New York State health officials have released updated guidelines for allocating ventilators in the event of a flu pandemic, emphasizing that the machines -- a limited resource -- would be distributed to hospitals based on medical need.

The allocation guidelines are part of the state's comprehensive pandemic flu strategy, which was fine-tuned six years ago at the height of the H1N1 flu scare. The issue of ventilator distribution has long been one fraught with emotion because of public fears that severe rationing of the machines would leave some people untreated.

Pandemic influenza is the worst form of flu and is characterized by a strain that circumnavigates the globe, causing waves of sickness and death. In severe influenza, fluid-filled lungs require mechanical assistance.

Ventilators are complex medical devices that provide artificial respiration for patients with severe breathing impairment. The machines are expected to be in short supply should a pandemic strain sweep through New York. Because all influenza viruses attack the lungs, medical experts would expect an extraordinary number of stricken people to require ventilation.

"Pandemic influenza is a foreseeable threat, and New York has a responsibility to plan now," State Commissioner of Health Dr. Howard Zucker said in a statement Wednesday. "These guidelines provide an ethical, clinical, and legal framework to help health care providers and the general public make difficult decisions in the event of an influenza pandemic."

Flu pandemics were documented in 1918, 1957 and 1968. The 1918 flu, which occurred at the end of World War I, remains the most devastating on record. At least 50 million people died. Among Americans, more people died of the flu than were killed in the war.

The Centers for Disease Control and Prevention during the 2009 H1N1 flu outbreak estimated that nationwide, 740,000 ventilators would be needed should a flu strain rage indefinitely out of control. Officials did not provide an estimate of the number of ventilators in New York.

Zucker said the current guidelines provide directions for distributing ventilators and seek to save the most lives. However, the newly crafted protocols are nonbinding and designed with what state health authorities say is "sufficient flexibility."

The protocols are divided into adult guidelines, pediatric guidelines, neonatal guidelines and Legal Consideration when Implementing the Guidelines.

New York is the first state to develop clinical protocols to address the special needs of children and newborns, state health officials said. The adult clinical protocols were updated and revised from draft guidelines written in 2007. Key in all sections of the document is equity in distribution.

All patients in need are to be evaluated based on universally applied clinical criteria, highlighting survival potential. Patients most likely to survive would be given highest priority. The evaluation criteria should not include any of the following: race, ethnicity, sexual orientation, socio-economic status, advanced age, perceived quality of life, ability to pay, role in the community, or other subjective standards.

The guidelines were developed with advice from experts in medicine, ethics, law, and health policy. Nonexpert advice also played into drafting the guidelines, state health officials said.

"Extensive efforts were made to obtain public input during their development," said Susie Han, deputy director of New York State's Task Force on Life and the Law, who headed the panel that developed the protocols.

The task force worked with state health officials to craft the document. Han said the protocol guidelines "are a living document, intended to be updated and revised."Pandemic flu strains are unlike seasonal influenza, which generally starts in late fall and continues through early spring. Globe-circling pandemic strains can start at any time of year, experts say.

These highly lethal forms of flu arise from a novel flu strain that has undergone what scientists call antigenic shift, which means a sudden dramatic genetic change in a dominant circulating Type A flu strain.

Such lethal strains can occur when a flu virus that had been circulating in animal populations suddenly jumps to people and becomes easily transmissable from person to person.


http://www.newsday.com/long-island/state-updates-rules-on-ventilators-in-event-of-flu-pandemic-1.11167772