By coincidence today, I finished Dr. Sheri Fink's Five Days at Memorial: Life and Death at a Storm-Ravaged Hospital. In this remarkable book, Dr. Fink--whom I am looking forward to see lecture in Pittsburgh--details the events that occurred at Memorial Hospital during Hurricane Katrina. Specifically, she focuses on the gut-wrenching decisions physicians and nurses had to make as the hospital appeared to become increasingly non-functional and rescue prospects thought to be dim.
It was in this setting, and without any framework to apply in such an austere situation, that several doctors and nurses found themselves. Faced with the grim choices of which patients could be moved, which couldn't, and in what order to prioritize them decisions were made. As is widely known, allegations of euthanasia surfaced leading to a formal criminal investigation.
To me the theme of the book is that hospitals and other facilities must diligiently prepare for disasters and ensure that during a disaster full situational awareness (e.g. what the true prospects of rescue are, what the conditions are in the entire complex, etc.) is strived for. Also, guidance for physicians that is transparent and widely disseminated--prior to events--must be available for aid in decision-making, especially when conditions call for the rationing of scarce resources.
Fortunately, since Katrina (and because of it) such a need has been recognized and guidance on Crisis Standards of Care have been developed.
Now, to put this in today's context, think of how this might apply and is being applied in West Africa. In more than one sense Ebola can be thought of as a hurricane unleaded on the populations of Guinea, Liberia, and Sierra Leone. Bereft of experience in dealing with Ebola--this is their first outbreak--these nations are akin to the doctors in Katrina and, like them, they are confronted with stark choices.
Who to treat? Who to admit? Who to give IV fluids to? Who to give personal protective equipment to? These are the decisions being contemplated right now in what can only be described as a situation in which extreme crisis standards of care are the norm.
Reading Dr. Fink's book with the context of Ebola in mind shows how widely applicable her astute observations are.