A Bird Flu Pandemic Could Create Shortage of Hospital Ventilators

When a person catches the flu, the infection can affect the lungs and cause difficulty breathing. In serious cases, people need a breathing machine, or ventilator, to help them stay alive.

But if there was a worldwide outbreak of the bird flu among humans, the number of people who need a ventilator could far exceed supply.

A "medium-level" flu pandemic would likely cause between 89,000 to 207,000 deaths and about 314,000 to 734,000 people to be hospitalized in the United States, according to the Centers for Disease Control and Prevention. A large percentage of these hospitalized patients could be critically ill and require a ventilator.

With that in mind, doctors throughout the country are debating how to parse out a limited supply of ventilators in the event of an outbreak.

Dr. John Hick, an emergency physician at Hennepin County Medical Center in Minneapolis, has been working on a plan where the limited number of ventilators would be used for healthier patients, while the sickest patients would not receive them unless one became available.

His plan attempts to do the "greatest good for the greatest number" because the healthier patients would be more likely to benefit from ventilation and ultimately have a better outcome, he said. His proposal was published in the February issue of the journal Academic Emergency Medicine.

"In a disaster where we are were short on resources, and are not going to be able to receive resources from other sources to fill the needs, we would have to prioritize patients that have a better chance of survival," he said. "For example, deciding to take a very sick patient with multiple organs failing off the ventilator in order to give it to a patient with a better chance of recovery."

Another proposal would give priority for ventilators to patients who are health care workers. The plan also would give priority to health care workers' family members and key health system leaders, such as hospital chief executive officers.

"It is a really controversial topic, but if you look at an overall goal of achieving the maximum benefit for the most number of people, it would make sense to put people to work who can help save lives," said the doctor who proposed the approach, Kristi Koenig, director of public health preparedness in the Department of Emergency Medicine at the University of California at Irvine. "We know that in many cases if people cannot assure the safety of their own families, they will not be effective at work."

Doctors also are discussing what to do with patients who are on a ventilator long term and would likely be dependent on it for the rest of their lives. If there's a flu pandemic, some doctors may consider removing these patients from ventilators so that they can be used in other people more likely to benefit from them.

"It is going to be very difficult to justify withdrawing the ventilator from a patient that is chronically dependent on it, even if another patient exists that could benefit more from the ventilator. The fundamental rights of the patient would need to be respected even in a pandemic emergency," said Gerard Magill, a professor at the Center for Health Care Ethics at Saint Louis University.

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