A N.Y. Hospital Tells Doctors They’ll Be Supported In Decisions To ‘Withhold Futile Intubations’ Amid Ventilator Shortages
Doctors have been bracing themselves to cope with the looming threat of having to ration care because of a lack of ventilators and other medical equipment. As other New York hospitals split ventilators between two patients, NYU Langone Health has started telling doctors to "think more critically" about who gets care. In other news on equipment shortages: how taxpayer-funded low-cost ventilators ended up overseas, innovators who are rising to solve the problem, and tariffs that may be hurting the country's efforts to fight pandemic.
NYU Langone Health, one of the nation鈥檚 top academic medical centers, told emergency-room doctors that they have 鈥渟ole discretion鈥 to place patients on ventilators and institutional backing to 鈥渨ithhold futile intubations.鈥 A March 28 email from Robert Femia, who heads the New York health center鈥檚 department of emergency medicine, underscored the life-or-death decisions placed on the shoulders of bedside physicians as they treat increasing numbers of coronavirus patients with a limited supply of ventilators. New York state guidelines, established in 2015, recommend that hospitals appoint a triage officer or committee鈥攕omeone other than the attending physician鈥攖o decide who gets a ventilator when rationing is necessary. (Ramachandran and Palazzolo, 3/30)
"In Emergency Medicine, we do not have the luxury of time, data, or committees to help with our critical triage decisions. Senior hospital leadership recognizes this and supports us to use our best clinical judgment," the email from Dr. Robert Fernia said, according to The Journal.
"For those patients who you feel intubation will not change their ultimate clinical outcome (for example cardiac arrests, some chronic disease patients at end of life, etc) you will have support in your decision making at the department and institutional level to withhold futile intubations," the email continued. (del Valle, 3/31)
State and local health departments across the country have developed detailed emergency health plans in recent years, often in response to major natural disasters, such as Hurricane Katrina, or outbreaks of diseases, such as the avian and swine flus. Many of these plans, such as those in Minnesota and New York, included guidelines for rationing care in the event of shortages of medical supplies or personnel. Federal health agencies have not issued guidelines on how to make such decisions. For example, states say they don鈥檛 understand the criteria the federal government has been using in allocating limited medical resources from the U.S. stockpile. (Ollove, 3/31)
Five years ago, the U.S. Department of Health and Human Services tried to plug a crucial hole in its preparations for a global pandemic, signing a $13.8 million contract with a Pennsylvania manufacturer to create a low-cost, portable, easy-to-use ventilator that could be stockpiled for emergencies. This past September, with the design of the new Trilogy Evo Universal finally cleared by the Food and Drug Administration, HHS ordered 10,000 of the ventilators for the Strategic National Stockpile at a cost of $3,280 each. But as the pandemic continues to spread across the globe, there is still not a single Trilogy Evo Universal in the stockpile. (Callahan, Rotella and Golden, 3/30)
It started with a fanciful email from one self-described science geek to another. 鈥淗ey, we should make a ventilator,鈥 Dr. Chris Zahner, a University of Texas pathologist and former NASA engineer, wrote to Aisen Caro Chacin, an artist and medical device designer, after he learned about Italian hospitals struggling to treat the crush of coronavirus patients gasping for air. Two and a half days later, Dr. Zahner and Dr. Chacin were testing out their prototype at the university鈥檚 medical fabrication lab in Galveston: a simple air pump that uses ordinary blood pressure cuffs, car valves sold by auto parts stores and items found in most hospital supply closets. (Jacobs and Abrams, 3/30)
There are moments when Gui Cavalcanti feels like he woke up in a dystopian universe 鈥 a guy with no background in medical or disaster response, suddenly leading an international effort on Facebook to design medical equipment to fight the Covid-19 pandemic, the gravest public-health threat of our time. 鈥淚 have never worked so hard for a job I didn鈥檛 want in the first place,鈥 Mr. Cavalcanti wrote in a text, as part of a recent interview. Essential medical supplies, from exam gloves to ventilators, are in short supply. (Petri, 3/31)
U.S. Trade Representative Robert Lighthizer on Monday said the United States would seek to promote more domestic manufacturing of key medical supplies in light of the strategic vulnerabilities laid bare by the coronavirus pandemic. (3/30)
The trade war with China includes about $5 billion worth of tariffs on medical products from the country. And while states across the country are struggling to get medical supplies they need to fight the coronavirus, President Trump confirmed on Friday that reports he鈥檚 considering pulling back on those tariffs are not true. (Hobson, 3/30)
