Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks

Auriemma, Catherine L.; Molinero, Ashli; Houtrow, Amy J.; Persad, Govind; White, Douglas B.; Halpern, Scott D.

doi:10.1080/15265161.2020.1764141

Cited by 41 publications

(36 citation statements)

References 28 publications

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“…Because of this there is great debate over the use of quality-adjusted life years in policy making [46]. Even when purportedly "objective" criteria are used to allocate health care resources, subjective notions and ideas about the quality or desirability of life with disabilities may play an influential role [47].…”

Section: Concern For Disability Discrimination During the Pandemicmentioning

confidence: 99%

“…Having a human rights-based strategy in place before catastrophic events happen is key for a disability inclusive response [50]. The core principles of dignity, nondiscrimination, equality of opportunity, and accessibility should be central during resource allocation protocol development [47]. To create successful disability inclusive community-based responses, planners need to ensure that people with disabilities have roles and responsibilities in the design and implementation of the responses [50].…”

Section: Concern For Disability Discrimination During the Pandemicmentioning

confidence: 99%

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Children with disabilities in the United States and the COVID-19 pandemic

Houtrow

Harris²,

Molinero³

et al. 2020

PRM

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Children with disabilities are disproportionately impacted by COVID-19 and the containment response. Their caregivers must now adapt to increased stressors such as lack of access to needed therapies, medical supplies, and nursing care. Prior to COVID-19 these families were already marginalized, and this has only worsened during the pandemic. As a vulnerable population, children with disabilities have not been the focus of much discussion during the pandemic, likely because the disease disproportionately impacts older individuals. Nonetheless, children with disabilities should be a focus of evaluation and intervention to mitigate the negative consequences of COVID-19 and the resulting containment strategies. Their needs should be included in future crisis planning, as well. In order to raise awareness of pediatric rehabilitation professionals, health care administrators, policy makers, and advocates, this manuscript provides a discussion of the following topics: the immediate and ongoing impacts on children with disabilities and their families, the ethical concerns and implications of triage protocols for scarce resources that consider disability in their scoring systems, and optimizing medical care and educational needs in the time of COVID.

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Section: Concern For Disability Discrimination During the Pandemicmentioning

confidence: 99%

Section: Concern For Disability Discrimination During the Pandemicmentioning

confidence: 99%

Children with disabilities in the United States and the COVID-19 pandemic

Houtrow

Harris²,

Molinero³

et al. 2020

PRM

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“…During disasters, it is important that triage procedures be carefully decided upon to guide healthcare workers and standardise care (Sztajnkrycer, Madsen & Báez 2006 ; White & Lo 2020 ). Triage is a necessary process where need outstrips demand, and it is essential that triage decisions be based on the best available evidence (Auriemma et al 2020 ; Joebges & Biller-Andorno 2020 ).…”

Section: Triagementioning

confidence: 99%

COVID-19, disability and the context of healthcare triage in South Africa: Notes in a time of pandemic

McKinney

Swartz

2020

African Journal of Disability

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During disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa’s Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are ‘worth’ saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed.

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“…Some of these recommendations deviate from the 2015 Guidelines with regard to the clinical/triage considerations as well. For example, recent recommendations have suggested that exclusion criteria should not be part of a triage protocol, due to their potentially discriminator effects, 25,26,31,32 and the Office for Civil Rights (OCR) at the United States Department of Health and Human Services (HHS) issued a bulletin 33 to ensure that institutions do not deny resources based on disability 34 or advanced age. 7 While the 2015 Guidelines include exclusion criteria, the list of criteria was revised from the draft 2007 guidelines to only include medical conditions that would fall under the revised definition of (short-term) survival (see the above section Definition of "Survival").…”

Section: Discussionmentioning

confidence: 99%

Clinical and Ethical Considerations in Allocation of Ventilators in an Influenza Pandemic or Other Public Health Disaster: A Comparison of the 2007 and 2015 New York State Ventilator Allocation Guidelines

Han

Koch

2020

Disaster med. public health prep.

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Objective: During an influenza or COVID-19 pandemic that results in acute respiratory distress, available ventilators will not meet demand. In 2007, the NYS Task Force on Life and the Law and Department of Health released draft Guidelines for ethical allocation of ventilators for adults. In 2015, updated guidelines were released to ensure that: (1) revisions reflect the public’s values and (2) the triage protocol is substantiated by evidence-based clinical data. We summarize the development and content of the 2015 Guidelines compared to the 2007 version, emphasizing new/revised aspects of the ethical considerations and clinical protocol. Methods: We compared the 2007 and 2015 guidelines, with particular emphasis on the ethical issues and clinical protocols. Results: The 2015 Guidelines retained much of the ethical and clinical framework of the 2007 draft. The triage protocol was revised using evidence-based clinical data. Patients with the highest likelihood of short-term survival with ventilator therapy have priority access. Protocol consists of exclusion criteria, the sequential organ failure assessment (SOFA) score, and periodic clinical assessments. Guidance is provided on secondary triage criteria. Other forms of medical intervention/palliative care and review of triage decisions are discussed. Conclusions: The 2015 Guidelines reflect advances in medicine and societal values and provide an evidenced-based framework to save the most lives. The framework could be adapted in other emergencies, such as the COVID-19 pandemic, that require ventilators.

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Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks

Cited by 41 publications

References 28 publications

Children with disabilities in the United States and the COVID-19 pandemic

Children with disabilities in the United States and the COVID-19 pandemic

COVID-19, disability and the context of healthcare triage in South Africa: Notes in a time of pandemic

Clinical and Ethical Considerations in Allocation of Ventilators in an Influenza Pandemic or Other Public Health Disaster: A Comparison of the 2007 and 2015 New York State Ventilator Allocation Guidelines

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