For Immediate Release
November 12, 2009

KDHE Office of Communications
communications@kdheks.gov, 785-296-0461

Making Tough Choices in a Health Emergency

A Column by Jason Eberhart-Phillips, MD
Kansas State Health Officer and Director of Health
Kansas Department of Health and Environment

What ought to happen in a public health emergency if the number of patients needing acute medical care rapidly exceeds the capacity of hospitals to provide it?

What should be done if the health care needs of the community are suddenly so great that they overwhelm the ability of the health care system to provide care at the usual high standards?

In such a crisis – whether it’s due to a natural disaster, a terrorist attack, or a flu pandemic – how should hospitals allocate scarce life-saving resources in the face of crushing patient demand?

These are not easy questions. In fact, they are down right uncomfortable for most people to think about. We Americans aren’t used to dealing with shortages, least of all when we need emergency care in a hospital.

But in Kansas we know that good planning means that we think long and hard about tough questions like these, as many other states are doing in the name of preparedness.

Now, thanks to a team of experts in health care, law and ethics led by the Kansas Health Institute and the Kansas Department of Health and Environment, we are beginning to find some practical answers. The fruits of the panel’s hard work can be found in a report entitled “Guide for planning the use of scarce resources during a public health emergency,” which is being released today.

During an overwhelming public health emergency there may not be enough medications, equipment or available hospital staff to offer everyone the same excellent care we are accustomed to receiving in Kansas hospitals. At such times it may be necessary to shift the usual practice of hospitals doing everything to save each life to a model of allocating scarce resources in a different manner to save as many lives as possible.

For example, in Kansas hospitals there are only so many mechanical ventilators, machines that breathe for patients unable to breathe for themselves. If hospitals are flooded with patients in respiratory distress due to a severe flu pandemic or another disease, doctors will to forced to decide who gets hooked up to a machine and who doesn’t.

Using sound ethical principles, the new guide provides some direction in solving such dilemmas. Instead of treating the sickest or most injured first, it suggests that doctors focus instead on reserving scarce treatment resources for individuals who have both a critical need and are likely to survive.

A person’s gender, social class, race or insurance status would have no place in decisions about their access to critical treatments. Neither would considerations of patients’ ages or judgments about their “quality of life.” Instead, decisions about allocating scarce resources such as mechanical ventilators in an emergency would depend entirely on objective clinical evaluations, performed in each hospital by independent physicians.

In the case of patients vying for a finite number of breathing machines, each would be scored on the function of major organ systems. Those most likely to die without the use of a ventilator, but with a high probability of surviving if they can use one, would get the highest priority.

The guidance in the report is strictly voluntary. It doesn’t lay down rules or mandates for hospitals to follow. The report is currently being shared with Kansas doctors and hospital administrators for their review and comments.

Members of the public will also be given an opportunity soon to offer their views. Understanding of this complex topic by both health care professionals and the public is essential well before there is an emergency that causes critical resources to become scarce.

No one likes to imagine such an emergency. For the moment, the H1N1 flu pandemic is not putting such a strain on our health care system that the measures proposed in the report would come into play. But we would be remiss not to plan for a day when life-saving health care resources do fall short in the face of overwhelming needs.

This new report represents a significant step forward in such planning for Kansas. To read the report yourself, go to: http://www.kdheks.gov/cphp/download/GuideforPlanningUseofScarceResources.pdf