The sickest or the healthiest? The young? The elderly?
Deciding who should receive care when the supply of time, medicine and people is inadequate takes us straight to economics.
Journalist/physician Sheri Fink won a Pulitzer Prize for the NY Times article that led to Five Days at Memorial. At the top of my best books list, Five Days details the response to Katrina (August, 2005) by a medical staff that was isolated when flood waters rose. With hundred degree temperatures, toilets overflowing and no electricity, they were responsible for approximately 200 patients. As conditions worsened they had to decide who to help, who to abandon, and how to abandon an individual.
I recall the tragic dilemma of the medical personnel who were treating a partially paralyzed 380 pound gentleman. Too heavy to be carried to a safer area, he was floors away from other patients who needed the staff’s attention. And yet, how could they leave him alone with no food or water? Faced with these decisions, some of the hospital staff was accused of giving lethal doses of morphine to certain patients.
Defined as “sorting,” triage refers to how we allocate limited resources during an emergency. Its origin takes us back to a Napoleonic general who treated the sickest soldiers first.
Because we are still debating how to manage triage, a group in Maryland is developing a protocol. Rather than working in isolation though, they have set up a series of community forums. Their goal? To create recommendations for state guidelines.
One of their scenarios involved a flu pandemic. Imagine dealing with a shortage of ventilators. Deciding who gets to breathe, you have to select the recipients. Should you treat the sickest or those with the most years to live? Should you favor medical providers or lottery winners? Participants were told to ignore character but many refused to save a murderer.
Our Bottom Line: Triage Economics
At this point you may be thinking that triage dilemmas are about ethics and healthcare. But triage allocates limited resources. And allocating limited resources is what economics is all about.
My sources and more: So many stories relate to triage. They begin with the Napoleonic General who first said the wounded should be treated in order of need. They include the decisions made at Memorial Hospital during Katrina that were described in Sheri Fink’s book and her NY Times articles. However, if you just want one mesmerizing source, do listen to the Radio Lab podcast, “Playing God.”