Government Report Answers Who Lives, Who Dies in Flu Pandemic

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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.

And gun owners and others that refuse to bow at the alter of Big Brother.

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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.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_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.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

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

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list "was emotionally difficult for everyone."

That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."
 
Thats when roving gangs of gun caring thugs(zombies) will steel the meds for themselfs. Doctors playing God .
 
That sounds bad, but it's pretty standard from a triage perspective. First priority goes to people who are the worst off, but who can still be saved. Based on statistics in such a situation, it's likely that most of the resources that would go into saving the elderly or people who are already seriously injured would likely be ineffective.

eg, imagine you're a doctor in a field situation and have three people...one person with a broken arm, another with a gunshot wound to the chest who is critical but can be saved, and another who is about to be dead in two minutes, tops. Obviously you work on the gunshot patient. The two minutes you spend on the dying person will take away from the other person's chance at possibly making it. Whenever you get around to it, you can take care of the guy with the broken arm.
 
This is nothing new

Our Elected Officials signed an agreement (not a treaty requiring ratification by Congress) that in the event of a pandemic, the World Health Organization could call for and be granted Marshal Law in the US. This will have to be enforced by Natl. Guardsmen and U.N. peacekeepers as the active duty military will be prevented by Constitutional law from occupying in that capacity. It will happen in the name of disaster relief and the results will be nothing less than catastrophic to the general populous. Good luck getting to grandma's house for Sunday dinner and shopping for food will be nonexistent.
 
It's horrid, but what else can be done except to set procedures for choosing who gets scarce medical resources?

Unfortunately, ethics is not considered of particular importance today. That such decisions may have to be made is an unfortunate fact. Who makes them and how they are made is what makes those of us who think about it uneasy. I don't trust those who buy into the currently acceptable way of thinking to make these types of choices.
 
Sounds triage like, but I have fears as a gimp that it will be streached and modified like all others. Flu pandemic is my worst fear. Hard to protect oneself from. I was watching the news in december as they were talking about a strain of the flu this year that was terribly harmful and difficult that broke out on the east coast in december. By the end of January I had it. I was shook fairly good by that experience. If things go bad, head for isolation and keep others away from you. ARG
 
Who makes them and how they are made is what makes those of us who think about it uneasy. I don't trust those who buy into the currently acceptable way of thinking to make these types of choices.
Doctors should be making those decisions, and on the basis of well-accepted practice. The problem here is that in a pandemic situation with a super-contagious disease that affects many people over a huge area, you really need all doctors to be making decisions that are consistent with each other, in order to save the maximum number of people possible. Confusion and lack of a single, clear plan during an emergency doesn't usually end in a minimum of lives lost.

Everyone should really be exposed to some medical education in middle and high school and college - up to the point of doing CPR, advanced first aid, and what to do during public health emergencies like pandemics, radiation leaks, etc. That would reduce a lot of anxiety during such incidents, and decrease the government's perceived rationale for rolling over people's civil rights.
 
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