Mareiniss Darren P, Levy Frederick, Regan Linda
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Disaster Med. 2011 Nov-Dec;6(6):329-38. doi: 10.5055/ajdm.2011.0072.
In the event of a catastrophic disaster, healthcare resources may be completely overwhelmed. To address this, the federal Agency for Healthcare Research and Quality has recommended using "crisis standards of care"during such an event. These standards would recommend allocating scarce medical resources to do the greatest good for the greatest number of patients. In a dire catastrophic event, such standards may include the allocation of intensive care unit (ICU) resources to maximize patient survival. Triage protocols that seek to efficiently allocate ICU resources during a disaster have been reviewed by the Institute of Medicine. Such protocols suggest the exclusion of patients with high mortality or high resource requirements from ICU care to do the most good for the greatest number of patients. In extreme circumstances, these protocols recommend withdrawing ICU resources from sicker patients in favor of more salvageable patients. However, if providers were to follow the earlier protocols in a disaster and withdraw and reallocate ICU care, criminal or civil liability could result. Two legal solutions to avoid this potential for liability have been suggested in this article.
在发生灾难性灾难时，医疗资源可能会完全不堪重负。为应对这一情况，联邦医疗保健研究与质量局建议在此类事件中采用“危机护理标准”。这些标准将建议分配稀缺的医疗资源，以便为最多的患者带来最大的益处。在极端灾难性事件中，此类标准可能包括分配重症监护病房（ICU）资源，以最大限度地提高患者存活率。医学研究所已对旨在在灾难期间有效分配ICU资源的分诊方案进行了审查。此类方案建议将死亡率高或资源需求高的患者排除在ICU护理之外，以便为最多的患者带来最大的益处。在极端情况下，这些方案建议从病情较重的患者身上撤回ICU资源，转而支持更有可能获救的患者。然而，如果医疗服务提供者在灾难中遵循早期的方案，撤回并重新分配ICU护理，可能会导致刑事或民事责任。本文提出了两种避免这种潜在责任的法律解决方案。
