{"id":3335,"date":"2018-10-19T15:51:30","date_gmt":"2018-10-19T15:51:30","guid":{"rendered":"http:\/\/tvndy.ca\/?p=3335"},"modified":"2018-10-22T23:19:52","modified_gmt":"2018-10-22T23:19:52","slug":"webcast-archive-discrimination-natural-disasters","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2018\/10\/webcast-archive-discrimination-natural-disasters\/","title":{"rendered":"Webcast archive: Discrimination &#038; natural disasters"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/4NjgVCWC0zc?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen><\/iframe><\/p>\n<p>In this episode of\u00a0<em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:<\/p>\n<ul>\n<li>Discrimination in hospitals after natural disasters<\/li>\n<\/ul>\n<p>Please note that this text is only a script and that our webcast contains additional commentary.<\/p>\n<p><strong>DISCRIMINATION IN HOSPITALS AFTER NATURAL DISASTERS<\/strong><\/p>\n<ul>\n<li>Two weeks ago, we discussed the effects of disability on\u00a0<a href=\"https:\/\/tvndy.ca\/en\/2018\/10\/webcast-archive-18-10-05\/\">planning for and recovering from natural disasters<\/a>. We briefly touched on the ways in which scarce rescue and health care resources are allocated in a major emergency.<\/li>\n<li>Hospitals already do this every day; emergency departments and Intensive care units routinely use triage systems (rather than by randomized methods like \u201cfirst come, first served\u201d or by lottery) to dictate who is treated first and who gets access to limited ICU beds and diagnostic imaging equipment.\u00a0 In normal conditions (when resources are plentiful and demand is within a normal range), the sicker you are, the sooner you will be treated. For example, someone with a broken bone will probably be seen before a person with a stuffy nose.<\/li>\n<\/ul>\n<ul>\n<li>Napoleon\u2019s battle surgeon\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Dominique_Jean_Larrey\">Baron Dominique Jean Larry<\/a>\u00a0was the first to use a system of triage and field ambulances.\u00a0 His plan was guided by the idea that \u201cThose who are dangerously wounded should receive the first attention, without regard to rank or distinction,\u201d in keeping with the French revolution\u2019s value of \u00e9galit\u00e9.<\/li>\n<li>But the goals in battlefield triage are not the same as in hospitals or disaster situations.\u00a0 In 1846, British naval surgeon John Wilson assigned a higher priority to people whose treatment was likely to be successful.\u00a0 His policy delayed treatment to people with less severe wounds,\u00a0<strong>and\u00a0<\/strong>those whose wounds are probably fatal.\u00a0 This trend continues to today.<\/li>\n<li>Triage has\u00a0<a href=\"https:\/\/www.researchgate.net\/publication\/6658138_Triage_in_Medicine_Part_I_Concept_History_and_Types\">three elements<\/a>:\n<ul>\n<li>A situation where there are\u00a0<strong>not enough resources<\/strong>\u00a0for the number of people who need them;<\/li>\n<li>Someone in authority\u00a0<strong>evaluates each person\u2019s needs<\/strong>, and assigns them a priority;<\/li>\n<li>Priorities are assigned\u00a0<strong>according to an established system<\/strong>\u00a0or plan.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>It\u2019s worth noting that the\u00a0<a href=\"https:\/\/www.academia.edu\/5185324\/Triage_in_Medicine_Part_II_Underlying_Values_and_Principles\">values<\/a>\u00a0that are supposed to guide triage systems may be more dangerous to disabled people than they appear:\n<ul>\n<li><strong>Preserve and protect endangered human life<\/strong>:\u00a0 Since disabled lives are often not considered fully human, this value may not be strictly applied to disabled people.<\/li>\n<li><strong>Preserve or restore function or health<\/strong>:\u00a0 Because disabled people cannot be \u201crestored\u201d to \u201cnormal\u201d health, this value also acts as a prejudice against us.<\/li>\n<li><strong>Efficient use of resources<\/strong>\u00a0to achieve the best overall outcome:\u00a0 Where the first two values don\u2019t strongly support the care of disabled people, use of resources to help them will not be considered \u201cefficient\u201d<\/li>\n<li><strong>Fairness:<\/strong>\n<ul>\n<li>Actions that conform to the\u00a0<strong>agreed-upon rules<\/strong>:\u00a0 The decision-maker\u2019s perception and prejudice will affect whether they apply the rules fairly.<\/li>\n<li>Actions that conform to\u00a0<strong>accepted standards or principles of justice<\/strong>:\u00a0 What is \u201caccepted\u201d in a society that views life with a disability as a fate worse than death?<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Most triage systems go something like this:\n<ul>\n<li>Priority 1 \u2013 people who need immediate treatment to save their lives (red tag);<\/li>\n<li>Priority 2 \u2013 People who need urgent, but not immediate, medical care (yellow tag);<\/li>\n<li>Priority 3 \u2013 People requiring only minor treatment (green tag);<\/li>\n<li>Priority 4 \u2013 People who are not physically injured but may be traumatized or disoriented (white tag);<\/li>\n<li>Priority 5 \u2013 People who are dead or so severely injured they are expected to die of their injuries in a matter of hours or days. (black tag).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>However, the\u00a0<a href=\"https:\/\/caep.ca\/wp-content\/uploads\/2017\/06\/module_1_slides_v2.5_2012.pdf\">Canadian Triage and Acuity Scale<\/a>\u00a0is more optimistic\n<ul>\n<li>Level 1 \u2013 Resuscitation (blue)<\/li>\n<li>Level 2 \u2013 Emergent (red)<\/li>\n<li>Level 3 \u2013 Urgent (yellow)<\/li>\n<li>Level 4 \u2013 Less urgent (green)<\/li>\n<li>Level 5 \u2013 Non-urgent (white)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>When we talked about disasters two weeks ago, we mentioned a book by Dr. Sheri Fink, called\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Five_Days_at_Memorial\">Five Days at Memorial<\/a>, about the events and decisions that led to an estimated 20 people being euthanized at a\u00a0<a href=\"https:\/\/www.propublica.org\/article\/the-deadly-choices-at-memorial-826\">New Orleans hospital after Hurricane Katrina<\/a>. The staff identified people with \u201cDo Not Resuscitate\u201d orders, those who couldn\u2019t walk or who were difficult to carry as the last to be evacuated, though most of them were not in danger of dying.\u00a0 As the stressful conditions continued into the third day, and the medical staff were being airlifted out, it became clear that this group of patients would not be evacuated.\u00a0 Rather than abandoning them, medical staff elected to administer high doses of morphine and sedatives to euthanize them.<\/li>\n<li>Where they exist, protocols for medical resource allocation are usually drawn up by government agencies, panels of \u201cexperts\u201d or hospital administrators and insurance actuaries.\u00a0 While some of these policies are flexible, others call for refusing care to older adults and those with medical conditions such as kidney failure or advanced cancer.\u00a0\u00a0<a href=\"http:\/\/www.cmaj.ca\/content\/175\/11\/1377.full\">Ontario developed a protocol<\/a>\u00a0in 2006 following the SARS (Severe Acute Respiratory Syndrome) outbreak to prepare for a large-scale epidemic.<\/li>\n<\/ul>\n<ul>\n<li>In 2016 Sheri Fink reported on\u00a0<a href=\"https:\/\/www.nytimes.com\/2016\/08\/22\/us\/whose-lives-should-be-saved-to-help-shape-policy-researchers-in-maryland-ask-the-public.html\">a series of public consultations<\/a>\u00a0held in the state of Maryland to create a policy for prioritizing healthcare in an emergency. The organizers found that a broader perspective raised some unexpected questions about discrimination and access to ventilators for people in a coma.<\/li>\n<li>These issues are not limited to developed or western countries.\u00a0 Following the\u00a0<a href=\"https:\/\/www.nytimes.com\/2016\/08\/22\/us\/whose-lives-should-be-saved-to-help-shape-policy-researchers-in-maryland-ask-the-public.html\">2011 earthquake and nuclear meltdown<\/a>\u00a0at the Fukushima facility, those whose evacuations from nearby hospitals were delayed ran a greater risk of radiation poisoning.\u00a0 And during the 2014\u00a0<a href=\"https:\/\/www.nytimes.com\/2014\/10\/28\/world\/africa\/wish-to-do-more-in-ebola-fight-meets-reality-in-liberia.html\">Ebola outbreaks in Africa<\/a>, health care workers could spend only a short time in biohazard suits that overheated quickly, thus limiting patient care and forcing agonizing choices.<\/li>\n<\/ul>\n<ul>\n<li>It\u2019s not just in triage and allocation policies that disability discrimination shows up.\u00a0 Under the Trump administration, the Federal Emergency Management Agency in the US has\u00a0<a href=\"https:\/\/www.pbs.org\/newshour\/nation\/as-disasters-strike-advocates-worry-fema-policy-changes-put-disability-community-at-risk\">reduced the number of accessibility coordinators<\/a>\u00a0available to deal with disability issues at disaster sites from 60 to five.<\/li>\n<li>Marcie Roth, of the\u00a0<strong><a href=\"http:\/\/www.disasterstrategies.org\/index.php\/about-pids\">Partnership for Inclusive Disaster Strategies<\/a><\/strong>, is a former FEMA employee.\u00a0 She anticipates a lot of confusion and unmet need following the cuts. Coordinators are now expected to supervise disaster areas\u00a0<strong>by phone<\/strong>, rather than in person.<\/li>\n<li>Some people at Memorial Hospital in New Orleans had family members with them to advocate on their behalf, to get water or medications, or to try to get DNRs removed.\u00a0 Even so, some of these family members, who would only leave the hospital with the assurance that their loved one would shortly be evacuated, later found out that their relative had been euthanized.\u00a0 Unfortunately, we have to be vigilant in demanding assistance to live, not to die.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nA webcast on: natural disasters, hospitals, and situations of discrimination. We look at Hurricane Katrina and the Ebola outbreaks, plus the history, rationale, and examples of triage systems.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2018\/10\/webcast-archive-discrimination-natural-disasters\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Discrimination &#038; natural disasters&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2018\/10\/webcast-archive-discrimination-natural-disasters\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Discrimination &#038; natural disasters&rdquo;<\/span>&hellip;<\/a><\/div>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[92],"tags":[34,121,157,158,155,156,118],"class_list":["post-3335","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-discrimination","tag-euthanasia-disability","tag-fema","tag-hurricane-katrina","tag-natural-disasters","tag-triage","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/3335","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/comments?post=3335"}],"version-history":[{"count":6,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/3335\/revisions"}],"predecessor-version":[{"id":3338,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/3335\/revisions\/3338"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=3335"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=3335"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=3335"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}