Managing Older Adults With Presumed COVID-19 in the Emergency Department

A Rational Approach to Rationing

Tony Rosen, MD MPH; Lauren E. Ferrante, MD MHS; Shan W. Liu, MD SD; Emily A. Benton, MD; Mary R. Mulcare, MD; Michael E. Stern, MD; Kevin Biese, MD; Ula Hwang, MD MPH; Martine Sanon, MD


J Am Geriatr Soc. 2020;68(8):1631-1635. 

In This Article

Strategies to Increase Ability to Provide Care to More Patients Should be Encouraged

Finally, several strategies have been implemented to avoid the need for rationing. These include increasing ventilator access by developing safe split-ventilation strategies and using anesthesia machines as ventilators. ICU capacity may be expanded by transforming operating rooms, Post-Anesthesia Care Units, and other spaces into ICU space, and setting up field hospitals. Health care providers may be recruited from other less-impacted regions. Furthermore, even proactive, upstream advanced care planning conversations may help avert the need for any rationing. We strongly endorse and encourage these efforts, as they are likely particularly to help older adults who may be among the first groups to suffer from rationing. As interdisciplinary health professionals, we wish to offer all of our patients, regardless of age, any and all treatments aligned with their goals of care, without ever having to make clinical decisions limited by resource scarcity.