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Disaster management and palliative care
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I am a member of the Wisconsin State Taskforce on Emergency Palliative Care. This is a subpanel of a larger disaster management task force for the state. Our initial meeting was last week and I want to share some thoughts with you because I found this entire intellectual exercise interesting. I will focus on this issue over the next few blog entries.
To start, I should discuss a possible scenario for context. The state task force accepts that a mass casualty event will occur: pandemic flu, bioterrorism, natural disaster, etc. Pandemic flu is the easiest to conceive of because there is real history based on prior pandemic flu outbreaks. We may safely assume that:
- pandemic flu outbreak is inevitable (e.g. SARS or “bird flu”);
- everyone will be affected to some extent;
- the first wave may last one to three months while the entire pandemic will last two to three years;
- widespread illness will increase the likelihood of sudden and significant shortages of medical resources;
- preventative and treatment measures will be in short supply; and
- health care workers and first responders will be at higher risk of exposure and thus, staffing will be impacted.
Based on a 30% to 35% attack rate and severity of illness seen during the 1968 pandemic, over a six to 12 week period there would be a devastating impact on the entire nation’s healthcare system, taxing it beyond its capacity to care for all the acutely ill patients. We must also conclude that resources and personnel would be diverted to caring for the acutely ill and patients with chronic illness, such as cancer, would temporarily go untreated. The following table shows the estimated patient volumes:
Estimated patient
volumes |
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When one realizes the dramatic impact this would place on the healthcare system for months or years, one realizes that difficult decisions must be made in triaging limiting resources. The emergency palliative care task force is part of the triage decision and also the therapy decisions for patients determined most appropriate for palliative care.
We concluded there would be several categories of patients who would be triaged to palliative care:
- those exposed to the event who are expected to die over the course of days/weeks;
- the already existing palliative care patients (hospice, etc.);
- patients with advanced illness whose situation will be worsened by the scarcity of resources (CANCER patients, other organ-dysfunction patients); and
- patients who are triaged simply because of scarce resources.
In my next blog I will consider the care of these patients further. I’m interested to hear if there are others who have thought about care of their patients amidst a disaster.