Doctors could be forced to decide who to save in flu pandemic

Experts say it’s not a case of if but when a flu pandemic hits Queensland, and when hospitals reach capacity, clinicians could be faced with horrifying life or death decisions.

QUEENSLAND is grossly under prepared for the inevitable flu pandemic and when hospitals reach capacity clinicians could faced the horrifying decision of who is more deserving of lifesaving ventilation or an intensive care bed.

These are the shocking concerns of leading Queensland palliative care specialist Dr Will Cairns who says that the Queensland Health Pandemic Influenza Plan May 2018 does not address how the state would deal with clinical demands exceeding capacity.

“But not to bag just Queensland, all the other states do not have an outlined plan of action that clinicians should follow during such a crisis,” Dr Cairns said last night.

“This needs to be discussed across the country.”

A flu pandemic is inevitable in Queensland, experts say.

Dr Cairns is Clinical Lead for Queensland’s Statewide Strategy for care at the end of life, and was Director of the Townsville Palliative Care Service since 1992.

He is on the verge of retirement from medicine and has outlined his fears in the latest Medical Journal of Australia.

“It is clear that, given the average length of stay in the ICU and the inevitable absenteeism of skilled staff due to illness, the sheer volume of demand would rapidly overwhelm our capacity to provide 21st century, highly intensive treatment to match the needs and expectations of all patients,” he wrote.

The flu has claimed 83 lives so far this year in Queensland and is shaping up to be the worst season on record.

Professor Robert Booy, Head of the Clinical Research team at the National Centre for Immunisation Research and Surveillance (NCIRS), told The Courier-Mail that a flu pandemic was likely but we were prepared for it.

“It’s not a matter of “if” but “when”. We can’t say exactly when but we have been preparing for it since before the 2009 (swine flu) pandemic and I believe we have never been better prepared even if it is not perfect,” Prof Booy said.

An electron microscope image of the influenza virus. Picture: Getty

But Dr Cairns says “we got lucky in 2009” and if a pandemic with a similar impact to the 1918 Spanish flu hit Australia today, about 8 million would develop influenza and about 2.5 per cent – or 200,000 people – would die.

“If there are more sick people than we can possibly treat, how should we decide who to treat?” the palliative care expert wrote. “How should our community be prepared for the realities of a pandemic and how might we reach consensus in prospectively deciding appropriate responses? “What ethical framework would guide decision making and would the law protect clinicians and others who are forced to make choices between patients?”

He added: “Clearly, senior ICU consultants have already been thinking about what they will have to do, however, there is little evidence that planners have moved beyond organisational matters.”

“My review of the large number of Australian documents that emerge on a routine internet search for pandemic disaster planning in Australia did not find anything that addressed the practical problems of resource allocation – if such documents exist, they should be highly visible. In fact, I found more discussion of how to deal with a surfeit of dead bodies than guidance for the ethical clinical care of those still alive,” Dr Cairns wrote.

Dr Cairns believes a big part of the crisis response is a well-supported frontline palliative care service.

“Our community also needs to know before the event that, in times of calamity such as an influenza pandemic, we will still care for them, even when we cannot provide the treatment they have been encouraged to expect,” he wrote.