Date Added: 2/22/2010
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Is it morally and ethically right to refuse care to patients who are critical? –Nova Scotia’s Health System Triage Protocol for Critical Care.

Nova Scotia’s health care system is challenged for resources. A pandemic can further cripple the system leading to chaos. Since the outbreak of SARS in 2003, scarcity of resources and an overwhelmed system have posed a significant challenge for health care decision makers. SARS raised doubts around the effectiveness of our care delivery framework especially during a pandemic and the more recent H1N1 overwhelmed the emergency room visits with influenza-like illnesses. During a pandemic an overcrowded critical care unit of a hospital is forced to redirect patients to hospitals further away for care even if a patient is critically ill. There have been several cases where patients have died en-route to other hospitals because the hospitals closest to them were overcrowded.  Currently patients requiring any critical care resources are admitted on a first-come first-served basis without proper protocols for assessment leaving the ones who require these resources for survival, defenseless. It is in times likes these that proper planning of critical care resources is critical.

A logical solution one would think would be to allocate scarce resources in areas of great need. The problem however is in categorizing these areas of great need during a pandemic. What is the definition of a legitimate need? How does one decide what is the right legitimate need to allocate these scarce resources? Who should receive care and who should be refused care? Unfortunately there are no existing ethic principles or values that clearly define the answer to these questions.

Due to these critical challenges it became evident and necessary that a triage protocol be developed to ensure all patients received critical care in an equitable and just manner. This is a challenge in itself; like Ontario, Nova Scotia does not have the means currently to ensure such a protocol is incorporated in a fair and consistent manner across the province.  The primary challenge is the need for high degree of collaboration and integration among Districts/IWK and the local level providers providing critical care services. Districts would need to establish linkages between and among themselves prior to and during a pandemic event. Districts would also require governance structures to enforce accountability among their local level providers.

But despite these overwhelming concerns, Nova Scotia has taken the first steps towards creating a healthy critical care system. The protocol in draft form is currently being reviewed by Nova Scotia’s health authorities and local level providers. Once approved the draft protocol will be made available to the public for feedback, and after all the updates have been completed the protocol will be incorporated in an open and transparent manner. This complete process should take some time but Nova Scotia is aiming to incorporate the protocol before the onset of another pandemic.

To read more, select : http://www.hitug.org/uploadfile/Report_Nova%20Scotia_Critical%20Triage%20Protocol.pdf