[Tinki]

I came across this article today and I have to share this. It scares the heck out of me. The part about people with uncontroled diabetes being amoung the ones to die, I'm feeling that is a little vauge. I'd like to know how they are going to determine uncontroled diabetes in a national disaster. Are they going to have the time to do instant A1C's? Are they going to take our word for it? Anyway, here's the article:

Who should MDs let die in a pandemic? Report offers answers By LINDSEY TANNER, AP Medical Writer
Mon May 5, 9:47 AM ET



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.

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."

[Keezheekoni]

Gee, should I say goodbye to my dad and mother-in-law now? They are two of the worst controlled people I know... I ask my dad for his A1c and he says it's "somewhere in the 8s". At least he knows his. My MIL said something close to "what's an A1c" the other day...sheesh.

I do want to know what they consider poorly controlled. Anything above what A1c? People who've already had complications? I mean, seriously...if you're under 6% you're okay?? It doesn't say...

[fgummett]

Ever watch MASH? I assumed they were talking about how to ration medical facilities in the event of a pandemic... in the military it is called triage and basically comes down to the most effective use of limited facilities. Under normal conditions in the ER for example, the most severely injured would take priority... but consider the number of resources being devoted to that one person who may have a poor chance of survival anyway... whereas under triage they may be placed aside and kept comfortable while those same resources may be able to help several people who have a greater chance of survival. It's not a moral question simply a pragmatic approach but of course it has moral implications. War or pandemic changes the rules... rather than trying to save everyone no matter what the cost... an approach which would quickly become overwhelmed and end up helping no-one... it becomes a case of saving the majority at the cost of a few. Triage is also not always a death sentence either... the critically injured who is set aside is kept comfortable and minimal care is applied to try to keep them alive. If they are still alive after the rush is over they will of course then receive priority treatment.

[xMenace]

Maybe this is what's needed to get peoples asses in gear! Getting most of us to take control of their diseas would take a huge (and growing) load off the system.

[morrisma]

Originally Posted by xMenace

Maybe this is what's needed to get peoples asses in gear! Getting most of us to take control of their diseas would take a huge (and growing) load off the system.

John,
You have a point but if their own personal well-being doesn't motivate than how will the vague threat of a pandemic and it's tough choices, again vague, move people.

Sad but true: Even enlightened self-interest is a dying concept in many places.

[xMenace]

Originally Posted by morrisma

John,
You have a point but if their own personal well-being doesn't motivate than how will the vague threat of a pandemic and it's tough choices, again vague, move people.

Sad but true: Even enlightened self-interest is a dying concept in many places.

All I know is that whatever is being done now, it's definately not working for most.