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Coronavirus Crisis: Rationing Ventilators In Nightmare Scenario

BOSTON (CBS) - A group of Brigham and Women's Hospital clinicians sit in a circle and discuss a nightmare scenario: what if the hospital has one available ventilator and multiple patients struggling to breathe on their own.

Right now, that is a hypothetical scenario in Massachusetts. The Brigham's Chief Medical Officer, Dr. Sunil "Sunny" Eappen says it is better to plan for the worst.

"Our modeling says that we will not run out of ICU beds and ventilators," Eappen said. "You don't want to be preparing for it when you're in the middle of that crisis."

That is why the Brigham is training staff on how to ration ventilators by boiling a patient's likelihood of survival down to a number between 1 and 4, with a lower score meaning the more likely the patient's chance of short term and long term survival. In this hypothetical scenario, patients with lower scores would be given priority for ventilators.

The criteria follow triage guidelines released by the state in the event hospitals are stripped of resources.

First, clinicians would look at a patient's SOFA score, a mortality prediction based on the dysfunction of organ systems.

"Sort of an acute indicator of how your labs are right now," Eappen said.

Then, any comorbidities are considered and points are assigned based on those.

Eappen says pregnant women are given some priority if the fetus is past the point of viability, roughly 24 weeks. Age can also be used as a tie-breaker with younger people receiving access to a ventilator first.

A triage officer, separate from the clinical team caring for patients, assigns the final score.

"Things like race, ethnicity, handicap status, is not a player in this. It doesn't make a difference what you come in with," Eappen said.

Eappen says the practice is not perfect but it is thoughtful.

"We want to avoid it but I think they're ready if we needed to do it," Eappen said.

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