Friday , January 15 2021

Advanced triage: who will be treated, in the worst case scenario?

How could medical teams choose which patients to treat if there was a complete overflow of hospitals and a lack of resources made it impossible to treat all those who needed it?

• Read also: COVID-19: most hospitals have reached maximum level of shedding

• Read also: Woman fears the worst after her canceled surgery

The scenario called the “Intensive Care Prioritization Protocol”, which we never thought should be used in Quebec, is ready to be implemented, but ultimately, not for a few weeks, and only if the situation in hospitals changes. degrades further.

When the saturation rate in the province’s hospitals reaches 200%, the protocol will be put in place. At 150%, we will prepare for this advanced triage.

“The majority of hospitals in Quebec, at the moment, are at the maximum level of load shedding,” said the Assistant Deputy Minister of Health, the Dre Lucie Opatrny, who participated in the authorities’ press briefing on Monday.

Staff are currently being trained to deal with the worst case scenario and written simulations are underway.

An independent committee, set up in each hospital, will have to make the tough decisions. It excludes attending physicians, who will not have to comment.

Will medical teams choose based on age?

“The clinical rating scale is complex,” explains Dr.re Vardit Ravitsky, in an interview with TVA Nouvelles.

“There are several elements of assessment that are really medical. It leads to this idea of “predicted mortality”. We want to maximize the benefits and prioritize the patients who have the greatest chance of survival, ”says the bioethicist.

“Once the clinical evaluation is completed, if ever there are two patients who have exactly the same clinical condition, the age criterion [cycle de vie] comes into play. The idea is to prioritize patients who are younger to give a chance of a full life ”, continues Dre Ravitsky.

Other criteria

However, this is not the only criterion that could allow the committees to decide who, with an equal chance of survival, will be treated.

According to the protocol, the nursing staff could also be prioritized.

“This rule makes it possible to promote the treatment of health and social services personnel who are exposed to the risk of contagion when providing care and services to the population. During a pandemic, it is important to protect and support the health of staff in order to ensure that essential care and services continue to be provided, ”reads the document posted online by Public Health.

Chance, or randomization, could be used.

“When all the other decision rules do not allow prioritization, the prioritization team proceeds by randomization. This approach to justice allows for equal opportunities between individuals. The rationale for randomization reduces the burden of decision-making by not leaving it to one person (such as the chair of the prioritization team), which can lead to mental harm and burnout after repeated cases. “

Furthermore, it is considered that this process is fair when uncertainty is high, and that it mitigates the risk of bias implicit in the decision-making.

Already 140,000 surgeries are waiting to be performed. In greater Montreal, the number of hospitalizations has practically doubled since mid-December: from 472, the number of patients treated for COVID-19 reached 1071 on Sunday.

The Journal is looking for testimonials from people who have been carriers of COVID-19 without knowing it and who have seen those around them fall ill when they themselves had no symptoms. Since the start of the pandemic, many asymptomatic people have infected those around them without knowing it. This has happened in particular in CHSLDs and sports circles. We would love to hear from you if you have experienced such a situation.

You can write to our journalist Simon Baillargeon (simon.baillargeon@quebecormedia.com)

www.journaldemontreal.com

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