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Canadians mull pandemic plans

4th December 2006

Health officials in Canada are developing priorities which may eventually govern who gets access to critical care during a human influenza pandemic.

Pandemic preparedness officials in Ontario province have drafted a triage protocol to guide the allocation of resources in the initial days or weeks of a pandemic if the system is overwhelmed.

Patients with a poor prognosis despite care in an intensive care unit, patients who require resources that simply cannot be provided during a pandemic, and patients with advanced medical illnesses with a poor prognosis as well as influenza are likely to meet criteria for exclusion.

Inclusion criteria identify patients who may benefit from admission to critical care units and primarily focus on respiratory failure.

The Working Group of the Ontario Provincial Pandemic Plan, which comprises specialists in critical care, infectious diseases, medical ethics, military medicine, triage, and disaster management, was convened by the provincial government of Ontario in December 2004.

Group member Michael Christian said that in a moderate or severe pandemic, doctors would need to look at how they could do the most with the resources available to them.

The triage protocol uses the sequential organ failure assessment (SOFA) score, and makes use of a concept known as 'minimum qualifications for survival', enabling a ceiling to be set on the amount of resources that can be expended on any one person. It also hopes to identify early stage patients who are not improving and who are likely to have a poor outcome.

But Christian emphasised the Ontario group's protocol was just a starting point, which still needed further consultation, and which could be adapted to specific circumstances.


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