According to the modifications, a team must evaluate the prioritization of patients and decide to whom the resources are given.
Patients who are more likely to survive with the help of critical medicine will have priority to receive ventilators and other supplies, whether or not they have COVID-19, according to the Bioethical Guide for the Allocation of Limited Resources for Critical Medicine in Emergency Situations.
The General Health Council made changes to the guide due to the controversy that originated an earlier version that prioritized the principle of “lives to be completed”, that is, that of the youngest over that of the elderly. Now the allocation of resources will be determined by a triage team, which will calculate the score of each patient considering their current infection situation, their past situation (pre-existing comorbidities) and the expectation of survival to treatment.
The objective of the guide is to protect the health of the population, that is, to save the greatest number of lives, which is why those who are more likely to survive with the help of critical medicine are prioritized over patients who are less likely.
The document indicates that saving the greatest number of lives requires evaluating the probability that a patient improves and survives and the time that said the patient would use the scarce resources that can be reused, which implies that sometimes it is necessary to select among patients with similar characteristics and Medical prognosis.
The principles of social justice –in which all people have the same value and the same rights–, human dignity, solidarity and equity should guide the Bioethics Guide and be decisive at the time of assignment.
Who Will Have Priority To Receive Resources?
The prioritization mechanism includes both the initial allocation of resources and the reallocation of resources that are already being used and must be applied to both COVID19 patients and patients who require critical care for other conditions.
Having COVID-19 does not make a patient a higher priority in accessing scarce critical medicine resources. “
The process is done in two steps; first, the initial prioritization score of each patient is calculated, according to a scale that indicates the probability of survival for both patients with COVID-19 and for patients without COVID-19, as soon as “ make clinically clear ”that a patient needs critical medicine, it should start as soon as possible.
However, the score of patients who are using the resources should be re-evaluated periodically, to assess whether it is appropriate to change the status.
This evaluation will only be carried out in patients who have already been stabilized and, if possible, they will be provided with temporary mechanical ventilation, in which the prioritization score is calculated, which should be informed to the relatives.
As a special case, it is established that priority of access to the scarce resources of critical medicine should be given to health personnel who combat the emergency of COVID-19, this means that health personnel who face the pandemic must pass at the top of the list for scarce critical medicine resources when required.
The only exception to this assignment is when the health personnel present such comorbidities, or their prognosis is such that it would be futile for them to access these resources.
What Should Not Be Considered For The Allocation Of Resources?
Political affiliation, religion, head of household, perceived social value, nationality or immigration status, age, gender, ethnic origin, orientation, sexuality, gender identity, disabilities, and legal or socioeconomic status.
Nor should the first-come-first-serve principle be considered during a health emergency, since it unfairly benefits people who live in urban populations and near hospital units, compared to those patients who are foreigners.