The New England Journal of Medicine featured an article by the Israeli medical team that set up a field hospital less than 48 hours after a major earthquake hit Haiti. When there is so much suffering, whom do you help first?
Under normal circumstances, triage involves setting priorities among patients with conditions of various degrees of clinical urgency, to determine the order in which care will be delivered, presuming that it will ultimately be delivered to all. After the Haitian earthquake, however, it was impossible to treat everyone who needed care, and thus the first triage decision we often had to make was which patients we would accept and which would be denied treatment. We were forced to recognize that persons with the most urgent need for care are often the same ones who require the greatest expenditure of resources. Therefore, we first had to determine whether these patients’ lives could be saved.
Our triage algorithm consisted of three questions: How urgent is this patient’s condition? Do we have adequate resources to meet this patient’s needs? And assuming we admit this patient and provide the level of care required, can the patient’s life be saved?
In the first days of our deployment, most of the patients we saw had recently been removed from the rubble. The majority had limbs that were compromised by open, infected wounds. Untreated, open fractures meant infection, gas gangrene, and ultimately death. Clearly, the sooner after injury the patient received medical attention, the better his or her chances of survival. Late-arriving patients who already had sepsis had a poor chance of survival. But there was no clear cutoff time beyond which patients could not be saved; each case had to be evaluated individually.
Read the full article here: The Israeli Field Hospital in Haiti— Ethical Dilemmas in Early Disaster Response.
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