Does @NYGovCuomo know if the “Ventilator Allocation Guidelines” from 2015 have been updated? If not, does he realize the guidelines recommend a “lottery” system to choose who gets a ventilator and who doesn’t, and to remove ventilators from people not expected to survive?
And that there’s a color-coded system in place in case of a pandemic resulting in a shortage of ventilators? Death panels are death panels. Yes: choosing who will not receive life-saving treatment means people will die. Those are the guidelines New York has in place.
Ranting at the federal government is simply an attempt to distract from state government failure.
VENTILATOR ALLOCATION GUIDELINES
New York State Task Force on Life and the Law
New York State Department of Health
November 2015
health.ny.gov/regulations/ta…
VENTILATOR ALLOCATION GUIDELINES
New York State Task Force on Life and the Law
New York State Department of Health
November 2015
health.ny.gov/regulations/ta…
In some circumstances, a triage officer/committee must select one of many eligible red color code patients to receive ventilator therapy. A patient’s likelihood of survival (i.e., assessment of mortality risk) is the most important consideration when evaluating a patient.
However, there may be a situation where multiple patients have been assigned a red color code, which indicates they all have the highest level of access to ventilator therapy, and they all have equal (or near equal) likelihoods of survival.
If the eligible patient pool consists of only adults or only children, a randomization process, such as a lottery, is used each time a ventilator becomes available because there are no other evidence-based clinical factors available to consider.
Patients waiting for ventilator therapy wait in an eligible patient pool. However, in limited circumstances, if: (1) the pool of patients eligible for ventilator therapy includes both adults and children, and
(2) all available clinical data suggest that the probability of mortality among the pool of patients have been found equivalent (i.e., all patients are assigned a red color code), then young age may be utilized as a tie-breaker to select a patient for ventilator therapy.
In addition, there may be a scenario where there is an incoming red code patient(s) eligible for ventilator therapy and a triage officer/committee must remove a ventilator from a patient whose health is not improving.
In this situation, first, patients in the blue category (or the yellow category if there are no blue code patients receiving ventilator therapy, they are vulnerable for removal from ventilator therapy if they fail to meet criteria for continued ventilator use.
If the pool of ventilated patients vulnerable for removal consists of only adults or only children, a randomization process, such as a lottery, is used each time to select the (blue or yellow) patient who will no longer receive ventilator therapy.
However, in limited circumstances, if: (1) the pool of ventilated patients eligible for ventilator withdrawal includes both adults and children, and
(2) all available clinical data suggest that the probability of mortality among the pool of ventilated patients has been found equivalent, then young age may be utilized as a tie-breaker and the ventilator is withdrawn from the adult patient.
A patient may only be removed from a ventilator after an official clinical assessment has occurred or where the patient develops a medical condition on the exclusion criteria list. However, if all ventilated patients are in the red category,
none of the patients are removed from ventilator therapy, even if there is an eligible (red color code) patient waiting.
Efforts will be made to inform and gather feedback from the public before a pandemic. Public outreach will inform people about the goals and steps of the clinical ventilator allocation protocols.
Information should emphasize that pandemic influenza is potentially fatal, that health care providers are doing their best with the limited resources, and the public must adjust to a different way of providing and receiving health care than is customary.
Instead, a protocol based only on clinical factors will be used to determine whether a patient receives ventilator treatment to support the goal of saving the greatest number of lives in an influenza pandemic where there are a limited number of available ventilators.
Patients and families should be informed that ventilator therapy represents a trial of therapy that may not improve a patient’s condition sufficiently and that the ventilator will be removed if this approach does not enable the patient to meet specific criteria.
Finally, once the Guidelines are implemented, there must be real-time data collection and analysis to modify the Guidelines based on new information.
Data collection and analysis on the pandemic viral strain, such as symptoms, disease course, treatments, and survival, are necessary so that the clinical ventilator allocation protocols may be adjusted accordingly to ensure that patients receive the best care possible.
In addition, data collection must include real-time availability of ventilators so that triage decisions are made to allocate resources most effectively.
Knowing the exact availability of ventilators also assists a triage officer/committee in providing the most appropriate treatment options for patients.
