The Mexican authorities have issued guidelines for the criteria that health workers should apply when allocating equipment, as well as telling them how to proceed when equipment is scarce.
Due to the scarcity of medical equipment for attending to the health emergency caused by COVID-19 in Mexico, the authorities have issued guidelines that determine how staff should allocate available materials if several people need them at the same time.
According to the Bioethics Guide to Allocating Critical Care Resources issued recently by the General Health Council, the objective of public health practice is for the population’s health to be as good as possible according to the available resources, which is the criterion that should take precedence during a public health emergency.
“If two patients need mechanical ventilation and one of them would take twice as long to recover (two weeks instead of one week) due to a concurrent disorder, then the ventilator should be allocated to the patient who does not have the concurrent disorder and would take half the time to recover. This is the case because the scarce resource (i.e. the mechanical ventilator) could be used again sooner to save another life,” explains the document.
Patients with severe COVID-19 symptoms need to be put on a ventilator, which gets air into and out of the lungs and enables sick people to survive.
Several companies across the globe, as well as research groups, have concentrated their efforts on making ventilators, although there are still not enough available.
In the guide, the health authorities acknowledge that scarcity leads to dilemmas such as the allocation of a single available device to patients with similar medical conditions and ages, and establishes that the choice in this case should be random.
If there’s a young patient and an elderly patient, the governing principle should be: “saving the greatest number of lives to be completed,” it says. “A life to be completed should be understood as one that has not yet gone through the different states of human bio-psychological-social development (childhood, adolescence, adulthood, old age). It’s necessary to choose those at the earliest stages of lives to be completed.”
The federal Bioethics Guide to Allocating Critical Care Resources establishes that health workers who treat patients directly should not make triage decisions, as these specialists cannot determine which seriously ill person should be allocated the medical equipment available.
This measure avoids conflicts of interest when allocating resources, maintains procedural fairness, and avoids the moral distress of workers responsible for critically ill patients.
“The triage team don’t need to be present in the health service,” says the document, although it clarifies that decisions made should be communicated to admission staff, the attending physician, and patients and their relatives.
If the necessary resources are available, social service or palliative care staff should be present when patients or their relatives are informed that these seriously ill people will not be admitted to the intensive care unit or patients are informed that intensive care (such as a mechanical ventilator) will be removed. Affected parties can appeal, and the Triage Review Committee will make the final decision.
Request to the U.S.
On April 10, Mexican President Andrés Manual López Obrador asked his American counterpart Donald Trump to sell him medical equipment to attend to the health emergency.
“I told him we know they’re going through a difficult period, with a general lack of ventilators and monitors, but I also explained to him that they have more possibilities: they have more production plants, more technological development,” said the Mexican president.
Last week, a plane came to Mexico with face masks, gloves, and ventilators purchased from China: Further deliveries are expected.