Tag: Mr Dawson
Who gets the ventilator when there are limited numbers? Who takes priority when beds fill up?
- Doctors have asked Sydney Health Ethics, a centre at the University of Sydney, to construct guidelines on how to prioritise patients and resources
- The request comes amid concerns ICUs will be overwhelmed by COVID-19 patients
- The guidelines provided serve as a framework, not a set of rules
These are the difficult decisions doctors — particularly those in intensive care units (ICUs) — are expected to regularly face as the coronavirus pandemic worsens.
With the virus already putting pressure on Australia’s healthcare system, some medical professionals have turned to ethicists to help direct the process.
Sydney Health Ethics, located within the University of Sydney, was approached by an ICU doctor to come up with a series of ethics guidelines to help deal with the unprecedented crisis.
“We’re concerned about how the guidance in the future might be implemented,” centre director Angus Dawson told The Drum.
Mr Dawson said decision-making dramatically shifted when hospitals moved from normal practice to “pandemic practice”.
“Once we are in a pandemic situation and we are responding to a particular event and we have constraints placed upon the resources we have, then we have to do something different,” he said.
“Clinicians will always do what’s best for their patient, but if they’re all doing that, there’s no system for resource allocation in place.”
Former director of the intensive care unit at St George Hospital, George Skowronski, said the decisions doctors were likely to face due to the pandemic would be “way outside” what any of them would have experienced before.
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“We’ve never faced the kind of resource constraints that we potentially could face in this situation,” he told The Drum.
Dr Skowronski, a contributor to the guidelines, welcomed their release.
“The more we can prepare the better we will do the job,” he said.
He said medical professionals had been keeping an eye on what was happening internationally.
“What we’re doing at this stage is looking at the best evidence we can find from the experience overseas to try to be able to predict who is likely to benefit, who is likely to survive, who is likely to get the best long-term outcomes,” he said.
Researchers warn of difficult times ICUs face
The ethics request comes amid mounting pressure on ICUs due to the COVID-19 pandemic.
Earlier this month, The Grattan Institute’s Stephen Duckett warned ICUs could run out of ventilators and staff by April 11 if cases continued to double every three days.
“That’s what really, really concerns me — we almost have no time!” he told The Drum.
Mr Duckett compared potential case numbers of COVID-19 and the amount of ICU beds they would require to current availability of beds.
He also tested what would happen if resources were boosted.
“If we double the number of ICU beds, that buys us three or four days,” he said.
“If we halve the proportion of people going into an intensive care unit, that gains us three days.
“These add up, of course, but they still leave us in April.”
He said the information should have been a wake-up call for the Government to enforce a shutdown of all things that were not “truly essential”.
Government secures access to private equipment, staff
One third of Australia’s intensive-care capacity is in the private sector.
Today, the Federal Government struck a deal with the country’s 657 private hospitals to expand hospital bed numbers by 34,000 to tackle the pandemic.
The deal also opens up access to private hospital staffing and equipment, such as ventilators.
Your questions on coronavirus answered:
- What are the symptoms of COVID-19 and should I worry about my cough or sore throat?
- Who is eligible for free child care?
- Can I get unpaid pandemic leave or annual leave at half-pay if I am self-isolating?
Speaking to The Drum today, Mr Duckett said he was not sure there was a need to subsidise private hospitals.
“There are lots of other industries which would put their hand up and say we’d like to be subsidised for not doing anything,” he told The Drum.
“I’m not entirely sure this was a necessary step. It’s certainly not a well targeted step.”
How do we determine who gets what?
There were several different proposals put to the Sydney Health Ethics team about how to choose who gets priority in an ICU.
“It’s not saying ‘this is a list in a particular order’,” Mr Dawson said.
“It’s trying to say to people these are the kinds of things you’re going to have to think about and it’s good to think about them in advance.”
“What we are suggesting is that the number one issue ought to be trying to get the best possible value out of any resource that we have.
“That would be used to prioritise [patients].”
In cases of potential “tie-breakers”, Dr Skowronski said it would be reasonable to take social issues into account.
This would include prioritising First Nations communities due to existing healthcare disadvantages.
Mr Dawson said he hoped his team’s ethics guidelines would not even need to be used.
“This is all about prep for what needs to happen in the event of resources being truly constrained,” he said.
“If we’re lucky and we don’t have numbers turning up then they won’t come in to play, because the normal practice won’t have changed.”
What the experts are saying about coronavirus:
- Cruise ships have been directed to leave Australian waters but enforcing that will prove difficult
- April is a dangerous month for workers, with JobKeeper payments not arriving until May
Norfolk Island 2899
Maureen King has quite a collection of hearing devices bequeathed to her by Norfolk Islanders who died last year.
- Maureen King has been rejuvenating hearing aids for residents of Norfolk Island for 20 years
- Her work helps residents who are struggling financially and help them avoid a flight to the mainland
- When she gets a particularly dirty one, she ‘counts to 10 and thinks of England’
The tiny island, home to just over 2,000 residents, sits in the Pacific Ocean, 1,400 kilometres east of Byron Bay.
There are no audiologists based on the island, nor technicians to repair hearing devices — which is where Ms King comes in.
Ms King, 80, voluntarily repairs, restores, and recirculates hearing devices so her fellow islanders can: “hear their families tell them they love them”.
While the latest hearing technology enables users to control their devices from their smartphones, Ms King said with good care and know-how, it was possible to re-use basic devices over and over again.
“Many people who live on the island can’t afford new devices, or can’t make the necessary trip all the way to Australia, so I tell them I’ll make them one,” she said.
A ready ear for all
For more than two decades, Ms King’s unique skillset has touched hundreds in the tight-knit community.
Following the death of an islander with a hearing device, it has become tradition for loved ones to take it along to Ms King’s home.
There, they are cleaned and sent off to the next person in need.
“People knock on my door. We have a chat, a cup of tea, and we talk about their loss and they leave the hearing aids with me,” she said.
“For some, it’s too hard to talk about their grief so they just leave them quietly by my door.
“I don’t and won’t accept payment of any kind … it’s the Norfolk way to help your community.”
Filling a much-needed gap
Now retired, Ms King made her living in New Zealand as a teacher before moving to Norfolk Island to run a children’s clothing store.
Everything she learned about hearing aids came from a visiting specialist, Steve Dawson.
She formed a close bond with him through her association with the Norfolk Island Quota Club, an international organisation helping the deaf and hard of hearing.
For two decades Mr Dawson travelled from his audiology practice in Ballina on the New South Wales north coast to visit patients on Norfolk.
But last June, he became unable to travel due to illness and as a result, Ms King’s skills became more vital than ever.
When they first met, he helped Ms King set up her workshop with all the essentials, including a wide range of batteries and tools.
“He also gave me a sterilising machine which I use extensively, and of course I rely heavily on cleaning cloths and gel sterilisers,” she said.
Surprisingly, she said, the work was not too complex.
“I don’t have to fiddle too much with wiring because it’s usually encased in plastic [and] anything that is just too hard, I send back to Mr Dawson in Ballina,” she said.
While the thought of sticky, yellow earwax might irk many, Ms King said she did not mind.
“If I’m dealing with a dirty one I count to 10 and think of England,” she said.
“I wash my hands religiously and I’m very careful not to upset anyone about it.”
She estimated some of the hearing aids still in circulation on the island were more that 20 years old.
‘That’s Norfolk Island’
Ms King said patients arrived at her house at all hours of the day or night.
“No matter what time of day, even on Christmas eve, I can have visits,” she said.
“If anyone presents to the hospital and pharmacy with problems, even tourists, they’re all directed to me.
“While I can’t walk on water, I have a go.”
Ms King said her friends understood and admired her charity work.
“They know it’s just part and parcel of who I am and my service to the island,” she said.
And while she does not accept payment, she said it was nice to be thanked.
“One Christmas Day I found a bag by my door [and] in it was a wee piece of pumpkin, some potatoes, a wee cauliflower, and some beans,” she said.
“I knew who they were from; that’s Norfolk Island.”