The problem is two-fold. If a hospital is overwhelmed with critically ill patients, there won’t be enough equipment or staff to go around. So you’re forced to ration resources—there’s no alternative unless you can transfer the patient to another facility. The other issue is that it may be futile to do cardiopulmonary resuscitation on a certain subset of patients, because they all die anyway. Use your limited resources on patients who have a fair chance of eventually walking out of the hospital.
From The Washington Post:
Halpern’s document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree.
Wyese, the Michigan ICU nurse, said his own hospital has been thinking about these issues for years but still is unprepared.
“They made us do all kinds of mandatory education and fittings and made it sound like they are prepared,” he said. “But when it hits the fan, they don’t have the supplies so the plans they had in place aren’t working.
”Over the weekend, Wyese said, a suspected covid-19 patient was rushed in and put into a negative pressure room to prevent the virus spread. In normal times, a nurse in full hazmat-type gear would sit with the patient to care for him, but there was little equipment to spare. So Wyese had to monitor him from the outside. Before he walked inside, he said, he would have to put on a face shield, N95 mask, and other equipment and slather antibacterial foam on his bald head as the hospital did not have any more head coverings. Only one powered air-purifying respirator or PAPR was available for the room and others nearby that could be used when performing an invasive procedure — but it was 150 feet away.
While he said his hospital’s policy still called for a full response to patients whose heart or breathing stopped, he worried any efforts would be challenging, if not futile.
“By the time you get all gowned up and double-gloved the patient is going to be dead,” he said. “We are going to be coding dead people. It is a nightmare.”
I hadn’t thought about it before, but that last sentence has some truth to it. If someone is circling the drain toward cardiac or pulmonary arrest, it’s best to do it before they actually “code.”
Steve Parker, M.D.