On March 20th, I wrote a blog article called MACRO-TRIAGE, where I called for the exclusion of flu patients from hospitals in an attempt to save the system from collapse during a pandemic. While I can't claim to have any influence over the decision makers in the health care industry, it is apparent they are thinking along the same lines.
Later this week, the American College of Physicians (ACP), the largest medical-specialty organization and the second-largest physician group in the United States, boasting 119,000 members, will release a policy paper entitled:
The Health Care Response to Pandemic Influenza
An excerpt from this report, which deals with the crux of the matter, follows :
A pandemic, ACP warns, will place extraordinary and sustained demands on the U.S. health care system. It will require all non-hospital-based health care providers, internists and family practice providers in particular, to be prepared to counsel, diagnose, treat and monitor patients outside of hospital settings in order to decrease the likelihood of surges that would overwhelm hospital capacity.
Their plan, very simply, is to treat flu victims as out-patients. Victims would be cared for at home primarily, by family members. They have recognized the obvious, that hospitals cannot handle the pandemic load and would collapse under the onslaught of patients.
Presumably, the sickest of the sick, early on at least, would be admitted to hospitals. But the limited number of beds, and the almost non-existant surge capacity of ventilators will undoubtedly mean that even those deathly ill may be denied hospital care once a pandemic begins in earnest.
Whether this idea will work or not, remains to be seen. How many people will show up at hospitals demanding admission for themselves or loved ones? How many people will accept that they must go home and take their chances? I hope someone is planning for increased security at hospitals. They're gonna need it.
Triage. It's never pretty. But sometimes it is essential.
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