Arizona resource allocation

[nimbus]

Am I reading this correctly? The people who least need intensive care resources get priority over people who need them the most. And the SOFA score bumps up if the doctor chooses norepi over dopamine. How many people would choose dopamine over norepi to treat hypotension in real life? Guess you start with dopamine if you want your patient to get a vent.

Saddest part is that their wave could have been prevented.

https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/sdmac/covid-19-addendum.pdf

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[MediMike]

Am I reading this correctly? The people who least need intensive care resources get priority over people who need them the most. And the SOFA score bumps up if the doctor chooses norepi over dopamine.

Yeah. Weird huh? They are basing this on an article from the Canadian Medical Association (doi.org/10.1503/cmaj.060911)

Probably a joke here about socialized medicine and death panels...

 

[Zekchar]

Didn't read the entire article or publication, but my suspicion is that they are trying to avoid putting too many resources towards demented 90 year old nursing home patients with COVID. They may be trying to use major resources on those who are most likely to survive the experience rather than those whose prospects are poor to start with and will consume excess resources while taking limited space from those with the potential for better outcomes. Not saying I agree or disagree with this, but thats my initial impression.

I remember reading that most healthcare resources are spent within the last 30 days of life. This may be grounds to officially justify not doing just that.

 

[Beeftenderloin]

This makes total sense. Little old granny with CHF, HTN, DM, and COPD on home O2 probably won’t survive an ICU stay in the best of circumstances. With limited resources and staff, virtually no chance. The younger, healthier people that require critical care resources (ICU care, intubation, vasopressors) are more likely to survive and thus should be the priority for resource allocation. This is what they did in Italy when it was really bad there. I don’t think anyone over 65 or >1 organ system dysfunction got more than a non rebreather and a prayer.

It’s not a situation anyone wants to be in. But when you have to pick who gets the vent, the otherwise healthy 40 year old or the 80 year old with the long problem list, well... sorry grandma.

 

[chocomorsel]

Yeah. Weird huh? They are basing this on an article from the Canadian Medical Association (doi.org/10.1503/cmaj.060911)

View attachment 311627
Probably a joke here about socialized medicine and death panels...

This is how they do it in the military. Literally people get tagged with different colors. The point is to use those resources to try to maximize the chance of survival for that patient.
As in, save those resources for patients who have a better chance of survival versus those who are in MSOF and other comorbidities who have a poor chance of survival.
In other words, when resources are scarce, let’s not waste them on patients who most likely aren’t going to survive.

Makes perfect sense so me. However there is a margin of error where we think someone isn’t gonna make it but they surprise you.

It’s not really a as much a death panel as much as it is using scarce resources wisely. We should really try to implement some version of this outside of Covid shortages. We really flog patients in this country instead of transitioning to comfort measures.

 

[MediMike]

This is how they do it in the military. Literally people get tagged with different colors. The point is to use those resources to try to maximize the chance of survival for that patient.
As in, save those resources for patients who have a better chance of survival versus those who are in MSOF and other comorbidities who have a poor chance of survival.
In other words, when resources are scarce, let’s not waste them on patients who most likely aren’t going to survive.

Makes perfect sense so me. However there is a margin of error where we think someone isn’t gonna make it but they surprise you.

It’s not really a as much a death panel as much as it is using scarce resources wisely. We should really try to implement some version of this outside of Covid shortages. We really flog patients in this country instead of transitioning to comfort measures.

I think the "joke" part of that comment got overlooked a touch.

I completely agree with the principles of START and JUMP triage in disaster situations, but in disaster/MCIs the patients who are dead get left, then the most critically injured after that.

Clearly a different environment than we operate in, my concern with this model is the single organ system failure taking priority over say...two organs. So a patient with failing hemodynamics may get a bed over someone with hypotension AND respiratory failure? When that individual with a single system down could likely be cared for in a step-down or modified unit? Now if that single organ system failing was defined as pulmonary in nature (because I think the majority of us can agree that ventilated patients should likely be cared for in the unit) then this system makes sense to me.

Or maybe I'm making it too black and white.

 

[nimbus]

I have no problem that they are prioritizing patients. I just have issue with the way they are scoring.

 

[abolt18]

If only there was something they could have done differently to not even come to this point of having to limit resources due to a massive surge... Hmmmm

 

[IMGASMD]

If only there was something they could have done differently to not even come to this point of having to limit resources due to a massive surge... Hmmmm

That makes sense.