https://www.seattletimes.com/seattle-news/it-will-not-be-pretty-state-preparing-to-make-life-or-death-decisions-if-coronavirus-overwhelms-health-care-system/?utm_source=marketingcloud&utm_medium=email&utm_campaign=BNA_032220010143+State+prepares+to+make+life-or-death+choices+%27It+will+not+be+pretty%27_3_21_2020&utm_term=

‘It will not be pretty’: State preparing to make life-or-death decisions if coronavirus overwhelms health care system

By Mike Carter
Seattle Times staff reporter
Washington state and hospital officials have been meeting to consider what once was almost unthinkable — how to decide who lives and dies if, as feared, the coronavirus pandemic overwhelms the state’s health care system.

“We don’t want to do it. We don’t think we should have to do it,” said Cassie Sauer, chief executive of the Washington State Hospital Association, which along with state and local health officials has been involved in refining what Sauer called a “crisis standard of care” — essentially guidelines to health care officials on who should receive treatment and who should be left to die.

“If we have to do this, then we want to do it in a fair and rational and thoughtful way,” Sauer said.

Dr. Vicki Sakata, the senior medical adviser to the Northwest Health Care Response Network, said a group of medical officials and other experts have been discussing how the state would deal with a crisis that overwhelmed the medical system. She prefers to add the word “planning” to the idea of “crisis standard of care” because, in her mind, the goal is to avoid a crisis in the first place.

That said, the state is prepared to act if it has to and has developed guidelines that will be implemented across the system, from the bedside doctor to hospital systems.

“We will do it as a state under an ethical framework that is part of the state plan,” she said. “It will be overseen by an objective team who has been thoroughly briefed on the protocols and processes, and will be undertaken in a transparent and equitable manner.

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“But, make no mistake, it will not be pretty,” said Sakata, who is a practicing emergency medicine physician. “That’s why we are taking the steps we are taking now, the social distancing, the hand washing, all of that, so sometime down the road nobody is left having to decide who gets resources, and who doesn’t.”

Sakata said her network, which comprises 15 Western Washington counties, has been working on crisis standard-of-care planning since 2012, and wanted to assure the public all efforts and resources are being aimed at managing the COVID-19 outbreak so the health care system doesn’t collapse under the strain of too many patients at once.

The orders restricting gatherings and urging people to practice social distancing are all aimed at slowing the outbreak and spreading the cases that do appear out over time so the system is not swamped.

Sauer said she was talking about the plan in hopes of convincing the federal government to release additional medical stores from the Strategic National Stockpile, where it keeps much-needed ventilators and other equipment necessary to treat the sickest of the COVID-19 victims.

“This is America,” she said. “We have resources. We should not be in this position.”

The New York Times reported on Friday that state and health care officials held a conference call to discuss the triage plan. It reported the plan will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation they will die, the newspaper reported.

State Department of Health (DOH) officials told The Seattle Times on Friday they were meeting to further refine guidelines. DOH Director Dr. Kathy Lofy, in an email, acknowledged development of the crisis triage plan.

“Over the past several years, a group of clinical experts in the Puget Sound area developed guidance around how health care might need to be delivered differently during emergencies if supplies, staffing, and or hospital beds become limited,” Lofy wrote. “We are doing everything possible to slow the spread of the virus and increase resources within the health care system so that resources will be available for everyone who needs them.”

DOH spokeswoman Lisa Stromme said the department will release information on the triage guidelines soon, saying it is “one of our top priorities.

“However, it will not be discussed externally until we can discuss it internally in the right way,” Stromme said. “It’s too crucial.”

Sauer is concerned it is too early to determine whether the social distancing order by state and local officials and the shuttering of restaurants, schools and public places will effectively slow the spread of the virus. If not, Sauer said most projections indicate regional hospitals will be swamped with COVID-19 patients over the next several weeks.

Some projections put Seattle’s outbreak on the same scale, but just a few weeks behind, northern Italy, where on Thursday alone there were more than 5,300 new COVID-19 cases reported. Italy has reported 41,000 infections and more than 3,400 people have died, some because doctors there have had to make choices like Sauer and her colleagues were talking about in Seattle on Friday.

Sauer said the guidelines are being finalized and she hopes they are never implemented. If they are, then treatments will be allocated to “the greatest number of people who are likely to survive,” with others provided comfort care and allowed to die.

The decision will be made regionally, so no one doctor or hospital will have to make the decision, Sauer said. At that point, it is anticipated every hospital would be overcrowded and resources would be limited.

The coronavirus has proved to be particularly virulent among the aged and individuals suffering from underlying health problems. If a triage plan has to implemented, Sauer said, decisions will be mostly be based on people in those two categories.

“They will be less likely to receive care, and more likely to die” so people with a better chance of recovering can live, she said.

Obamacare death panels are a hoax

Yes another great promise from someone who promised you could keep your existing doctor and I give to America affordable health care.

A week ago Thursday (3/12) I mentioned my close friend's wife (a nurse with a practice in WA) was already alarmed and that the situation was getting out of control.

https://www.24hourcampfire.com/ubbt...ampfire-and-the-coronavirus#Post14655067

I have been getting daily updates from him. He is in the 911/public safety biz like me - we are both voluntarily quarantined at home and locked out of the office since we are critical assets.

I know it's all a joke here, but in WA, they are very concerned about having to decide who gets a vent and who dies in the hallway.

The military has been doing that for years on the battlefield. It's called triage, assigning level of care to severity of wound. They don't waste precious time and resources on perceived terminal cases. They treat the ones they think they can save.

Now, you don't see that in the civilian world, but who knows.

And, Obummer did have high level consultants who had done reseaerch and written papers on that subject. They were thinking out of the box, or should I say who went into the box....

DF

.

It’s only a joke to those who aren’t dealing with it yet....

https://komonews.com/news/coronavir...cale-of-outbreak-in-wash-says-top-doctor

Read that article, she says a tsunami is on its way....

What a perfectly delightful pack of monsters running the show. Might I assume they will check voter registration first?

Here in Washington? Of course they will.

Here is some good news from someone that has waited in line on the slab for priority patients, it hurts beyond comprehension and you’ll only die if God wants you home.

Just imagine what it must be like in NYC.

I suppose that's better than not planning on it.

No....party affiliation wouldn’t affect treatment priorities, would it?

Next you’ll suggest some states will soon enact a death tax.

I live on the West side of Puget Sound. Far away from the Freaks, Geeks, weirdo’s and queers. If this goes the way it very likely could, it’s going to turn into a complete chit show on the East side of Puget Sound. Not to mention Seattle has a huge, and I do mean huge homeless population. It gets a rolling through there, Yippee Kay Yah Mudder Fudder.

Stay safe.

Yeah, it's called triage. That's what happens when you have more patients than capacity to treat them.

Democrats....they are not worth spit.

Right on Q ...

NY State has 12,315 cases. NYC (just the five boroughs) have 6,166 confirmed cases alone. The NYC metro area is responsible for Terri vast majority of those 12K cases.

Intubation, along with the medically-induced coma, is something like 20 days, average?? Ain't enough ventilators, or staff, to handle what's coming.

The videos you posted in the other thread are terrifying.

An example would be like new mexico

There are 2 million people in the state of New Mexico

Low end is that 20% or 400,000 people will contract the virus

1/5 of those people may need hospital care/ a hospital bed
- which is 80,000 people

There are only 4500 hospital beds in the whole state



They would need lots of cots. Little to no staff after a while from exhaustion. No equipment and possible shortage of even basic supply's.

Triage would in effect be a place to put the corpses.

The math does not lie - our healthcare system Will Succumb to this virus.

“We will do it as a state under an ethical framework that is part of the state plan,” she said. “It will be overseen by an objective team who has been thoroughly briefed on the protocols and processes, and will be undertaken in a transparent and equitable manner.

They make it sound like you could pick up a turd by the clean end!

Yeah, for sure.

Just another lie they wanted us to swallow.

The collective thinks like that. Sheep are property of the mgr.

DF

Actually, they may decide who is and who is not treated. I doubt they will apply a death sentence to anyone.

Well that don’t sound near dramatic enough. You need to throw in “death panel” lol.

I wonder if the politicians will get treatment....

Death panel was a phrase for those who wrote Obamacare, and decided who and what to ration. Someone will decide again who lives and dies when rationing happens.

I live in Forks, on the Olympic peninsula in Washington, and we're seeing a whole different aspects of this schit-show. Evidently, social distancing for the people in the east side of Puget sound means head West! Couldn't buy a parking spot at any of the National Park trailheads this morning, and every wide spot on state or forest service land has a tent pitched in it! Sometime last night some locals started posting signs along the highway in and out of town stating that tourists weren't wanted or welcome.

That will be the case in every hospital or treatment facility across the world, if/when they become overwhelmed.

I doubt the state gov't will have a triage doctor in each hospital. It will most likely be the call of the triage nurse or doctor on duty, to assess and make decisions.

You assume they will all get sick at the same time?

I don't assume anything. Not my department.

My grandmother in Michigan, they said they wouldn't treat anyone over 80. She is 94.

I am almost 80 years old, I have no misgivings about my chances of treatment or survival if the SHTF . If I lived in Western Washington or Oregon I would be loading up my camper and heading for some tiny town in Idaho.

We live in Michigan, and I haven’t heard anything about this!!!!

PREZACTLY!!!

The local yokels sure expect to go into the cities and find tools, materials, groceries, medical services, and dental services they don't have in the stix. Imagine how they would howl if they were turned back.

This will happen when people do not follow guidelines given to them by leadership of individual states and by the Federal Government. The only way to cope with the pandemic is not to overwhelm the healthcare system by doing everything possible to prevent spreading of infection. Since there will not be enough test for nearly everyone people have to stay in relative isolation and interact with others in community only when it's absolutely necessary. Obviously if the infection spreads at current rate there will not be enough spaces and equipment to treat everyone at medical facilities, therefore, difficult decisions will have to be made. Based on available space only those with highest chance of survival will be treated. Obviously any deaths due to shortages of space/equipment will be assigned to the current leadership.

If you were in charge of medicine distribution and had a choice of saving a 25 year old employed parent of 2 children or a 78 year old nursing home patient, who would you choose? If I had one dose of life saving medicine and it was a choice between me (age 67) and my son (age 35) he would get it. If it were 2 strangers and I had that same decision the younger person would get it. Now I am going to depart from that scenario and say that criminal prisoners should be last in line.

Triage! Triage is a practice that’s been used throughout the history of modern medicine even though it may been called something else back then it was still nothing more than what it is now. Triage is basically categorizing patients in a mass casualty incident by the severity of their trauma illness. Triage allows medical professionals to work on saving the lives of those with a better chance of living than those that are not likely to survive. With a limited number of resources available it’s better to use those resources on the patients that are most likely to respond favorably to the treatments. It’s always been tough on me when we had a mass casualty incident and I had to triage patients, I don’t like playing God and while I understand with and agree with the concept of triage that’s what it felt like to me.

Exactly correct

If it came to me or my grandson or some other good young man there would be no choice to make. The choice is obvious. It might come to a point where we older Americans chose to stay at home and die in familiar surroundings with the old hacksaw spouse at our sides. My wife is 100% in accordance.

I don't see the story here, or I should say any reason for a story.

Anyone with two cents worth of brain cells knows that the first duty of first responders and medical care providers in the case of emergency response is triage.

You do not waste time or resources on patients with no hope for survival.

I heard the cut off is now 60 yrs old in Northern Italy.

So, I guess it depends on how bad it gets.

DF

Most if not all countries with infections have possibility of facing this dilemma. With limited personnel, facilities, equipment they have to do what has to be done.

The thread you linked is now 10 days old. So by now the Doc's should be making these life & Death decisions..... are the bodies piling up?
Or just maybe half of Washington's libtards are rushing to the hospital thinking they have the covid.
The hospital worker I know had 19 people in the covid wing check out after the results came back negative and her floor is empty.... not one positive case in the whole hospital.

I`m sure illegal aliens will have priority...

No Fuqking doubt!!! 😡

Hospital ethics boards are in place to make these decisions all the time, not just for this crisis. Such decisions are made any time there is a limited supply and a higher demand for a resource. An example of this rationing process that gets done every day around the country is for organ transplants.

If interested, the original lead author of the organ rationing process (commissioned by Ronald Reagan) wrote a book outlining the process:
"Life on the Line" by John Kilner, Eerdmans 1992.

"Ethics boards" were mentioned back when Obummer was rolling out Obummercare...

That's essentially synonymous with the death panel idea, just with a more palatable name...

DF

You do realize that "ethics boards" have existed for health care rationaing since before WWI. And that they convene on a daily basis regionally around the country to make decisions on scarce resources both in total and for individual cases. And that Obama and his "care" had absolutely nothing to do with any of it. The current directives were developed under the direction of the Reagan administration (with ongoing reviews/updates of course).

Oh, and the author linked above, Kilner, is a born-again evangelical Bible-thumping Christian who took his "plan" from what he read in the Bible, specifically what he saw in Moses, Jesus, and Paul's actions.

Seems like I remember Sarah Palin catching a lot of $hit for talking about “death panels”. 🤬

That what it will be like if we get national healthcare for even minor surgery’s

I think this is exactly what is going on in Italy and other 2nd world countries in Europe.

For sure.

DF

Reading a thread like this feels about like walking 10 miles during a steady drizzle of crap. Where are the expressions of thought about better solutions, the ideas that stir hope, the expectation for success rather than misery?

As an example and for purpose of discussion, rather than all the fuss about employing various "ethical panels" (whose ethics??) to decide fate, and with regard to giving treatment with available equipment/meds/supplies/etc.,, what would be wrong with the concept of first in/first served?

Its all based on age of the patient. Those that have lived a full life and are wards of the state are better left to die, over the younger patients who can recover, go back to work, and pay taxes to keep the public trough full.

That is the purpose of medical ethics boards that have operated in this country for over a century now. They follow guidelines developed to minimize suffering, maximize care, and do it all without devaluing humanity to the greatest extent possible. Thankfully, the current guidelines were developed according to Christian principles and codified under the Reagan administration.

Do you-all realize that these boards meet and do this work all the time, every day in this country, for all sorts of medical problems for which there is short supply, at every hospital and regional medical center everywhere?

No, that would be about 3% of the decision-making process there. No sense in dramatizing this process that goes on everyday.

What the F*** do you holier than thou maroons think happens every SINGLE F****** DAY in the transplant world?

There's not enough organs, or money, to go around to do the ridiculous heroic effort thing for every delusional patient out there that thinks the "new" trial drug or treatment is going to save them.....

We already spend twice as much, as a percentage of GDP, on "health" care than anyone else. What would be enough?

Yes, but realization of and familiarity with the concept, as well as existence of longstanding practice, does not mean that the most proper, compassionate and equitable goals are being met. Being the group and playing the role does not always produce the highest outcomes - existence of guidelines and going through the "process" is no guarantee of efficacy and positive results. Your statements seem knowledgeable, but not much responsive to the core and spirit of the inquiry.

I truly am not following what you're trying to say here. We don't live in a perfect world, but these sort of decisions are made every day for all sorts of scenarios (such as Dutch noted above concerning organ transplants). The process that is followed currently in the USA was codified under the Reagan administration specifically to deal with kidney transplants, then widened to apply to other situations of medical scarcity and even triage at times.

Such a process is the ONLY way of insuring that "compassionate and equitable goals" are met that are "responsive to the core and spirit of the inquiry." Without such a process, it is simply will-to-power or finances that drive the choices.

"Death panels", "Ethics boards" are what you get under 2 situations:

- A shortage of medical resources or
- situations where the patient is a cost center rather than a revenue source, i.e. socialized medicine.

Then all medicine practiced in the United States is already "socialized medicine" unless your paying the veterinarian on the side to take your appendix out or something.

Do you have an alternative method that works better to maintain care for those who need it in a situation of limited resources?

I do not have such an alternative (not working in the healthcare field) and, more to the point, do not see any emphasis on striving for better practice - that is why I asked the questions. A practitioner describing the long history of "the process" and praising the current practice - which is NOT applied consistently here and there - is not a satisfactory response. Then, the statement that IT IS THE ONLY WAY exemplifies limited thinking and might explain lack of effort toward better performance.