Critical Care is Critical

One of the advantages of living in a society with advanced medical care is access to an extensive array of complex devices and procedures delivered by highly trained professionals. Conditions that otherwise would result in death can be cured in a significant number of people as a result. In rich countries, we assume that everything that can be done to save our lives and the lives of our loved ones will be be done, including the use of Intensive Care Units (ICUs).

However, ICUs and other forms of Critical Care, especially the use of ventilators, are extremely expensive. Further, the number of people trained in their use is limited. Although ICUs are usually available to those in wealthy nations, this will almost certainly not be the case during a pandemic.

From The Guardian

The swine flu pandemic could cause a severe shortage of intensive care beds in hospitals, especially in children’s units, experts warned today.

More than double the present number of beds may be needed in some regions, while there could also be shortages of ventilators to help patients breathe.

Facilities for children were likely to become quickly exhausted, while hospitals could face massive extra demand, researchers said in the journal Anaesthesia. Hospitals in the south-east, south-west and east of England, as well as the east Midlands, were likely to be hardest hit.

The predictions came as a pregnant woman from Scotland, critically ill with swine flu, was flown for specialist treatment to Sweden because the five beds at the UK specialist centre for her condition in Leicester were full.

From the Waikato Times:

Canterbury intensive care specialist Geoff Shaw, whose unit had 10 critically ill swine flu patients last night, warned yesterday that both life-saving ventilators and specialist ICU staff were in limited supply. Doctors could be forced to ration care if increasing numbers of swine flu patients in critical condition were admitted to hospital.

“We’ve got more people requiring ventilators and it’s only expected to get worse,” he said. “We don’t have the resources to manage the case-load if patients continue to come in in increased numbers, and at some stage we may have to make some difficult decisions about who gets care.”

What does it mean if a decision is made that someone will not receive critical care? Almost certainly death. In the early stages of a pandemic, these decisions can be prioritised based on the likelihood of survival. Thus, family members may be told that their loved one is unlikely to survive in any event and that advanced care would just prolong the inevitable. However, as the number of cases increases, care may not be offered to people who would survive if they had it. How then do doctors decide who lives and who dies. Who gets the ventilator: the 22 year old pregnant woman, the 45 year old nurse or the 12 year old boy with a chronic medical disorder?

For years, there have been discussions about how to value different people’s lives. These discussions are no longer academic. Doctors are likely already making these decisions in poor countries, with little attention from the press. In rich countries, the public’s expectations are different. Family members of the ill may not put the same value on a patient’s life as an hospital administrator.

Government leaders and public health authorities have a simple choice: either enact policies that decrease the number of patients with pandemic flu (like school closures) or prepare to explain to grieving family members why their loved ones life was not worth saving.


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