been accepted medical practice. I believe it dates back to the Napoleanic Wars (in which case it can be ascribed to another illegitemate, homicidal tyrant) but , of necessity, has undoubtably been the practice in any catastrophe mankind has faced as a community.

Impeach the bastard, malign the bastard, but don't fall for an obvious misinformation-ambush.

(EDIT: not sure why i wait till i post to proofread...)

I NEVER see my goofy mistakes until I've posted. Then I have to look at the ugly red edit notice.

Glad I'm not alone. The red badge of poor spelling haunts nearly all my posts.

:hi:

it's levees not levies.

Sorry ,but that's a pet peeve of mine.

order it from overseas, if one were so inclined. It is a bit expensive, though. This could be used for an avian flu outbreak.

Along with our respirator masks and various antibiotics (for secondary infections - antibiotics will do nothing for H5N1 or any other virus).

Our insurance company won't even let us have an extra inhaler for school (so I have to finagle dosing and dates to end up with an extra), let alone extra antibiotics and Tamiflu. How can we stockpile, which I think is a great thing, if we can't get our insurance to even let us have extra for school and home?

Perhaps some people might order from overseas pharmacies which is technically legal but kind of a gray area, you know? Probably, if a doctor or nurse did that, they would be unlikely to reveal that.

You won't see ANY Congressional reps turned away in case of emergencies. You won't see the elderly with extreme problems (can you say Cheney the Medical Borg) with the *right connections* being turned away.

Yes sirree -- those who *know* someone in the hospital won't be turned away, regardless of what bits aren't working.

Wonder if the slightly ill will be shut up with other plague victims - like the doctors who turned tail and RAN from the plague in London a few centuries ago? :sarcasm:

You think Raoul Castro and his ruling elite, spouses, and friends are going to be at the back of the queue?

haha I gotta' bridge to sell ya! :rofl:

This is reality. Face it. If you're not in the ruling corporate, capitalist, democratic, socialist, communist, republic what-have-you group, you are going to be screwed.

the flu will take plenty from their ranks as well. They may have the advantage of getting first dibs at a ventilator but that doesn't necessarily mean they survive.

Every hospital I have worked at has had triage instructions as part of their policy. It can be very very very difficult to have to make the decision when resources are limited.

in their pandemic preparedness planning. The US is simply late in the game.

http://www.nzma.org.nz/journal/118-1211/1343/

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030436&ct=1

Here's one scenario envisioned: http://www.med.govt.nz/templates/MultipageDocumentPage____14543.aspx

(Pretty spooky, eh?)

Bottom line is that it's wise to set evidenced based priorities and plan ahead of time for rationing and distribution of scarce resources (and not just medical resources).

Emergency departments in hospitals and clinics all across America are already operating at near capacity; how do you think that's going to look in a 1918 style pandemic, when staff (and their family members) are also affected?

Thanks for a moment of rationality.

triage. I am debating the fact that there are fifty million Americans currently uninsured now and that this is a "on-going crisis' in this nation even as we speak.
Not for one minute do I believe that the uninsured will be treated in the same manner as the insured. Why would they, they certainly are not now. Go ahead and plan on who will be treated and who will not be so that everyone is on the "same page here" but lets get this perfectly clear, there is no equality in health care in this country at this time and even if the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services state that in the event of a national pandemic flu outbreak there will be-they are full of b*ll Sh*t. Let us deal with the crisis at hand.:argh:

Imagine how many people would die if they ever decided that.

Oh wait...

you would see hospital staffs stopping the flesh-eating undead with clipboards asking for their policy numbers.

the servants quarters with the maid, valet, and fluffer?

If you'd read through the thread, you'd know that.

I'm a nurse. I know what I'm talking about.

"...The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force..."

Yes, if you are elderly, you are worthless, right? This is disgusting!

It is used to prioritize medical treatment all the time. My daughter has a condition that occasionally needs immediate treatment - when we hit the ER door with that condition we seldom wait more than 15 minutes, even if the waiting room is crowded. On the other hand, when she goes in with things than can stand to wait we sit and watch later arrivals be taken back relatively immediately.

I do have a problem when the sorting is dictated by the perceived worth of the individual being treated, as appears to be the case here:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

The two blue categories are not inherently related to the likelihood that using scarce resources on people in these categories would be medically futile (or would have a far lower medical return) than using the scarce resources on others. Those two categories (used as a criterion for triage without considering the health status of the individual involved) seem to me to be more based on who it is worth saving. Older people are not - even if they are in nearly perfect health as my grandmother was at that 85 (she died a year or so ago at age 101), and people who are mentally impaired (even if they are otherwise in perfect health).

Although I agree that the other categories - particularly the last - will tend to discriminate against those who have always had poor access to medical resources, the presence of conditions listed does generally mean that in a crisis a larger investment of medical resources will have to be made with a lower chance of success. A sad way to look at it, but in a true medical crisis resources have to be allocated - and they should be used where they will have the greatest likelihood of success. That makes it all the more important that we move now to a non-crisis health care model that ensures access to care for all who need it.

(Edited because I accidentally hit post rather than preview before I was done.)

I don't consider that discrimination in a worse case scenario to willfully choose to save a five year old over an elderly person. My grandmother would willingly give her life for her child, grandchild, or great grandchild in such a scenario I know this in every fiber of my being. It is just the cycle of life.

willingly giving up your life, and having that choice made for you. My grandmother might well have made the same choice - but allowing someone to sacrifice their own life is not the point with these guidelines. Devise some card (like the organ donor card/icon on the drivers' license) for individuals who would willingly sacrifice their lives in favor of younger folks - but it is not appropriate to pick a random age (without any reference to underlying medical conditions of the individuals involved) and declare that those older than the random age should be sacrificed in favor of those younger than the random age.

To permit the use of age as a criteria for medical treatment is to permit the allocation of scarce lifesaving resources to be based on the perceived value of the individual being saved, not on how effective those resources will be toward saving lives. The resources need to be allocated where they will do the most good.

The cycle of life also involves the fittest surviving, and that may well be a healthy 85 year old rather than a 5 year old that has multiple additional health concerns.

Difficult decisions will be made very, very quickly, and based on the stats, an 85 year old doesn't have much "life" left. A breast cancer patient with stage four cancer is not going to be at the front of the queue, either. That's just cold, hard reality. It has nothing to do with the person's perceived value to society on any given day, her intelligence, or anything else. At that point, the collective becomes more important than any one individual. It goes against everything I believe, but it is what it is - allocating limited resources to those who have the best chance of survival.

An arbitrary age is not, in and of itself, an indicator of "the best chance of survival."

The triage needs to be done based on investing limited resources to where they will have the most impact. The person with stage 4 breast cancer would not be allocated the resources because the investment of resources will have a very low rate return with a person with stage 4 breast cancer, since it will take far more resources to allow that person to survive. That would be true whether that person with stage 4 breast cancer is 86 or 30.

The same can't be said for using age as a triage criteria. The same allocation of resources will create essentially the same chance of survival for a healthy, active 86 year old as it would for a similarly healthy, active 30 year old. So if they both have the same chance of survival, the decision as to which one receives care is being made based on the perceived value of the person being saved - and that is wrong, pandemic or not.

You wrote, "The same allocation of resources will create essentially the same chance of survival for a healthy, active 86 year old as it would for a similarly healthy, active 30 year old." I'm sorry, but that is not true - at all! The elderly as a group take up much more resources just to recover from basic illnesses like bladder infections and bronchitis.

A bladder infection knocked my eighty-some year old grandmother on her butt - I'm talking about a walking, talking, sharp woman whom I would feel blessed to have that kind of health when I'm sixty-seven! We thought she was getting senile, it affected her so greatly. Even if she had the same rate of survival from a bladder infection that a 30 year old would, she was sick for almost three months. She recovered slowly, and then had to get her strength back. All of that took nursing care. That's what some of the medical personnel on this board have been trying to say. (And I'm happy to say that she made a full recovery. If only we could all be blessed with such sharp minds and good health.)

Regarding respiratory infections - pandemic flu, for example:

"Respiratory infections are common at all ages but are particularly sinister among the elderly because of the fragility and chronic comorbidity associated with this age group. " (bolding is mine) http://www.ncbi.nlm.nih.gov/pubmed/15482146 That's just the first site I pulled up.

In a pandemic situation, stats show that an elderly person will take up valuable resources - vents, beds, medicine, nursing care, etc., that could have been used to save multiple younger people. Advanced age - I'm afraid - is a general indicator of "the best chance of survival," and in a pandemic situation, you're not going to find an ER nurse sitting down with you and taking a long, detailed medical history to determine whether a particular elderly person has a better chance than most others.

We're talking about a situation that could turn into a riot at the hospital at any given moment due to lack of services, equipment, and care. Patients will be triaged through VERY QUICKLY.

One of the fears of many Americans will be the allocation of resources among americans when we go to single payer. (I'm optimistic - I say "when," not "if." haha) Now, go back and reread this thread, and you will understand the fears of some who won't vote for single payer. They are thinking of their own selves, and not the tens of millions who don't have any insurance.

African Americans are more likely to have out of control diabetes (45-61% of the African Americans with diabetes have an unacceptable H1AC according to one study - and African Americans are already diagnosed with diabetes at a rate higher than whites). African Americans are more likely to have dangerously high hypertension (again out of a population that is already more likely to have hypertension in the first place). Therefore, race is an acceptable triage criteria in a pandemic because "as a group (they) take up much more resources" to recover from illnesses which are complicated by out of control diabetes or recovery made harder by the strain severe hypertension places on organs.

The same argument could be made for homeless individuals, individuals living in poverty, or any number of other populations which, statistically, have a higher rate of health problems.

No - I don't believe race, homelessness, or poverty make acceptable triage criteria - any more than I believe age, without reference to health, is an acceptable triage criteria in a pandemic.

Just because a population, as a whole, is more likely to have certain health conditions does not make it right to base allocation of medical resources to individuals within that population solely based on their membership in a population that has a higher proportion of aggravating health conditions (whether that population is individuals over 85, race, or mental abilities, etc.).

Set out the health conditions that make survival less likely or more costly (as they did with the exception of age and mental ability) and triage based on the troublesome medical factors - not on the assumption that because someone is in a certain population those medical factors impact that individual.

may have more difficulties even if they survive the disease. They'll need more human resources to remain intubated, IV's patent, taking correct meds, and then there is the difficulty in surviving on their own (are their caregivers also sic?) after discharge. There isn't an assignment of "worth" of the person, just practicality in surviving the hospitalization and discharge.

My own son may not qualify for medical help because of his autism. It is just a practicality.

Hey, they'd be doing them a FAVOR, right? Goin' home to Jebus and all ...



:sarcasm:

I ask because I read some time ago that infants were also to be given low priotity in a pandemic situation.

This was based on the fact that societal investment versus future beenefits is highest in people from their teens to their forties.

It makes as little sense to expend scarce resources in a crisis saving infants (in whom there is little social investment and who are easily replaced) as it does to expend resources saving geriatrics (whose limited future social contributions make them low priority.)

This particular set of guidelines seems to not deal with the issue of infants. I guess it is just too explosive to be up-front on this. But if you don't deal with it now, then when?

- B

And yes, my understanding is that very small infants also get a low rank in these sorts of things. It's a horrifying thought, but it fits overall.

A 90 year old, or a person with other major medical complications, is going to take far longer to recover than a younger healthier person. It's not simply a matter of them taking a bed away from a younger person, but the fact that they'll be there longer, they'll require more medicine and caregiver time than other patients, and despite all that, they're still more likely to die because of the systemic trauma associated with their other conditions. The focus isn't on "who contributes most", but who is the most likely to walk out healthy in the shortest period of time with the least amount of medical assistance.

As I understand the triage concept in a pandemic, you have to choose who will receive life-saving care, and who won't. I agree that survivability is a factor to consider, but it is also legitimate to consider relative potential societal contribution of individuals, and relative societal investment in individuals who are competing for care.

On that basis, I think infants score low, since there is minimal sunk societal investment in them (i.e. education, training, etc.) and they can easily be replaced. Society has a significant investment in a 20 year-old, however, and a 20 year-old is better equipped to benefit society right away, compared to an infant.

On the other hand, social cohesion would also be needed by society during a pandemic, and this could result in choosing children over adults, regardless of social investment and potential benefits.

The more I think about this stuff, the less inclined I am to think that rational decisions will actually be made in a pandemic situation. I am ionclined to think that the veneer of civilization will quickly disappear, particularly in highly individualistic societies such as America. Authoritarian societies will likely cope better in the long run.

- B

I haven't read all of the articles in the med journals on this, but I've never seen anyone suggesting babies get thrown out. Maybe they'd triage based on the infant's health and survivability, just like older kids and adults? I don't know.

might make it more likely that we'll do something so that we have enough resources that those priorities would be less necessary. but if they are, then they would be unavoidable.

my 85 grandmom is wonderful but my 10 year old brother hasnt had as much time as her to even see life. he shoudl get priority as much as it woudl suck to lose my grandma

Triage occurs in every emergency room, every day, every hour. A system of prioritization must exist so that a person having a stroke or heart attack does not sit in the waiting room while sore throats and dental pain and coughs and colds get treated first.

The point here is simple. How do we prioritize when the system becomes overloaded?

Too many posts here are questioning available resources, allocations, etc.-- all valid issues, but not relevant to the discussion. Even a perfect health care system will not have all the resources it needs to deal with a major disaster, pandemic, etc.

The management of disasters was not invented with this article in Yahoo. As usual, the media does not report that health professionals have been getting training in this area for a decade or more, and systems are in place for initiating command posts, determining resource allocation, mobilization of available resources on a regional basis, etc. There are systems in place for statewide or regionwide communication between hospitals, EMS, law enforcement, Fire Depts, Hazmat teams, etc. Drills have been ongoing for years in most hospitals.

None of these decisions are easy, but it makes a whole lot of difference when you are in the trenches and experiencing a disaster, and algorithms are in place for getting things done. It saves a lot more lives and gets a whole lot more people treated more expediently.

And by the way, the lack of medical insurance is not a factor in making these decisions.

Everyone's been talking about it. There aren't enough beds, ventilators, or staff, and it worries everyone. I've never heard anyone talk about ability to pay or insurance being a factor. I'd think that billing would go out the window in a disaster--how could you keep up on the EMR if there's no power and no paper charts to use?

Drills have helped so that chaos would not reign.

Resources are a tough issue. I suppose you could stockpile gurneys. Stocking vents would be costly and difficult due to maintenance issues. Meds could be overstocked and rotated out yearly (at what cost?). Staffing is a tricky issue-- having everyone and then some on call in case of disaster is an approach.

It's difficult to keep a broad spectrum approach to preparedness; as you know, an infectious disease disaster is only one of many types of overloading situations. You've got mass trauma, fire, biochemical, radiation, etc. and the need to keep things on hand for all these potentialities.

Our most recent overload was 18 patients from a local school with carbon monoxide exposure/inhalation syndromes, and that was plenty. But the system in place was in effect, with other area EMS systems and hospitals absorbing the overload, otherwise we would have gotten 40 or more patients...

We just lost the peds floor of our hospital. The press release in the paper blamed the nurses, but a nurse friend of mine said it was because we lost a pediatrician and the others didn't want to cover the call. That sounds more like what I would expect. If we had a peds event, like that CO exposure, we'd have to turf them all 30 miles away. Not good.

If we had gotten slammed with higher acuity stuff, it would have been a nightmare.

I wish everyone could spend a day with me or your hubby, just to get a sense of the nature of the decisions and priorities we have to deal with. And also to realize that public perception is far removed from reality.

I rarely post in health issues forum because it would take so long to explain, to dig out of the holes that rapidly become created. I read a few posts and feel buried. I admire your continued efforts as an informed and extremely patient contributor.

I tell my husband all the time that most people really have no idea what his job is like. Most Americans really don't deal with death on a regular basis. I knew a knitter who refused to go to funerals entirely and had never gone to one ever, and I doubt she's the only one. That leaves tv shows and the internet for people's information and reality base, and they just don't understand a lot of actual medicine. Hubby's had family members who refuse to sign a no-code order for a loved one when there's obviously no chance their loved one will ever recover, and he's had patients yell at him for all sorts of stuff that he has no control over because they saw some ad that promised they'd get all better (and not get any of the many side effects). It's a hard job, and people can't always visualize all of the mess behind the scenes.

so the number of available MDs, RNs, EMTs and other health professionals will dwindle in a pandemic. They will get sick and die too, just as the patients will.

Even if we have enough material supplies and hospital beds to cover a pandemic, we will not have enough medical personnel to deal with them all.

The 1918 pandemic was awful in that way, as was the Plague in the middle ages. Imagine 30% of the people you know around you suddenly dying off. Everybody, jobs and station in life don't matter to diseases.

With the health problems the kids and I have, we can't get the smallpox shot, and Hubby can't get it because he could give it to us until the site heals over. Then there's H5N1 or something like that--no protection is 100%, and what if they called my husband in on a Code Black, and then he never came home?

24-hour fear-mongering.

I thought the end of the USSR was supposed to usher in world peace.

"Nothing can be done except to hunker down as individuals, every man for himself."

Optimistic bunch, these democrats.

I can read the same discussion on the right-wing boards.

In a dog-eat-dog world, who wouldn't pick the tougher dogs?

I thought being a democrat meant something different

means paying attention to the science and world events not praying something will go away if we don't talk about it.

It would be an awesome root cellar and extra pantry, not to mention safer in case of tornadoes, which we're at risk for.

I've always wondered, though, what do you do for oxygen in those things? If a bomb explodes within a good-sized radius, the massive firestorm from it would suck up all the oxygen anywhere, so what did people do for oxygen, or did they just put in really nice storm shelters/pantries?

As for Democrats being different, we are--we're planning ahead instead of wallowing in fear and ignorance. :)

Myself, I prefer "freedom from fear" for everyone.

They freak when a woman decides to terminate a pregnancy. Shouldn't they be just as vocal about a doctor deciding to terminate the medical treatment of a patient?

down load "flusurge" from the CDC. You can enter variables such as population demographics, mortality and morbidity rates, and see what the impact on your hospitals will be. You decide. SHould we buy and stockpile mechanical ventilators to insure that every person who needs one will have one available? If so, we need to start pumping huge dollars into respiratory therapy schools so we will have staff to manage the huge number of cases.

http://www.cdc.gov/flu/tools/flusurge/