Now that Arizona Is In Crisis Standards of Care (for the Most Critically Ill COVID Patients), How Will Doctors Allocate Treatment?

Now that each and every extracorporeal membrane oxygenation (ECMO) machine in Arizona is being used, we are essentially in Crisis Standards of Care, at least for the most critically ill COVID patients (ECMO machines are the last resort for COVID patients in severe respiratory failure).

“Crisis Standards of Care” is basically a protocol for making healthcare decisions when the system can’t provide all of the care that everybody needs because the needs outstrip the resources. It’s a protocol to help healthcare providers objectively decide who gets care when resources don’t allow everyone to get treatment.

Arizona has two documents that outline how doctors are supposed to make life and death decisions because there aren’t enough resources to treat all patients.

Arizona Crisis Standards of Care – Full Document

Arizona Crisis Standards of Care Addendum April 2021

The reports specify statewide triage protocols to use when demand outstrips supply. It has a section on “Stabilization of Patients Awaiting Triage” and “Triage Protocols for Scarce Resource Allocation”.  From a big picture point of view, all patients who can potentially benefit from therapies are offered treatment when resources are sufficient, but when resources aren’t (as is the case right now for patients in respiratory failure), patients get assessed to determine how best to allocate care. The documents outline objective triage protocols to make those decisions (called tertiary triage).

The Crisis Standards of Care protocol uses a stepwise scoring system process to determine how to prioritize patients. People with lower scores would be a higher priority for treatment because they’re more likely to survive.

Patients with lower scores would be given priority for care (see the reports for details). But sometimes, several people might have the same score (color coding).  If that happens, the protocol says that additional factors may be considered as priorities. Those priorities include:

1. Pediatric patients < 18 years of age;

2. First responders or front-line healthcare workers;

3. Single caretakers for minors or dependent adults;

4. Pregnant patients; and

5. Short-term survival to hospital discharge based on clinical judgement, provided this judgement is made
   without regard to basis of race, ethnicity, color, national origin, religion, sex, disability, veteran status,
   age, genetic information, sexual orientation, gender identity, perceived quality of life, resource intensity/duration, perceived social worth, or any other ethically irrelevant criteria.

This is our new reality folks, again. Sadly, it didn’t have to be this way if only Governor Ducey had used evidence-based policies to incentivize vaccination (e.g. vaccination mandates) and other tools like universal masking requirements in public indoor environments.