Moral injury. A
1/I was present with my nursing colleagues @MGHBirth today for an in service about the ESOC which stands for the Emergency Standard of Care. This is the framework used to triage critical care. This means you come to hospital for any reason (car crash, anything

2/&need life sustaining care but there aren't enough resources. So the MD in charge of you will assess your chances of survival were you to receive the care. Then a second MD ("triage doctor") makes the same assessment. There are 3 levels of thus type of triage.

3/If resources are only kind of scarce, then life sustaining care might only be withheld from people with an 80% chance of dying even with all resuscitative/sustaining care. Basically, we do everything but you would really probably die anyway.

4/If we reached level 2 triage then people who would have a 50% chance of dying even if all the care might not receive full intervention. At level 3, someone who has a 30% chance of dying would lose out on a full code and sustaining care.

5/In level 3 triage, it means that under normal circumstances, we would try to save you and 70% chance our efforts would be successful. But if we reached that situation, which we are facing now in Ontario, that person might not be able to receive the care they need.

6/To repeat, this is not just for covid pts. If we reach this, it would be province wide & for everyone. So...you crash your car, you discover you have a bad shellfish allergy, you fall off your bike, anything that lands you in the ER...

7/& under ESOC your medical team might not be allowed to try to save you. To be clear, we aren't there yet. Hospital staff have been & continue to be creative& self sacrificing to increase our ICU capacity province wide.

8/But the fact that our bioethicists are taking the time to come & train us in specialties not even focused on critical care (read: labour and birth) should make you very very worried. It means we are being forced to consider planning for this

9/Leadership & administrative staff have considered these plans before during this pandemic. But I'm pretty sure that this is the 1st time frontline nursing/midwifery/social work have received this information in the form of training

10/And I want to tell @fordnation &@celliottability & @Sflecce that even being asked to prepare for ESOC constitutes a moral injury. I came home from the hospital & cried.& I bet Doug doesn't even know what ESOC is. His negligence should be considered criminal by every Ontarian

11/it didn't have to be this way. Lack of leadership is fully responsible for deaths of our citizens & moral injuries to our healthcare providers. Don't let them blame it on anything else. /fin.

12/I forgot. What happens if we have gone through this triaging process province wide and there are still more people who with < 30% mortality risk (meaning they qualify for full care)? We asked. The bioethicist didn't answer for a second. Then she said, "a lottery".