一份文件显示，阿拉巴马州的一项“紧急行动计划”可能会限制患有多种冠状病毒大流行的痴呆症和严重癌症等多种医疗条件的人使用呼吸机。
新闻周刊审查的文件概述了在“因果关系的呼吸紧急情况”（如持续的大流行）中的“机械呼吸机分类标准”。阿拉巴马州州长凯·艾维（Cay Ivey）于3月13日宣布继续传播COVID-19，这是该州的公共卫生紧急事件。
该文件包含医院和医疗设施的不同层次或操作，以供州长宣布发生公共卫生突发事件时遵循。根据这些等级，医院可以限制那些患有各种医疗状况的人使用机械呼吸机。根据AL.com的说法，该文档并不是为了应对当前的COVID-19大流行而创建，而是为了计划患者对呼吸机的需求可能使现有机器数量黯然失色的情况。该计划于2009年起草，修订版于2010年在全州生效。
该文件包含了仅限于使用机械呼吸机的大量医疗状况清单，并为医院提供了不同的图表，并逐步说明了哪些患者将获得呼吸机的指导。不能使用呼吸机的某些医疗状况包括心脏骤停，严重创伤，痴呆，转移性癌症，严重烧伤，艾滋病和“严重智力低下”。
该计划还包括第二层，与第一层不同，该第二层将由各个医院而不是由州实施。该方面表明，可以将一些已经使用机械呼吸机的患者从他们身上移走，以创造更多的资源供在使用期间使用健康危机。
在发送给《新闻周刊》的电子邮件中，阿拉巴马州公共卫生部（ADPH）解释说，该计划是由ADPH的领导制定的，“得到了众多医学，法律宗教，学术和道德专业人士的意见。”
电子邮件中写道：“附件无意代替临床判断。医疗决定仍由医疗专业人员（作为治疗提供者）与患者及其患者家属进行讨论。”
根据约翰·霍普金斯大学提供的追踪器，随着新型冠状病毒的继续传播，在美国感染了62,000例，在阿拉巴马州感染了至少283例，对机械呼吸机的需求在增加。
根据阿拉巴马州医院协会的数据，该州目前有1334台呼吸机，平均每天有546台在使用，而冠状病毒感染患者的呼吸机仅不到800台。
如果阿拉巴马州的医院发现冠状病毒病例大量涌入，并且对呼吸机的需求增加，则该州文件建议在“最后的措施”中，医院和医疗机构应“向具有最大生存机会的人提供积极治疗。如果这需要从其他人那里去除支持治疗。”
ALABAMA PLAN COULD RESTRICT VENTILATOR ACCESS FOR PEOPLE WITH ADVANCED DEMENTIA, SEVERE CANCER AND OTHER CONDITIONS
An "emergency operations plan" in Alabama could restrict ventilator access for people suffering from a number of different medical conditions, such as dementia and severe cancer, amid the global coronavirus pandemic, a document shows.
The document reviewed by Newsweek outlines "criteria for mechanical ventilator triage," in the event of a "mass-causality respiratory emergency," like the ongoing pandemic. Alabama Governor Kay Ivey declared the continued spread of COVID-19 a state public health emergency on March 13.
The document contains different tiers or operations for hospitals and medical facilities to follow in the event that the state's governor declares a public health emergency. According to the tiers, hospitals could restrict mechanical ventilator access for those suffering from a wide range of medical conditions. The document was not created as a response to the current COVID-19 pandemic, according to AL.com, but rather to plan for a situation where patient demand for ventilators could eclipse the number of machines available. The plan was drafted in 2009, and a revised version was put into effect across the state in 2010.
The document includes an extensive list of medical conditions that would be restricted to mechanical ventilator access, as well as providing different charts with step by step instructions for hospitals that determine which patients will be given the ventilators. Some of the medical conditions that would be excluded from ventilator use include cardiac arrest, severe trauma, dementia, metastasized cancer, severe burns, AIDS and "severe mental retardation."
The plan also includes a second tier, which would be implemented by individual hospitals and not by the state, unlike tier 1. This aspect suggests that some patients who are already on mechanical ventilators could be removed from them to create more resources to be used during a health crisis.
In an email sent to Newsweek, the Alabama Department of Public Health (ADPH) explained that the plan was developed by the leadership of the ADPH, "with input from multiple medical, legal religious, academic and ethics professionals."
"The Annex is not intended to be a replacement for clinical judgement. Decision for care remain those of the medical professional, as the treating provider, in discussion with the patient and the patient's family," the email read.
As the novel coronavirus continues to spread, infecting over 62,000 in the U.S. and at least 283 in Alabama, according to a tracker provided by Johns Hopkins University, the need for mechanical ventilators increases.
According to the Alabama Hospital Association, the state currently has 1,334 ventilators, and on average, about 546 of them are in use on any given day, leaving slightly less than 800 ventilators for patients infected with the coronavirus.
If Alabama hospitals see an influx in coronavirus cases and an increased need for ventilators, the state document recommends that in "measures of last resort" hospitals and medical facilities "should then be directed to provide aggressive treatment to those with the greatest chance of survival even if that requires removal of supportive care from others."
