State Health Department Seeks Public Engagement on Ventilator Allocation Guidelines

Proposed Policy Would Take Effect During a Severe Influenza Pandemic

Albany, N.Y. (Aug. 23, 2007) - The state Department of Health is seeking further public comment on its draft guidelines for rationing mechanical ventilators during a severe influenza pandemic.

The guidelines were developed by a panel of experts convened by the New York State Task Force on Life and the Law. Since their first release in March, the draft guidelines have been reviewed extensively by the medical community throughout New York State. However, public comment has been sparse and, therefore, insufficient.

Health Commissioner Richard F. Daines, M.D., said the Department needs to engage the public in dialogue about ventilator triage, making sure that the plan reflects community values about how to allocate scarce resources in a public health emergency.

"New York State continues to purchase and stockpile ventilators as part of our pandemic preparedness, but we know that in a severe pandemic, shortages are inevitable," Commissioner Daines said. "We want to work with the public to ensure that triage of 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 medical criteria. 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.

"While it is crucial to learn from experts, it is equally important to hear from community groups, including faith-based groups, parents, the elderly, the disabled, among others. We want to make sure that the plan reflects community values about the best way to share scarce critical care resources in a pandemic," said Tia Powell, M.D., Executive Director of the New York State Task Force on Life and the Law.

Key points of the proposal include:

  • In an overwhelming pandemic with a severe shortage of ventilators and staff to operate them, access to ventilators would depend on which patients have the best chance of survival if they receive ventilator support. Guidelines will determine whether patients start and/or continue on ventilator support.
  • The guidelines will apply to all patients who require critical care, not only those affected by pandemic influenza. There will be no prioritized access for health care workers as compared to children and other community members.
  • 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. DOH 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.

Experts in disaster medicine, critical care, infectious disease and medical ethics have already reviewed the plan and suggested useful revisions.

The New York State Task Force on Life and the Law is charged with devising public policy on issues arising from medical advances, including the determination of death, the withdrawal and withholding of life-sustaining treatment, organ transplantation, and assisted 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 ventilator allocation documents, go to: www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators.

Comments on the proposal may be sent to panflu@health.state.ny.us.