Tuesday, March 24, 2020

Hard Lessons: Triage

     You've seen the headline or tagline: in Italy, patients above a certain age aren't getting respiratory support.

     I'd like to tell you it's a huge lie, but while the details may be a little askew or oversimplified, the gist of it is true.

     There are a lot of people sick with coronavirus in Italy.  The number of them who need respirators exceeds the number of respirators available.  There's no way to save everyone.

     Let that sink in: There is no way to save everyone.

     Pretty horrible, isn't it?  That's the position doctors found themselves in World War One, the biggest if not the first collision of 20th-Century military technology with 19th-Century tactics.  Men were falling in vast numbers and many of them were not quite dead.  There were only a limited number of doctors and medics; field hospitals were minimal, medical supplies were inadequate.  Men were dying of easily-treated injuries while doctors labored to save those who were unlikely to live.  Something had to be done!

     There is no morally-satisfying answer to such a dilemma.  All that can be done is to mitigate harm; all that can be done is to try to do the greatest good with the resources available.  It's called triage: doctors began sorting patients into three groups:
  • Those who are likely to live, regardless of what care they receive;
  • Those who are unlikely to live, regardless of what care they receive;
  • Those for whom immediate care might make a positive difference in outcome.
     The last group was the only one that received full-on medical care.  Any leftover time or materials was spent on the first group.

     It is cold, harsh and heartbreaking.  The only worse things are all the other available options.  You're hearing stories of doctors breaking down in tears in Italian hospitals?  This is why.  They're not military doctors.  They learned about triage but they have never had to practice so harsh a version; even landslides and floods rarely put so much stress on medical resources.

     And this is why you're social distancing.  This is why you're being asked to stay home.  Overload the health system and you get a sorting-out that leaves the weakest dying, that leaves the strongest gasping for breath to get through the worst of the illness, and focuses resources where they will do the greatest good.

     It can happen here.

     Let's do everything we can to keep things from getting that bad.
     Further reading?  Tom Godwin's The Cold Equations.


Merle said...

I was first exposed to this in 1967, before my first trip to Viet Nam.
Hate to see it happen here.... :(

RandyGC said...

Triage seems to be one of the most difficult concepts folks taking CERT training seem to have.

Many folks understand the concept intellectually, but seem to lock up at the emotional level when it's put into practice, even during an exercise. And I have a feeling that a lot of folks that do OK in exercises are doing so because "this isn't real".

Thankfully we have never had to do it for real here. And I hope I never need to.

I do expect a second "pandemic" of PTSD cases for medical and EMS personnel when this is over.