# 4563
There’s a long article today in the Salt Lake Tribune about Utah’s guidelines for Triage during a mass casualty disaster, such as an earthquake, bio-terrorist attack, or a severe pandemic.
These guidelines envision the choices doctors must make when emergency medical needs outstrip available resources. I’ll just reproduce the opening to the story.
Follow the link to read it in its entirety.
I’ll wait.
In flu pandemic or earthquake, Utah hospitals could exclude patients
Health » Emergency would see some children and some seniors turned away.
By Heather May
The Salt Lake Tribune
Updated: 05/11/2010 11:13:28 PM MDT
When a killer flu strikes, with several thousand sick or injured and no room to spare in understaffed hospitals, care will be denied to the sickest adults and children.
Those who are severely burned, have incurable and spreading cancer, fatal genetic diseases, end-stage multiple sclerosis or severe dementia will be turned away. They can be sent elsewhere for comfort care, such as painkillers, but they will not be treated for the flu, according to controversial Utah triage guidelines being modeled across the country.
People older than 85 also wouldn't be admitted in the worst pandemic. Those who have signed "do not resuscitate" orders could be denied a bed.
Doctors could remove ventilators from patients deemed unlikely to recover, to give them to other patients.
These triage guidelines envision an outbreak -- or another public health emergency -- so severe that the health care system is unrecognizable. They apply to disasters from bioterrorism to an earthquake.
Utah Pandemic Influenza Guidelines / Worksheets
Utah Pandemic Influenza Hospital and ICU Triage Guidelines for Adults PDF Utah Pandemic Influenza Hospital and ICU Triage Guidelines for Pediatrics PDF B1 Adult Patient Worksheet PDF B2 Pediatric Patient Worksheet PDF
A hat tip to Carol@SC on the Flu Wiki for the link to this story.
While triage is an ugly concept to most people, it is important to have a clear set of preset rules or guidelines to help health care workers decide how to proceed when inundated by mass casualties.
Not only does it instill reason and consistency to the decision process, it protects health care workers from charges that they played favorites, or acted inappropriately.
Of course, if you, or someone you care about, is denied care or turned away because of these guidelines, you might not take too kindly to them.
In Triage, there are always winners and losers.
You concentrate on saving the salvageable, rather than expending valuable resources trying to save those who are unlikely to survive.
The decision to withhold care from those over a certain age, or those with serious comorbid conditions is more controversial, but when resources are scarce, you have to put them where they are likely to to the most good.
It’s never an easy decision.
Back in the Jurassic period, when I was a paramedic, we probably spent a couple of hours of classroom time talking about triage theory. There were no firm guidelines – nothing in writing - and frankly, it was up to each of our ambulance crews how to deal with triage at each scene.
It was an awful system, and left a terrible burden on the medics. All I can say is, we did the best we could.
Triage protocol is far better defined today for incidents like car wrecks and plane crashes, but when it comes to truly large-scale disasters there are a lot of gaps and grey areas.
While I understand how difficult, and distasteful, coming up with triage guidelines can be – these are crucial steps that must be taken now if we are to effectively deal with a mass casualty incident sometime down the road.
It’s not pretty. But it is essential.
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