Question

It is a busy night in the emergency room and the ICU is down to two open beds. At two in the morning, the ambulance pulls up to the emergency room door with three patients who had been involved in a shoot-out. Apparently, a sting operation had gone bad during a drug deal, and an undercover policeman and two drug dealers had been wounded. All three men appear to be in critical condition and need the services of the ICU (intensive care unit). How would you decide which of the men should receive the ICU beds? Given that the policeman was hurt in the line of duty, is this a time where social utility is an appropriate method for micro allocation of scarce resources?

Answer 1

Answer:

when allocating Intensive care unit (ICU) beds to patients during high demand, then the ICU beds should not give to patients who can get littile benefit from Intensive care treatment instead give ICU beds to critically ill patients.

The following conditions are considered when allocating ICU bed to these patients are:

-- Diagnosis of patients condition from gun shot,

--Severity of wound or any damage to organ during shoot out.

--Age of patients,

--Any coexisting disease of patient in past ,

--any recent cardiopulmonary arrest to in any patient,

-- Patient who can get benefit or those patients who cannot  recover to accept the  quality of life should not admitted first. Give the ICU beds to those patient who has hope to recovery.

-- actually, age is not consider for admission to ICU but in this case, doctors should note that increasing age is associate with more chance to coexisting diseases, and reduced phycological reserve in patients,

-- Diagonise the patient's health condition using Triage protocol and collect the patient medical information , any organ failure assessment on patient and determine critically ill patient and has chance to give ICU bed to critically ill patient.

--- diagonise any patient need advanced respiratory support or patient need in support of organ system then allocating ICU bed to them first.

--diagonise any patient has impairement of organs or require support for an acute reversible failure of another organ.

---should check any existing patients in the ICU who are out-of hours discharge , then they should discharge form ICU bed and can allocate this bed to patient in need.

-- Step down unit ( SDU) provides intermideate level of intensive care to patients in between Intensive care unit (ICU) and the general medical-surgical wards. if Intensive care unit beds are full, and no existing patients discharge from ICU then shift less critical patient to the step down unit with experienced nurses to provide quality of care.