Utah implements harsh triage guidelines for bioterror, epidemic emergencies
year since the outbreak started in April 2009, the flu has hospitalized 1,334 Utahns and killed 49.
May notes that by comparison, the triage guidelines anticipate thousands being hospitalized at once: Every emergency department would be overwhelmed, the state is 5,300 hospital beds would be full, along with another 1,100 beds placed in offices, conference rooms and exam space. Hospitals would be operating with 60 percent to 80 percent of their staff. Ventilators would be in high demand and short supply, without enough respiratory therapists to oversee their use.
Once the governor declared a public health emergency, the guidelines would apply in hospitals but also to physician offices, clinics, long-term care facilities and paramedics, so they do not transfer patients who would not be admitted.
Providers could not be sued for denying care in an emergency, except in cases of gross negligence or criminal conduct, under a 2007 state law.
The guidelines show eleven ways an adult can be excluded from care, ranging from a “severe neurologic event” with minimal chance of recovery, such as a stroke, to certain stages of cystic fibrosis. They do not address how to treat pregnant women, a matter to be decided in the fall.
Children 13 and younger would be turned away for six reasons, including underlying conditions that are often terminal by age 2, including Trisomy 13 or 18 and spinal muscular atrophy. Premature babies with an 80 percent or greater chance of dying would not be resuscitated.
Peter DeWeerd, a family medicine doctor who works in the emergency room of St. Mark’s Hospital, participated last summer in a mock drill to test the guidelines. “It’s going to be pandemonium,” DeWeerd predicted, noting that denying life-sustaining care runs counter to what doctors and nurses are trained to do. He recalled a mock mother fighting to get treatment for her 7-year-old daughter, who was in a wheelchair and had severe chronic respiratory illness. “She was doing everything she could to break through security,” he said recently. “There’s a point we say, ‘We’re sorry, we don’t have the ability to treat your child.’”
He emphasized the need for prevention through vaccinations and having emergency storages of food, water, medicine and blankets. “Those are the things that are going to keep me and my colleagues from having to make as many of those gut-wrenching, once-in-a-lifetime decisions.”
Guideline authors said they tried to avoid judging the quality of someone’s life. They acknowledge, though, that they
