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Explainer: What is “Crisis Standard Treatment”? | Nationwide

Boise, Idaho (AP) — Public health leaders say delta variants continue to spread unabated in much of the United States. Approved health care ration In parts of Idaho, Alaska and Montana.

At least five states, Georgia, Kentucky, Mississippi, Arkansas, and Texas, are filling more than 90% of their intensive care unit beds, according to data from the US Department of Health and Welfare.

The transition to distribution care occurs as the number of unvaccinated COVID-19 patients requiring hospitalization grows exponentially. Crisis care standards allow healthcare providers to provide scarce resources, such as ventilators, to patients who are most likely to survive.

But deciding who gets what is not an easy task.

What is “Crisis Standard Treatment”?

Care crisis standards provide healthcare providers with legal and ethical guidelines when there are too many patients and there are not enough resources to care for everything. Basically, they explain exactly how health care should be allocated to save as many lives as possible in the event of a disaster.

During the pandemic, some medical distribution procedures became commonplace, hospitals postponed elective surgery, and some doctors switched to online visits rather than seeing patients directly. However, more serious procedures were rare, such as which patients needed to be treated in a regular room or intensive care unit bed, and which patients could be treated in a hospital lobby or classroom.

At the extreme end of the spectrum, care crisis criteria are generally treated with analgesics and other palliative care until which patient receives mechanical ventilation or other life-saving medical intervention and which patient recovers or dies. Use the scoring system to determine what to do.

What is a scoring system? What is a “tie breaker”?

The state may use a combination of factors to come up with a patient’s “priority score.” Idaho When Montana Both systems consider how well the patient’s major organ system is functioning. Patients with signs of liver or kidney damage, low oxygen and blood clotting levels, and coma that are unable to respond to pain have a high score.

Both states score people based on saving the most “lifetime”. Therefore, if there is cancer or another illness that may affect future survival, they will get a higher score.

The lower the patient’s score, the more likely the patient is to survive and move towards the forefront of mechanical ventilation and other resources.

The plan also includes a “tie breaker” that works when there are not enough resources for all frontline people. Young people are the biggest tiebreakers, and children are a top priority.

In Idaho, pregnant women who are at least 28 weeks with a viable pregnancy will come next. Both states consider adults younger than the elderly, and Idaho’s fourth tiebreaker is whether patients perform essential tasks in responding to the public health crisis. The last tiebreaker is the lottery system.

If someone on the front line is given a ventilator and no improvement is seen within a certain period of time, Idaho says they should be taken off so that someone else can get a chance.

On Thursday, shortly after Idaho enacted a state-wide critical standard of care, Dr. Stephen Nemmerson of the St. Alphonsus Regional Medical Center in Boise, as far as he knows, was a patient in the state to provide equipment to someone. Said he was not excluded from life support. If I do not. But he warned that it would happen.

“It’s bad today. It’s going to get worse,” Nemmerson said. “I’m scared of all of us.”

Is the status of vaccination important?


In both Idaho and Montana, care crisis standards do not consider whether a person is vaccinated against COVID-19. Similarly, if a patient is injured in a car accident because he / she did not wear a seatbelt or drove while drunk, the patient will not be denied care.

“When it comes to patient care, the vaccination situation has nothing to do with us,” said Dr. Sherry Harkins, Chief Medical Officer at St. Peter’s Hospital in Helena.

What other changes will occur if the hospital operates under critical standard treatment?

Almost everything.

People can spend more time waiting for treatment not only in hospitals, but also in emergency medical centers, which are likely to serve more patients. Nurses care for more patients than usual. Some people can put them on stretchers or cribs instead of hospital beds. Patients may return home from the hospital as soon as possible during recovery, relying on prescriptions for friends, family, and home medical devices.

In some cases, the doctor may not save the patient’s life at all. The Idaho Care Plan Crisis Standard requires all adults to have a “no resuscitation order” if the state lacks sufficient ventilators.

That is, if a patient experiences cardiac arrest (the heart stops suddenly), there is no chest compressions, no attempt to restore the heart to a normal rhythm, and no opportunity to connect to life support. This is because resuscitation requires a lot of hospital staff and a lot of time and often fails. Also, if the patient is infected with COVID-19, the process of attempting to recover will release aerosolized viral particles into the air, putting staff at risk.

Montana’s plans are a little different, allowing individual doctors to decide whether to revive a patient on a case-by-case basis.

How does this affect healthcare professionals?

When you talk to your Idaho health care provider, you may hear the phrase “moral injury.” this is, Trauma Experience when a healthcare provider loses a patient or faces the inability to provide life-saving treatment. Ideally, critical standard treatment plans reduce moral injuries, but they are far from perfect.

Dr. Matthew Winia, an expert at the University of Colorado School of Medicine and Health Ethics, said state authorities should be responsible for establishing the strategies necessary to make triage decisions fairly. Bedside.

That is, make sure that the transfer system is working and working properly so that one hospital does not make a tragic decision due to lack of resources available at another facility. Means.

When faced with a serious shortage of staff and equipment, “I can’t really tell (to the patient or his family).’Do you want to go to the ER?’ You go to the patient and say,’We do it. I have to say, “I can’t, that’s an incredibly difficult situation,” Winia said.

“There’s no way to look at this and say it’s okay. It’s not OK,” he said. But if the hospital runs out of resources, “this is happening now,” Winia said.

What can I do to get it back to normal?

Health experts say vaccination is the best way to go Protects against the need for hospitalization Due to the coronavirus. The Idaho hospital crisis is primarily caused by a significant increase in the number of coronavirus patients in need of hospital care, Idaho Health and Welfare Director Dave Jepsen said Thursday.

The Idaho Ministry of Health also warns people to pay particular attention to all aspects of their daily lives by wearing seat belts, taking prescribed medications, and avoiding high-risk activities such as mountain biking until the crisis is over. I’m giving advice.


Lindsey Tanner contributed this report from Chicago. Iris Samuels contributed this report from Helena, Montana. Samuels is a corps member of the Associated Press / American Capitol News Initiative Report Report. Report for America is a non-profit national service program that places journalists in the local newsroom to report on unreported issues.

Explainer: What is “Crisis Standard Treatment”? | Nationwide

Source link Explainer: What is “Crisis Standard Treatment”? | Nationwide

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