Covid-19: Health staff could have to choose which patients get critical care if crisis worsens

Covid-19: Health staff could have to choose which patients get critical care if crisis worsens

The blueprint outlines how a dedicated triage committee will decide which patients get potentially life-saving treatment if facilities in Jersey become so strained during the Covid-19 pandemic.

Health bosses say the document plans for a worst-case scenario and currently the Island in in a strong position in relation to the pandemic.

Per 100,000 population, Jersey has up to ‘2.5 times’ as many critical care beds than the UK average (ten) and work has begun on a new 180-bed Nightingale hospital at Milbrook Park to cater for any excess need.

The government ordered two extra ventilators – machines that help extremely sick patients to breathe – on 17 March. They were due to take six weeks to arrive.

As of Wednesday evening, at the General Hospital and Overdale there were a total of 72 inpatients and 125 empty beds. There were 21 patients with confirmed Covid-19 in the General Hospital, and a further eight in other Health Department settings.

But, ahead of a press conference on Thursday afternoon, Chief Minister John Le Fondré, said in a statement: ‘We need to be prepared – as a government, as healthcare professionals, as patients, and as Islanders – to face what could become difficult decisions.

‘The government is doing all it can to support healthcare professionals in making decisions that could affect people’s lives and this ethical framework puts fairness at the heart of care.’

It has been stressed that other health authorities will have made similar plans but may not have shared them. The government say they are doing so to be as transparent as possible.

The 24-page ethical framework document states that: ‘Limited time and information in a Covid-19 pandemic make it justifiable to give priority to maximising the number of patients that survive treatment with a reasonable life expectancy and to regard maximising improvements in length of life as a subordinate aim.

‘Because maximising benefit is paramount in a pandemic, and there is no ethical distinction between withholding and withdrawing care, removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable.’

The document continues: ‘Patients should be made aware of this possibility at admission. Undoubtedly, withdrawing ventilators or ICU support from patients who arrived earlier to save those with better prognosis will be extremely psychologically traumatic for clinicians and some may be reluctant to do it. However, many guidelines agree that the decision to withdraw a scarce resource to save others is not an act of killing and does not require the patient’s consent. Initially allocating beds and ventilators according to the value of maximising benefits could help reduce the need for withdrawal.’

Decisions on critical care in a scenario where the Island’s health system becomes overwhelmed would be made by a Central Triage Committee. It is recognised that such life and death decisions could lead to ‘debilitating distress’ for clinicians and having a committee is designed to mitigate against that.

The rate of infection, based on government data published online, does seem to be slowing in the Island. Between 1 April and 9 April the number of positive cases increased by more than 100 from 96 to 198. From 9 April to Wednesday positive cases increased by just more than 20.

Medical director for the Health Department, Patrick Armstrong, said the ethical framework provides Islanders with the ‘assurance that if demand exceeds capacity, we have put in place a process which will guide how resources are used and that the decisions taken are fair, equitable, ethical and legal’.

Health Minister Richard Renouf stressed that treatment will still be given to everyone who needs it but the Island might not be able to ‘provide critical care to all those who might normally be considered for it’ should a worst-case situation arise.

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