Sunday, January 26, 2014

the last book I ever read (Sheri Fink's Five Days at Memorial, excerpt six)

from Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink:

Consigning certain sicker patients to go last has its risks, however. Predicting how a patient will fare is inexact and subject to biases. In one very small study of triage, experienced rescuers were asked to categorize the same patients and came up with widely different lists. Many patients who could have survived were mistakenly deemed unsalvageable by some rescuers. And patients’ conditions can change; more resources can become available to help those whose situations at first appear hopeless. The importance of reassessing each person is easy to forget once a ranking is assigned.

Designating a category of patients as beyond help creates the tragic possibility that a patient with a chance of survival will be miscategorized and left to die. To avoid this, some experts have concluded that patients seen to have little chance of survival must still be treated or evacuated—after those with severe injuries who need immediate attention to survive, but before those with significant injuries who can wait.

Pou and her colleagues had little if any training in triage systems and were not guided by any particular protocol. Pou viewed the sorting system they developed as heart-wrenching. To her, changing the evacuation order from sickest first to sickest last resulted from a sense among the doctors that they would not be able to save everyone.

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