Abstract
During an influenza or coronavirus disease 2019 (COVID-19) pandemic that results in acute respiratory distress, the number of available ventilators will not meet demand. In 2007, the New York State Task Force on Life and the Law and Department of Health released draft Guidelines for ethical allocation of ventilators for adults. In 2015, updated guidelines were released to ensure that: (1) revisions reflect the public's values and (2) the triage protocol is substantiated by evidence-based clinical data. We summarize the development and content of the 2015 Guidelines compared with the 2007 version, emphasizing new/revised aspects of the ethical considerations and clinical protocol. We compared the 2007 and 2015 guidelines, with particular emphasis on the ethical issues and clinical protocols. The 2015 Guidelines retained much of the ethical and clinical framework of the 2007 draft. The triage protocol was revised using evidence-based clinical data. Patients with the highest likelihood of short-term survival with ventilator therapy have priority access. Protocol consists of exclusion criteria, the sequential organ failure assessment (SOFA) score, and periodic clinical assessments. Guidance is provided on secondary triage criteria. Other forms of medical intervention/palliative care and review of triage decisions are discussed. The 2015 Guidelines reflect advances in medicine and societal values and provide an evidenced-based framework to save the most lives. The framework could be adapted in other emergencies, such as the COVID-19 pandemic, that require ventilators.
Highlights
The Guidelines recognize that patients generally expect to access or receive all necessary available health-care resources
The framework could be adapted in other emergencies, such as the COVID-19 pandemic, that require ventilators
Studies from COVID-19 cases in Wuhan, China, revealed that critically ill patients suffering from acute respiratory distress syndrome required ventilators.[1,2,3]
Summary
The Guidelines recognize that patients generally expect to access or receive all necessary available health-care resources. In certain public health emergencies, these expectations may not align with the realities of the situation. The introduction of new technologies, medications, and interventions shift the public’s expectations of care. During the 1918 influenza pandemic, there were no ventilators and the public expected treatment to be limited to addressing the symptoms of influenza. If an influenza pandemic of the same severity were to occur today, the public expectation will have shifted with the technology. With the World Health Organization’s (WHO’s) declaration that COVID19 is a pandemic,[16] the limited availability of ventilators will challenge the public’s expectation that patients should have access to all health-care treatments
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
