There remains an absence of a US national policy as the COVID-19 death rates mirror Spain and Italy. and the rate of infection is as fast in Louisiana as New York.


In the coming weeks, difficult decisions about who will live and who will die in Alabama may hinge on a little-discussed document outlining the state’s suggested “criteria for mechanical ventilator triage” during pandemics like the current COVID-19 outbreak.

According to the state document, any of a wide range of underlying health conditions – such as metastasized cancer, AIDS, “severe mental retardation,” advanced dementia and “severe burns” – could disqualify patients from being put on potentially lifesaving ventilators if a pandemic grows dire enough. And some people already on ventilators could be removed from them to make space for people impacted by the pandemic, according to the guidance.

Over the past two weeks, doctors in Italy have called on the world to take the disease more seriously, sharing horror stories about having to choose which people to put on ventilators. They have had to make those dire decisions based on patients’ age, underlying health problems and other considerations.

Under the triage criteria, which the Alabama Department of Public Health initially drafted in 2009, many patients could be denied access to ventilators and instead relegated to in-patient or home palliative care.

In April 2010, the State Committee of Public Health approved a revised version of the protocol detailing the exact processes hospitals and health care facilities should follow when making such decisions during a deadly flu outbreak or other major pandemic.

“ADPH suggests that hospitals utilize this criteria as a template for local and regional disaster management plans,” according to a 2009 ADPH study on the ethics of disaster response that analyzed the draft version of the protocol.

Dubbed “Criteria for Mechanical Ventilator Triage Following Proclamation of Mass-Casualty Respiratory Emergency,” the document is based on a three-tier triage criteria model designed by two Minnesota emergency doctors in 2008, according to the 2009 study.

The Alabama plan, which is still posted on the ADPH’s website, was developed as part of a years-long effort to prepare for potential pandemics and institute protocols for such events.


— Lawrence O'Donnell (@Lawrence) March 24, 2020


— Nate Murray (@eigenjoy) March 16, 2020


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