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Stewardship of Health Care Resources: Allocating Mechanical Ventilators During Pandemic Influenza

  • Authors: Jeffrey T. Berger, MD; Michele Mathes, JD
  • CME Released: 2/28/2013; Reviewed and Renewed: 3/10/2017
  • Valid for credit through: 3/10/2018, 11:59 PM EST
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Target Audience and Goal Statement

This article is intended for primary care physicians, emergency medicine specialists, critical care specialists, and other physicians who will respond to a public health emergency.

The goal of this activity is to evaluate ethical and practical issues of stewardship of healthcare resources.

Upon completion of this activity, participants will be able to:

  1. Evaluate ethical issues associated with public health emergencies
  2. Analyze who should provide triage for limited life-saving health resources
  3. Distinguish criteria which might be ethically acceptable in providing triage for limited life-saving health resources


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Jeffrey T. Berger, MD

    American College of Physicians Ethics, Professionalism and Human Rights Committee; Associate Professor of Medicine, Stony Brook University School of Medicine, Stony Brook, New York; Director of Clinical Ethics; Chief, Section of Hospice and Palliative Medicine; Medical Director, Palliative Care Consultation Service, Winthrop University Hospital, Mineola, New York


    Disclosure: Jeffrey T. Berger, MD, has disclosed no relevant financial relationships.

  • Michele Mathes, JD

    Senior Associate, Center for Ethics and Professionalism, American College of Physicians, Philadelphia, Pennsylvania


    Disclosure: Michele Mathes, JD, has disclosed no relevant financial relationships.


  • Lois Snyder Sulmasy, JD

    Director, Center for Ethics and Professionalism, American College of Physicians, Philadelphia, Pennsylvania

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Associate Professor and Residency Director, Department of Family Medicine, University of California-Irvine, Irvine


    Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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    The cases and commentary were developed by the American College of Physicians.

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Stewardship of Health Care Resources: Allocating Mechanical Ventilators During Pandemic Influenza: Case History


Case History

Pandemic influenza has gripped large portions of the United States including the area served by Community Medical Center, a 150-bed semi-rural hospital. Dr. Giles is a pulmonary/critical care physician staffing Community's 8-bed intensive care unit (ICU) in which every bed is occupied by a patient receiving mechanical ventilation. New patients are arriving regularly at the emergency department (ED) in respiratory distress. The chief medical officer looks to Dr. Giles to triage patients and allocate ventilators to best serve the community.

As a pulmonary specialist, Dr. Giles has cared for a number of hospital employees and their family members as well as community members with whom she shares civic and other activities. Among the patients currently in the ICU whose condition is most dire is the grandmother of the hospital's Director of Social Work and a deacon in Dr. Giles's church. The ED calls to tell Dr. Giles that they have three patients in need of the ICU, including a 24-year-old asthmatic with influenza. How should Dr. Giles proceed?

Table of Contents

  1. Introduction
  2. Case History
  3. Commentary
  • Print