New York State Health Department Releases Ventilator Allocation Guidelines for Comment

Proposed Hospital Policy Would Take Effect during a Severe Influenza Pandemic

ALBANY - March 16, 2007 - The New York State Health Department today released for public comment guidelines for rationing mechanical ventilators during a severe influenza pandemic. The proposed hospital policy was developed following extensive deliberation by a panel of experts convened by the New York State Task Force on Life and the Law.

"Although New York State continues to purchase and stockpile ventilators as part of our pandemic preparedness, we know that if a severe pandemic occurs, shortages are inevitable," Acting New York State Health Commissioner Richard F. Daines, M.D. said. "We must plan ahead to ensure that decisions to triage ventilators will be fair, and will benefit as many patients as possible."

The ventilator policy would take effect in the event of a severe pandemic – such as the 1918 "Spanish Flu" – resulting in a critical shortage of the breathing devices and staff to operate them. It calls for clinicians to evaluate patients based on objective, universally applied medical criteria. Non-clinical factors such as race, ethnicity, socio-economic status, perceived quality of life or ability to pay would not be weighed in the decision-making process.

Highlights of the proposal include:

  • In an overwhelming pandemic with a severe shortage of ventilators and staff to operate them, access to ventilators would depend only on which patients have the greatest medical need – and the best chance of survival – if they receive ventilator support.
  • Access to ventilators would be limited based on clinical factors that pose the highest probability of mortality, such as: cardiac arrest; end stage organ failure; severe irreversible neurologic condition with high risk of death; metastatic cancer with high risk of death. Age, non-life threatening disability and "social worth" are not exclusion criteria.
  • Hospitals will designate supervising physicians who will act as triage officers. These supervising physicians will take responsibility for triage decisions. Doctors who provide direct care for patients will not be asked to make the decision to withhold ventilator support.
  • These guidelines would apply only in an acute care setting (when patients are admitted to a hospital or treated in the emergency department). The guidelines would not cause patients in chronic care facilities to lose access to ventilators.
  • Palliative care will play a crucial role in providing comfort to patients, including those who do not receive ventilator treatment. The State Health Department is collaborating with the Hospice and Palliative Care Association to expand capacity to provide palliative care and bereavement counseling. Every effort will be made to keep patients comfortable. Patients will receive medications to treat pain and to reduce anxiety.

Once comments have been received, the expert panel will be reconvened. "This is a proposed policy that will be reviewed based on additional information garnered from clinicians, healthcare facilities, and the community," said Tia Powell, M.D., Executive Director of the New York State Task Force on Life and the Law. "We recognize that there are no perfect answers in response to the immense challenges posed by a severe pandemic – this proposal is a good start but we welcome feedback."

The New York State Task Force on Life and the Law is charged with devising public policy on a host of issues arising from medical advances, including: the determination of death, the withdrawal and withholding of life-sustaining treatment, organ transplantation, and new technologies and practices to assist reproduction. The Task Force encompasses expertise from many disciplines, and also reflects the wide spectrum of opinion and belief about bioethics issues in New York State.

To access the ventilator allocation guidance, go to www.health.ny.gov. Comments on the proposal may be sent to panflu@health.state.ny.us.