Coronavirus, intensive care doctors in Lombardy: “Timely actions or disastrous health calamity”. The access priority hypothesis: “Whoever has the most chance of survival first”

Place a age limit for access to intensive care, based on the greatest possibilities of survival. That’s what the Italian society of anesthesia, analgesia, resuscitation and intensive care in a technical document related to the emergency coronavirus. “It may be necessary to place an age limit on entry into intensive care. It is not a question of making merely valuable choices, but of reserving resources that could be very scarce for those in the community primis more probability of survival and secondly to those who can have more years of life saved, with a view to maximizing the benefits for the greatest number of people “, reads the report entitled” Recommendations of clinical ethics for admission to intensive treatments and for their suspension , in exceptional conditions of imbalance between needs and available resources “. The report was also disseminated and fully published on the Siaarti website, and is addressed to doctors. What in Lombardy region they decided to write directly to the governor Attilio Fontana to ask him to express their concerns to the central government: “In the absence of timely and adequate provisions by the Authorities we will be forced to face a event that we can only qualify as a disastrous health disaster“, Reads the document addressed to the President since Coordination of intensive care in Lombardy.

The dossier of anesthesiologists and resuscitators: “Priority for access to intensive care” – A real alarm, the one launched by doctors. According to the scientific society, the document wants to “provide a support to anesthesiologists-resuscitators currently committed to managing “the maxi-emergency” that has no precedent for characteristics and proportions“. “In a scenario of total saturation of the intensive resources, decide to maintain a criterion of ‘first come, first served’, Would still be equivalent to choosing to do not treat any subsequent patients which would be excluded from Intensive Care ”, reads between the 15 points of the seven-page text (you can read it here).

“Attention to who can benefit most from treatments” – According to Siaarti’s doctors, “an eventual inappropriate judgment access to intensive care based solely on distributive justice criteria (extreme imbalance between request and availability) is justified by the extraordinary nature of the situation “. “We are aware – continues the document – that tackling this issue can be morally and emotionally hard. As a scientific society we could have (kept silent) entrust everything to common sense, to the sensitivity and experience of the individual resuscitating anesthesiologist, or to attempt (as we have chosen to do) to illuminate his decision process with this small support that could help reduce anxiety, stress and above all the sense of loneliness. With this document of recommendations, Siaarti does not propose to treat some patients and limit treatments to others – they conclude – On the contrary, it is the emergency events that are forcing the anesthesiologists-resuscitators to focus attention on the appropriateness of the treatments to those who can benefit most, where resources are not sufficient for all patients “.

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The letter to Fontana: “Drastic measures or it will be disastrous medical disaster” –“The issue of ICU posts is the number one emergency triggered by the spread of the Covid-19 virus. Precisely to deal with the lack of beds in hospitals, the government provided in the decree passed last night the possibility of requisitioning hotels to be transformed into places of House assistance collective. Structures to be used for the quartancy of the positives not in serious conditions, which would therefore free places in hospitals. And it is precisely to healthcare facilities that the Coordination of intensive care in Lombardy in his document sent to Governor Fontana, who is asked to bring it to the attention of the Government and to the Commissioner for the Coronavirus emergency, Angelo Borrelli. “This is a serious event that puts us in the survival of not only Covid patients is dangerous, but also of that part of the population that in normal conditions turns to the Healthcare System for the treatment of acute or chronic events of any nature. Healthcare facilities are subjected to pressure that is greater than any possibility of an adequate response. Despite the enormous commitment of all healthcare personnel and the deployment of all available tools, correct management of the phenomenon is now impossible “, reads the letter signed by the representatives of the Lombard intensive therapies” Outpatient activities, non-urgent surgery, hospitalizations in medicine – the document continues – have fallen to levels close to zero. “The entire network of intensive care has been restructured, creating dedicated structures in which, fully harnessed to defend against infection, we work with great effort to assist serious and very serious patients, whose life depends on equipment technologically complex, unfortunately available in limited numbers. Also for this reason, immediate action is absolutely necessary adoption of drastic measures aimed at reducing social and useful contacts to contain the epidemic“. Then the warning: “In absence of timely and adequate provisions by the Authorities – concludes the document – we will be forced to to face an event that we can only qualify as one disastrous health disaster“.

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