Flip of coin may decide if you'll get treatment for flu
Friday October 13, 2006
By Martin Johnston

A flip of the coin may decide who gets medicine, ventilators or hospital beds if a flu pandemic ever takes grip here.

In an article in the New Zealand Medical Journal today, Michael Ardagh, professor of emergency medicine at the Christchurch School of Medicine, proposes a string of criteria to prioritise scarce resources in a time of disaster - and that's where a flip of the coin comes in.

Professor Ardagh says when potential patients cannot be separated on a "first come, first served" basis then access may have to be determined by "a process of equal and unbiased chance, such as tossing a coin or use of a ballot".

The proposals are an attempt to offer "pragmatic guidance" to help health workers decide on how to deny some patients access to resources during a time of overwhelming demand.

Health authorities acknowledge the health system will not cope at the height of a severe influenza pandemic, which, if similar to the 1918 Spanish flu, could affect 40 per cent of the population, resulting in 33,000 deaths.

No one can predict when a pandemic may strike but international health authorities have been on heightened alert since the re-emergence of H5N1 bird flu in 2003.

It is feared the virus could mutate and, therefore, spread easily among humans - but has not done so yet.

The Government has stockpiled the anti-flu medicine, Tamiflu, in the hope it will be effective against any pandemic and has enough in hand to treat about 20 per cent of the population.

However, Professor Ardagh says seven criteria can be considered before a coin is tossed.

One and two is establish whether the drug or other resource is appropriate for the patient and that there is competition for it.

Three asks about alternative treatments and four if any patients can have treatment deferred without significant harm.

Five looks at expanding resources, perhaps by redeploying outpatients staff into acute care, and six considers if harm can be mitigated for those who might miss out.

Seven sifts through those left by comparing their ability to benefit or help others. Having dependents or being a health worker could confer a higher ranking.

Professor Ardagh urges public discussion about the criteria, saying "explicit communication" of them before they are required will ease their application during a pandemic.