Battlefield triage arrives in UK

We’ve already seen it in Italy, now the UK, via The Tele:

Intensive care for coronavirus patients is now being limited to those “reasonably certain” to survive, a major NHS London trust has conceded.

A department head at Imperial College Healthcare revealed on Sunday that fewer and fewer marginal patients are being selected for ventilator treatment because so many serious cases require a fortnight on the machines.

It comes as the NHS faces the toughest week in its history, with the Deputy Chief Medical Officer, Dr Jenny Harries, warning the number of deaths will increase.

Imperial College Healthcare acknowledged that “very poorly patients with coronavirus may need to be on a ventilator for extended periods,” adding that “for some patients this would not be in their best interests”, but denied people are being denied care due to capacity problems….

Not much sign yet that the UK has it under control:

The US is next.

Hopefully Summer has saved us from SloMo guiding the narion into the same fate.

David Llewellyn-Smith
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Comments

  1. Makes perfect sense when the mortality of ventilated patients is probably 80%

    Why bother?

    We already do this during normal times – no 90 year olds from nursing homes are ventilated

    • The bit not being reported here is that there is no NIV which is what a patient with Type 1 Resp Failure would be put on normally. So they go from maximum 6L/min on Hudson (thought to be the safe limit regarding virus spread, some countries are using 8L/min but NSW Health are saying it is going to be 6 here) direct to ETT.

      That is a massive treatment gap vs normal escalating treatment protocol. In the past a large portion of patients would have been offered > 6L /min on NRB even up to 15L/min temporarily, then HFNP up to 50L/min or CPAP even though being deemed not suitable for ETT/ICU and would easily have survived on that intermediate therapy.

      So the issue is that patients who now fall into this treatment gap will die, whereas before they would not.

  2. Triage is nothing new. It is practiced every day by ambulance officers at trauma scenes and the triage nurse at hospital emergency departments. Where demand for medical attention exceeds supply, those who will survive and those who will die are ignored – no matter how much noise they are making – and all attention goes to those whose lives can be saved. This may seem ruthless but the logic is impeccable and must be followed.

    Civilians have the luxury of vaccilation and moral dilemmas, the professionals do not.

    The hospitals will quickly work out who – eg youngsters in otherwise perfect health – can be assisted by ventilators and who cannot, which will markedly change the mortality rate of those ventilated. This change in statistical outcomes will be lionized by politicians and journalists as ‘progress’ when it is nothing of the kind – it is merely advanced triage.

  3. i dont believe so. I strongly believe our numbers screwed. reason ours are slowing is because they have focused testing on travel connections. now that borders shut – finally – of course those will drop. the problem is the community spread is and has gone bang and we have no handle on this yet. whilst I agree fatalities are the wrong number, i suspect they will start to show that our fall is incorrect and this will be especially when our hospitals over run. Private Docs get ready for conscription.

      • Australians can still come in, and maybe temporary and permanent residency visa holders.
        AND they all have to go into 14 day mandatory, supervised, enforced quarantine.

      • Ye and in Vic my wife and I tried and tried to get tested when I tried no one knew where to get tested. Experts (Ian Mckay etc) were saying oh they available la di da – well I went to dorovitch and melbourne path and they couldnt help (at that time). Nor could ER at local hospital they were unconcerned and laughed at me. how things have changed. When my wife went she was told oh your Japanese visitors were outside the 2 week period. So lets guess if we were positive how many bloody peeps did we or could we have infected (we pulled our kids from daycare and kinder when I was sick and loooong before were “allowed” to. Daycare threatened us. So did Kinder. We isolated my parents (they going cold turkey as been over a month now). Most would not have done that. Nuts.