Oregon Guide Prioritizes Who Gets Care in a Crisis

A recent social media leak brought to light a chilling conversation that may be happening in hospitals throughout the world. What if social distancing efforts don’t flatten the curve and the need for urgent care far exceeds a community hospital’s capacity?    

The “Oregon Crisis Care Guide” was created years ago and offers guidance to hospital teams to use in the event of a natural disaster like an earthquake or a pandemic. The guidelines were last updated In 2018.  In some ways, the strategies bear similarities to those debated on Twitter and other platforms following the leak of a Michigan hospital document.   

 

On Friday, March 27 a Michigan NPR station reported that the previous night someone leaked the draft of a sensitive internal document on social media. The document outlined how the Henry Ford Health System would prioritize which patients will receive potentially life-saving treatment if demand surges beyond the hospital’s capacity.    

 

According to the letter: “Patients who have the best chance of getting better are our first priority.”   

 

It further outlines how patients who are unlikely to survive will care to ease their suffering. Among those patients includes people who have “severe heart, lung, kidney or liver failure; terminal cancer; or severe trauma or burns.” 

 

The “Oregon Crisis Care Guidance” is the result of a collaboration among members of a multi-disciplinary workgroup including nurses, physicians, emergency medical services providers, and experts in other related disciplines like ethics and law.  

 

The title page of the document credits over 40 co-sponsors including the Oregon Medical Association, The Oregon Health Authority, Oregon Nurses Association, and Samaritan Health Services.  

 

The introduction outlines extreme crisis situations where the guidance might apply.   

“In a public health crisis, healthcare resources may be overwhelmed. Hospitals and other buildings may be damaged. Healthcare workers may be killed, ill or injured. They may be caring for loved ones, or simply unable to reach their work location. At the same time, many in the community would be ill or injured and would need care. A public health crisis like this would be a great challenge to the healthcare community and the people of Oregon. To be ready, we need to plan for it now.”   

 

Like the Henry Ford Health System document, the guide states: “Priority for treatment of patients should be based to the greatest extent possible on evidence-based, objective measures to predict likelihood of survival. As a general principle, in order to save the greatest number of lives, life-saving interventions should be provided first to those most likely to benefit.”   

It also suggests “critical care exclusion” for patients with conditions like heart failure, liver disease, neurologic disease, some cancers, and “other conditions with an average life expectancy of less than six to twelve months.”   

 

The 66-page PDF offers more detail and nuance. It can be found along with the Crisis Care guidance Implementation Toolkit on the  Oregon Health Authority’s website.   

 

By Samantha Sied