BOISE, Idaho — The Idaho Department of Health and Welfare will no longer recommend hospital staff use someone's age as a determining factor for who gets a bed, a ventilator, or other care in crisis situations.
The department moved to make the changes to its Crisis Standards of Care document, which guides decisions on how to allocate scarce medical resources, after several groups raised concerns that the current metric amounts to discrimination based on age and disability.
Both the American Association of Retired Persons (AARP) and Disability Rights International (DRI) pushed for the revision, arguing it was not fair to automatically place seniors and those with disabilities in a lower priority group for treatment that could save their lives.
Previously, the document instructed triage teams to endeavor to save "life years" if there were not enough resources for all the people who needed them. Under that guidance, a dangerously sick 20-year-old - who may have decades of natural life span left - could receive care before a 72-year-old who was equally ill.
The changes to the document scrap that wording, IDHW Bureau Chief Sonja Schriever said.
"Instead of save life years, we are just trying to save the most lives," she said.
The revisions also took on so-called crisis standards of care "tie-breakers." Under the old guidance, preference for treatment would go to children under 18, to pregnant women at 28 weeks or more of gestation, and to medical workers or those deemed vital to public health and safety. The tie-breakers also delineated care preference along age groups, with the 18-40 bracket getting the highest priority after children, followed by 41-60, 61-75, and those over 75.
The updated guidance whittles the tiebreakers down to just two.
If a hospital has two patients who are equally sick and are competing for a single ventilator or other resources, the person whose "trajectory of illness" is declining the slowest will be the one to get care. If both are declining at the same rate, the patient with the greater prospect of surviving to the point of discharge from the hospital takes priority.
Schriever stressed that no hospital in Idaho has yet had to make a triage decision on one patient getting care over another.
"We haven't had to do that at all during this pandemic and during this crisis standards of care," she said. We have had more problems with staffing than with ventilators."
Chronic conditions that reduce a patient's chance of surviving, as well as conditions that make it unlikely the patient will live continue to bear consideration under the updated guidance, and could drop those patients into a lower priority when resources are limited.
The crisis standards of care changes passed with a unanimous vote Wednesday morning. For more on Idaho's crisis standards of care guidance, visit the Idaho Department of Health and Welfare website here.
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