Terrorism and the ethics of emergency medical care

Pesik, Nicki; Keim, Mark; Iserson, Kenneth V.

doi:10.1067/mem.2001.114316

Cited by 103 publications

(51 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The ethics literature on bioterrorism and battle-field triage informed our thinking and called our attention to important issues such as the duty to care, reciprocity, equity and good stewardship [20-25]. The importance of having ethically robust criteria and policies developed in advance of a pandemic influenza outbreak is underscored in this literature, for "critical decisions like these should not be made on an individual case-by-case basis" and "physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of policy or protocol" [22]. Robust disaster preparedness requires practising preventive ethics.…”

Section: Discussionmentioning

confidence: 99%

Pandemic influenza preparedness: an ethical framework to guide decision-making

et al. 2006

View full text Add to dashboard Cite

BackgroundPlanning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis.DiscussionIn this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework.SummaryThe need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.

show abstract

Section: Discussionmentioning

confidence: 99%

Pandemic influenza preparedness: an ethical framework to guide decision-making

et al. 2006

View full text Add to dashboard Cite

show abstract

“…It has also been described as “narrow social utility” and the “multiplier effect”. (18, 27) The National Vaccine Advisory Committee recommends this principle to allocate vaccines and anti-viral medications during a pandemic. (28) It gives first priority to workers in vaccine manufacturing and health care provider.…”

Section: What Principles Should Guide Allocation?mentioning

confidence: 99%

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions

White

Katz²,

Luce³

et al. 2009

Ann Intern Med

299

277

View full text Add to dashboard Cite

A public health emergency such as an influenza pandemic will lead to shortages of mechanical ventilators, critical care beds, and other potentially life saving treatments. This will raise difficult decisions about who will and will not receive these scarce resources. Existing recommendations reflect a narrow utilitarian perspective in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life saving treatments based on selective application of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of "life-years" saved, and prioritizing those who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and that justice requires that these principles be applied evenly, rather than selectively to the aged, functionally impaired, and those with certain chronic conditions. We discuss strategies to genuinely engage the public in setting the priorities that will guide allocation of scarce life sustaining treatments during a public health emergency.

show abstract

“…Acknowledging that triage is necessary to achieve the greatest good for the most number of people [4], we developed a concept for major incident triage based on the established triage Sieve and Paediatric Triage Tape (PTT) models [1,5]. Although several triage tools exists [6,7], the triage Sieve provided an off-the-shelf tool already taught in Major Incident Medical Management and Support (MIMMS) courses in two neighbouring countries (UK and Sweden).…”

Section: Introductionmentioning

confidence: 99%

A concept for major incident triage: full-scaled simulation feasibility study

et al. 2010

View full text Add to dashboard Cite

BackgroundEfficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents.MethodsThe learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).ResultsAmong the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.ConclusionsOur modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.

show abstract

Terrorism and the ethics of emergency medical care

Cited by 103 publications

References 15 publications

Pandemic influenza preparedness: an ethical framework to guide decision-making

Pandemic influenza preparedness: an ethical framework to guide decision-making

Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions

A concept for major incident triage: full-scaled simulation feasibility study

Contact Info

Product

Resources

About