Our COVID Response I Cover Story
A Plan for the Unthinkable: Writing the Rules for Ventilator Rationing By Sally Parker
As a palliative care doctor, Chin-Lin Ching (BA '01, MD '05, Res '08) is no stranger to agonizing life-and-death decisions. She helps families make them every day at Highland Hospital.
But when the pandemic hit, she felt as if she were living in a dystopian novel. Like most of her colleagues in the University of Rochester’s Coronavirus Ethics Response Group (CERG), she saw that COVID-19 was unlike anything she had ever encountered. Her job was to come up with a protocol for allocating ventilators in case of a shortage. It meant considering the unthinkable: “Who would get a ventilator, and who would we remove?” CERG decided right away that any plans around patient care would have to ensure nonbiased access. In a stand unique among its peers around the country, the team insisted community voices have a seat at the table from the start. As the coronavirus approached, overwhelming medical teams first in China, then Italy and New York City, “it felt probably as close to war as any of us would ever know,” Ching recalls. “In the spring, I would hear the phrase ‘We’re flying the plane as we’re building it.’ Not only that, we didn’t have instructions, and the plane was nosediving into the side of the mountain.” 4
ROCHESTER MEDICINE
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2021 SPECIAL EDITION
In March 2020, with COVID-19 cases multiplying across the state, University of Rochester Medical Center and its affiliate hospitals quickly formed CERG to develop a triage protocol for allocating mechanical ventilators to patients in respiratory failure, and to do it in a fair and equitable way. CERG’s goal from the start was to save the most lives and to protect bedside clinicians from making public health decisions. Physicians knew what their colleagues around the world were going through: With not enough ventilators for patients who needed them—and no protocol to support them—overwhelmed frontline providers were forced to choose who would get one and who wouldn’t. In the run-up to the virus’s arrival in the Rochester area, providers had a small window in which to prepare to do things differently. “My feeling all along was we had to come up with a system that wasn’t going to be random,” says David Kaufman, MD (Flw ’93), director of adult critical care at Strong Memorial Hospital and a CERG member. “I wanted a system to be in place that would not require a clinician to say, ‘I’m looking at this person right now, and I can tell they’re not going to do well, so I’m not going to put them on a ventilator and I’m going to give it to someone else.’ We wanted a system that would allow for fairness and for equity.”
