How could medical teams choose which patients to treat if a complete overflow in hospitals were to materialize and a lack of resources made it impossible to treat all those in need?
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The scenario called “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 deteriorates. again.
It is when the saturation rate in hospitals in the province reaches 200% that 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 Assistant Deputy Minister of Health, Dr. 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.
It is an independent committee that will be set up in each hospital that will have to make the difficult 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
“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, ”says Dr.re 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. In times of 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 ”, we can read in 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. “
On the other hand, this process is considered to be fair when uncertainty is high and to mitigate the risk of bias implicit in 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.
