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Spring 2002
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Allocation
of Resources
Two
Cardiac Arrests, One Medical Team
George Burnham and Donald Mattison were patients in adjoining rooms in
the rehabilitation division of a state medical center. George was a
33-year-old, severely retarded man who had lived in state institutions
since the age of three. His family had had no contact with him for over
twenty years. George had been trained to feed himself and to keep
himself reasonably clean, but at the age of 25 he had suffered a cardiac
arrest that left him with some paralysis. After rehabilitation he only
occasionally lacked bowel control. A second recent cardiac arrest left
him semi-paralyzed and totally incontinent. The chances of his regaining
even his former level of continence, the staff felt, were hopeless.
Donald Mattison, a 48-year-old businessman, active in community and
church affairs, married, and the father of four, had suffered a minor
stroke, which left him slightly paralyzed. In his six weeks on the
rehabilitation ward he had regained almost total use of his arm and leg.
His prognosis for full recovery seemed excellent.
The hospital has at least one cardiac-arrest team on duty twenty-four
hours a day, and one crash cart in every patient area at all times. The
possibility of simultaneous cardiac arrests seemed remote. If it were to
happen, there would not be time to transfer an additional crash care
from another patient area, since the rehabilitation ward is served by an
extremely slow elevator.
But in this case the improbably happened. George had a cardiac arrest at
3:00 one morning. Within four minutes the cardiac team had arrived in
his room and was ready to begin work. At that very moment Donald also
had a cardiac arrest. Knowing of the simultaneous cardiac arrests, every
team member hesitated. Two also knew both patients’ histories; he
others, including the tam leader, did not. After a moment, the team
leader said, “First come, first served. Let’s go to work.” With no
further hesitation, the team began to resuscitate George.
Without emergency aid, Donald died. George was resuscitated, but
suffered yet another cardiac arrest at 8:20 the next morning. This time
another team was unable to revive him, and he too died.
Did the team leader make the
right decision in resuscitating George instead of Donald?
- Is “first come, first served” the
proper principle to apply in such cases?
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Course
Overview