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Politics of triage

Posts (17)

  • Havoc1


    #9696816 - 11 years ago

    Triage is an unfortunate reality for guys in my profession. I never really thought about the politics of it. You treat the people you're most likely to save. In a mass casualty situation, what good are heroic actions on a single casualty without a pulse when it will likely result in the deaths of multiple guys with traumatic amputations or wounds that result in rapid blood loss?

    Is the "controversy" over this just a case of people never confronting reality? Note, I'm not sure you can even call it a controversy if I'm only seeing a "public health law expert" making a warning.

    Docs list who would be allowed to die in a catastrophe

    Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

    The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.
    If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

  • Titanroller


    #9696860 - 11 years ago

    When it comes down to it, those that think they can save everyone have to realize that you need to "Do the most good", which means saving those who can be saved, letting those go who need extreme/prolonged treatments, those who can't take care of themselves. Collation of resources means having every possible person available. I know that everyone thinks they should be saved and that everyone thinks that they're the most important in the world.

    You can't save everyone. Everyone dies, and we don't usually get the option on how to.

    And those who wish to criticize my views, don't give me bullshit about being ethical as it was brought up in the article. Being a Flight Combat Medic, I've seen more people die than any human should. I will save those that I can save, and pray for a quick and painless death for those I can't.

  • crusha09


    #9696963 - 11 years ago

    I agree with Titanroller. In this sort of situation, having any set of guidelines for who to treat first beyond severity of the wound is a good thing. It can only help the distribution of treatment further.

    What isn't clear to me is how the doctors would be able to differentiate between the "poorest" citizens. Are they only taking into account the state of the patient before the catastrophe, or is there more to it? How would they even have time to look through records and find chronic diseases a patient might have?

  • Titanroller


    #9697037 - 11 years ago

    At least In most countries they believe in equal treatment. Several countries still treat based upon the Caste system. There was recently an article out of India speaking of a pregnant woman who was forced to have her baby in an alley beside the hospital because the doctors would not treat her due to her last name, which symbolized that she was in a very low part of the old caste system that had been abolished years. Suffice to say, she and the baby did not make it, and both died about an hour after the birth.

  • armeav8r


    #9697387 - 11 years ago

    A wounded soldier has injuries, you as rescuer may or may not get some while attempting said rescue. Also, a RANGER never leaves a fallen comrade behind. That being said, combat realities settle in and you're liable to have to make hard choices in combat. That's why you get paid the big bucks.

    Your goal is to do the most good you can. You'll have less than a second in combat to decide which is the correct course of action. You wont give a fuck how rich or poor a person is. You'll only be concerned with the fact that they're wounded, they're on your side and they need help.

  • DiMono

    DiMono FIRST Member Star(s) Indication of membership status - One star is a FIRST member, two stars is Double Gold It's Back Baby!

    #9697625 - 11 years ago

    First of all, it's ludicrous that they mention SARS by name at the bottom of the article. The flu kills more people in a year than SARS has killed since we knew about it. Anyway...

    Rather than breaking it down in to who should be allowed to die, I'd list it as what order to treat people in. Something like this:

    Definitions first (not all possible injuries are included, it's meant as a reference scale):

    Trivial wounds - could walk home and put a band-aid on
    Light wounds - cuts, abraisions, pain, etc
    Moderate wounds - breaks, concussions, burns, etc
    Severe wounds - near amputations, crushed limbs, severe burns, etc
    Critical wounds - they're not getting better without long term care

    The thing is, the severity of an injury is going to be influenced by the patient's age and overall health; old people with a trend toward illness will have their injuries enhanced anyway. Those with trivial and light wounds can wait; they're in no danger. Verify their state as you go, recommend they go directly to the hospital (depending on severity of their wounds) and move on

    Triage order:

    Stabilize those with moderate wounds and get them removed from the scene
    Now that there's more space and less chaos, wtabilize those with severe wounds and treat them
    Now that you've helped as many people as you realistically should be able to, see which critical cases have the highest chances of survival

    Don't ignore someone because they're old, just choose a treatment order based on some rational set of guidelines. And yes, I know it's not as simple as I make it out to be; I'm not trying to lay down concrete guidelines here, just describing an idea.

  • USNavySGT


    #9697642 - 11 years ago

    In reply to Havoc1, #1:

    Nah, it's not that... the 'controversy' comes about from medical people talking out of turn, and the lawyers trying to set up what is sure to be a big-money class action suit after the next MASCAL... using the 'big tobacco' cases as a guideline for filing wrongful death suits against hospitals. I can see the TV and magazine ads now... "If you had a relative that died at *such-and-such* hospital between *such-and-such* days, please contact the law offices of *scumbag-ambulance-chaser-and-associates*."

    Every medical person knows that triage is a grim fact of their job, and the more people injured, the grimmer it gets. It's the way it goes. They shoulda just kept their mouths shut.

  • knuckles


    #9697664 - 11 years ago

    When I saw that article, I must admit that (even though being completely healthy at the moment which would potentially put me at the top of the list) I was offended. The fact that they would actually take the time to make out a list like this is quite appaling. I have to agree with what USNavySGT said about them keeping their mouths shut. It'll be interesting to see how this plays out.

  • pal_sch


    #9698656 - 11 years ago

    In reply to DiMono, #6:

    SARS was mentioned because it references the potential of a pandemic. Other varieties of the flu or related diseases are an equal (at the moment greater) threat, but SARS is one that is still in the public conciousness. Such an outbreak is when you would need a list like this.

    In the case of a major pandemic, you would have a limit number of effective vaccines and treatments to distribute within the population. You would want the most effective medicines to go to those who are most needed to keep the nation or region working. Hence a triage list.

    In a pandemic you would need to dedicate most of your resources to those who will keep others alive and healthy. That prioritises those who can work immediately after treatment and those who can be turned around quickly to free up the space for others. Those who are going to take a long time to heal either way don't need the most efficient treatments to turn them around, because they won't be helping society at large either way.

    For example, if a flu epidemic was expected or starting, you would dedicate your best resources to keeping your (hopefully expanded) medical staff as healthy as possible, even if this means using the majority of vaccines and treatments that would otherwise be intended for the elderly or at serious risk.

    Similarly in a mass casualty situation (plane crash or bombing), you might find casualties who could help rescue others after only minor medical treatment. That might tie a doctor up for a half hour while they stitch them up, but it gives you an extra pair of hands later in the day. Treating an OAP the same way won't give the same benefit to others.

    The publication of the list is a stupid idea, but does at least avoid it being leaked. Which it would be.

    I don't see how this could possibly be the basis of any legal cases. At least no successful ones. Any cases would have to be on a case-by-case basis, showing malpractice by individuals, as the practice itself is in no way facially illegal.

  • 1027duck


    #9702046 - 11 years ago

    They told me in CLS to treat the most seriously wounded first. That give if they are still treat able.

  • Havoc1


    #9702771 - 11 years ago

    If your CLS course was taught properly, the medics would have told you to exercise a slightly different form of triage that comes before what would be proper medical triage. Namely, you're a rifleman first, and if things are heavy, you don't stop fighting to treat the wounded. Leave that to the medics, because operating your weapon system may make the difference in stopping others from being wounded. Now, does it work out that way all the time?

  • Titanroller


    #9702823 - 11 years ago

    Shot in the leg? Here's a God-damned band-aid. Now, get your ass up here and give me cover fire.

  • nurse


    #9715823 - 11 years ago

    In reply to Havoc1, #1:

    Is the "controversy" over this just a case of people never confronting reality?

    I think so. Many people not in the healthcare industry can't appreciate the reality of a situation where triage would be needed. They would likely only see the situation from their point of view (save me, save my relatives)..... which is on the other side of the table. If you consider the people who are on the Do Not Save includes a lot of old grannys and think about just letting them die during a major catastrophe makes a lot of people feel bad. But....the fact remains that in a large scale catastrophe, many valuable resources are going to get ATE UP caring for people with advanced alzheimers, burn victims, and the brittle diabetics. It sucks but that is how it has to be for the greater good.

    I also think this article came about after the Memorial Medical Center drama unfold in New Orleans. No one wants that kind of shitty publicity........even if the circumstances were really that bad.

  • John117_MC


    #9715842 - 11 years ago

    In reply to nurse, #13:

    Is there really such a thing as a Do Not Save list? Or are you referencing DNRs?

    Or am I reading your post wrong? I thought you were saying that people actually put their names on a list to avoid being saved during such events.

    Post edited 5/09/08 12:37AM

  • nurse


    #9716570 - 11 years ago

    In reply to John117_MC, #14:

    no I was referring to the article itself and not DNR's

  • Tora_No_Shi


    #11396263 - 10 years ago

    Very interesting.. At least they are trying to get it right. In mas-cal situations, there are four classifications. I am going put these terms as plainly as I can.

    - Returned to duty with immediate care management. (Awww.... my knee has a boo-boo)

    - At risk if treatment or transport is delayed unreasonably. (You could loose that leg if the truck isn't here soon)

    -No immediate risk to life or limb. (Drink some water and walk it off)

    -No matter what we do, you'll probably die anyway.

    In an odd turn of events, it is the URGENT that is treated first with minimul sustaining care, then the IMMEDIATE, then DELAYED. Its a very tough call, and sometimes there is an audiable crack when the IC makes the call, but there comes a time in a MASCAL that the decision must be made to determine whether or not a casualty is worth the time and effort. Do you spent the time and resources trying to save one EXPECTANT over the several IMMEDIATEs and URGENTS that needed and could have actually benifited from those resources?

    I know that I sound cold and heartless, and we are all surrounded by the stigma of all life is precious (which it is) but this is the situation in which we must choke down our personal feelings of the matter and look at things with a cold, logical, analytical point of view. Let the ones go that you know you probably won't save to save the ones that you know you will help live. If I am FUBARed and Havoc had a chance, work on him first or I'll haunt you forever.

  • robotminione


    #11397200 - 10 years ago

    Hey, just wanted to point out that triage isn't only confined to battlefield/disaster situations (although it's more severe there). Have you been to an inner-city ER lately? They have more patients than beds, period. More complex prioritizations (due to more options for treatment than in the field, I assume) have been developed at standard hospitals.