New York State Department of Health and New York State Task Force on Life and the Law Update Ventilator Allocation Guidelines

ALBANY, N.Y. (November 25, 2015) - The New York State Department of Health and the New York State Task Force on Life and the Law released updated guidelines for allocating ventilators during an influenza pandemic in New York State.

"Pandemic influenza is a foreseeable threat, and New York has a responsibility to plan now," said Commissioner of Health Dr. Howard Zucker. "These guidelines provide an ethical, clinical, and legal framework to help health care providers and the general public make difficult decisions in the event of an influenza pandemic."

The guidelines provide direction for the distribution of ventilators in the event ofa severe pandemic, when there are insufficient ventilators to treat everyone who needs them. The guidelines balance the goal of saving the most lives with important societal values, such as protecting vulnerable populations. The guidelines are non-binding and designed with sufficient flexibility to adjust to changing clinical information.

The guidelines consist of four parts: Adult Guidelines, Pediatric Guidelines, Neonatal Guidelines, and Legal Consideration when Implementing the Guidelines. New York is the first state to develop innovative clinical protocols that address special considerations in treating children and neonates. The adult clinical protocol was updated and revised from the 2007 draft guidelines.

The guidelines were developed with input from experts in the fields of medicine, ethics, law, and policy as well as members of the public. Key points include:

  • The guidelines provide an evidence-based clinical framework that support the goal of saving the most lives in an influenza pandemic in which there are a limited number of available ventilators.
  • All patients in need of a ventilator are subject to one of the three clinical protocols, using objective, universally-applied clinical criteria to evaluate a patient's likelihood of survival. Patients who have the highest likelihood of survival with ventilator therapy receive priority. Factors such as race, ethnicity, sexual orientation, socio-economic status, advanced age, perceived quality of life, ability to pay, role in the community, or other subjective criteria will never be part of the evaluation in determining who receives ventilator therapy.
  • To ensure that patients receive the best possible care in a pandemic, the guidelines call for a triage officer or triage committee to determine who receives or continues to receive ventilator therapy. To prevent a conflict of interest, these decision-makers are not the patients' attending physicians. The decision regarding whether to use a triage officer or committee is up to each hospital, given the different resources at each site.
  • The guidelines apply only to patients at hospitals and not to ventilator-dependent chronic care patients at long-term care facilities, such as nursing homes. However, if such a patient requires hospital care, the patient is then subject to the clinical protocol.
    • Patients not receiving ventilator therapy should receive alternative forms of medical intervention. Palliative care will be provided to all patients to manage patient discomfort.
  • During a pandemic the guidelines will be modified as new information is obtained. Data collection and analysis of the pandemic viral strain, as well as symptoms, disease course, treatments, and survival, will be taken into consideration, so that patients receive the best care possible.
  • Additional public outreach efforts will be conducted regarding the guidelines and the public will have opportunities to comment on them.

"The guidelines were written to reflect the values of New Yorkers, and extensive efforts were made to obtain public input during their development," said Susie Han, Deputy Director of the New York State Task Force on Life and the Law and project chair of the guidelines. "The guidelines are a living document, intended to be updated and revised in line with advances in clinical knowledge and societal norms."

Established in 1985, the New York State Task Force on Life and the Law is the State's bioethics commission and consists of approximately 23 Governor-appointed experts who volunteer their time to assist the State in developing public policy on issues arising at the interface of medicine, law, and ethics. Chaired by New York State's Commissioner of Health, the Task Force is comprised of leaders in the fields of religion, philosophy, law, medicine, nursing, and bioethics. The Task Force has produced influential reports on cutting-edge bioethics issues, including the withholding and withdrawing of life-sustaining treatment, assisted reproductive technologies, organ transplantation, dietary supplements, surrogate decision-making, genetic testing, and research involving adults who lack capacity to consent.

Comments on the Guidelines may be sent to ventplan@health.ny.gov.

Ventilator Allocation Guidelines: http://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators/docs/ventilator_guidelines.pdf

FAQs on the Ventilator Allocation Guidelines: http://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators/docs/faqs.pdf