Thammasat hospital introduces ‘Withhold Intubation’ rule in severe aging COVID-19 cases
Due to the severe shortage of life-saving medical equipment, such as ventilators, the management of Thammasat University hospital has decided to apply a “Withhold Intubation Rule” for severe COVID-19 patients who are over 75 years old and who are also suffering from AIDS or incurable cancer or are at the end of life or in the last stage of clinical frailty state (increased vulnerability to poor resolution of homoeostasis after a stressor event, which increases the risk of adverse outcome).
The hospital’s management said in a statement yesterday that, due to the shortage of medical personnel and medical equipment in the wake of overcrowding in the hospital, doctors responsible for providing treatment will not put some severe cases of COVID-19 on ventilators, but will focus on palliative care under two conditions.
Firstly, in the case of patients who have drawn up a living will, verbally or in writing, or when there is a surrogate decision by family members that the patients do not want to be put on a ventilator. In case of the absence of advance instruction or a living will from the patients, the family members or close relatives will consult with medical experts over whether to use a ventilator or not.
Secondly, if the patients do not give any advance instruction or have not made a living will, the doctors in charge of their treatment will make the decision to use or not to use a ventilator, based on two conditions. The patients must be over 75 years old and suffer from either AIDS or an incurable cancer which has metastasised and the patient is at the end of life or is classified as being on the 6th level of the Clinical Frailty Scale (CFS).
The Thammasat field hospital, meanwhile, said that it is now accommodating 392 patients, including 50 children. The numbers do not include those being medically investigated in isolation.
The hospital said that it is trying its best to look after some 300 patients in home isolation, hoping that this approach will reduce the number of patients being admitted to general or field hospitals, which are now overwhelmed.
Besides COVID-19 patients, the hospital said that it still obliged to take care of non-COVID cases.