Prioritizing
 

I had a class in Toxicology today. The treatment for one particular poisoning (a common agent used in chemical warfare) is heroic doses of Atropine. The professor mentioned that if this agent was used in a major city, there would only be enough Atropine to treat about 10 patients.

That got me thinking. If I was ever a physician with 1000 poisoned patients in my care, how could I make the decision on who gets the life-saving treatment and -- more importantly -- who doesn't? Is first-come first-served the most fair method? Do I treat the oldest, the youngest, the most productive to society? What if the president ordered me to give preferential treatment to his son? What if the president was intoxicated, do I give him/her the treatment, no matter what protocol I was working under? Does he deserve it more than the 50 year old providing for 2 kids in college, a wife, and a mortgage?

I honestly don't know what I would do in that situation. Typically, I make fast decisions on my feet, and that's why people usually stick me into leadership roles. I do like to go into situations prepared however, so I believe this is worth thinking about. Any thoughts on the subject?

Let them all die. That's fair. Then make sweet love to a hot nurse.

There's no right way to do it. Whatever you do, do so decisively.

How can you determine who is more important to save. God, what a disgusting thought, isn't it. ;_;

I think maybe I'd start with saving the kids - if there were any involved. From there, I would save their respective mothers or fathers - but only one parent per child to survive.

I am sure that would satiate some, but hardly the majority.

Well, with this kind of knowledge, you would think that others might be thinking about this too? It's pretty crazy to picture a situation where remedies for a fatal intoxication are few. It gets me to thinking that there are likely other situations where solutions aren't plentiful. I guess it has to do with the likelihood of a situation like this happening where the need for more doses would be available.

If not treated, how long does one have to live before absolutely needing to be treated with Atropine?

Hmmm, I would say women and children first. Mainly because they are the future. The younger before the older as well.

I agree that it would be difficult to make decisions like that, but you have to have some common sense. Its one of those things they try to portray in Hollywood extreme case films.

The most fatal problem is respiratory with bronchial spasms and hypersecretion... think the worst asthmatic attack ever.

With ventillation, possibly an hour? I'm not sure.

Geez, that's pretty intense. I'll be sure to keep a ready supply of Atropine on-hand then :)

Was there any reason given for why this is? Is Atropine difficult to produce in large quantities or is it just not often needed and thus not kept in large supply? I would think that the scenario of a chemical weapon attack with this agent would prompt some kind of emergency supply of Atropine or something...

One would think so, but it almost seems like this is some sort of situation where unless the threat is actually realistically a problem, then it's not really going to be addressed.

Good point. I said in the original post that "Heroic doses of Atropine" would be required. That's because, say you needed a dose of atropine, you would be given 1-2 miligrams. 10 miligrams would be enough to put you into a coma.

For people with organophosphate poisoning, you might have to use 100-500 GRAMS, thousands of times more than a regular dose.

Hospitals would carry enough Atropine to cover any normal use for a long time, but the doses required to treat the intoxication are SO much larger you exhaust the supply extremely fast. I suppose you could use other anticholinergics that might be on hand.

exactly the point. make your own judgment about the situation and decide on your own, because if you didn't, mass hysteria would follow your influenced choices on the other side of that coin

I've read some figures that estimate death due to exposure to Sarin Gas even at low concentrations to follow within sixty seconds.

Administration of atropine would have to be almost immediate when exposed, which is why combat troops who face a risk of exposure carry atropine auto-injectors with them.

Its the kind of situation that simply demands action. An imminent decision is required, and whether it be a good one or a bad one, its better than the fallout of not deciding at all.