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    1. Dr. Evans learned something the doctors at Memorial did not learn in making life-and-death choices between patients and protocol for rationing ventilators. The guidelines are devised by experts in disaster medicine, bioethics, and public policy. Also setting out guidelines in advance of a crisis, was a way to avoid putting exhausted, stressed frontline health professionals in the position of having to come up with criteria for making tough decisions during a crisis, as the ragged staff at Memorial Medical Center must do after Hurricane Katrina.

    The questions that remain are: How to decide? How would New York hospitals handle the massive demand for life support equipment? What on earth are we going to do?

    2. The changes that take place in disaster planning post-Hurricane Katrina was that this nonprofit parent company had a highly organized local command center and was offering proactive and robust assistance not only to its own hospitals but also others in the region, it was much different from the support that Tenet and Lifecare headquarters provided to their hospital at the time of Katrina.

    What remained unaddressed was just as in the lead-up to Katrina, some staff members said they had never pondered or planned for what they would do in case of a failure of the backup plan to the backup plan-a complete loss of power, slower-burning problems of medicine and beyond our vulnerabilities, our trouble grappling with uncertainty, how we die, how we prioritize and divide what is most precious and vital and limited.

    The reason is the federal, state, and local health departments in the United state had failed to prepare proper planning for unforeseen disasters.

    This story impacts my feeling about AMA, that they don’t have a standard or policy for medical associates on how to deal with situations in times of disaster.

    3. Maryland’s strengths approach to disaster planning was that Maryland was the first state to tackle the problem by developing a framework for making decisions in disaster planning, It’s about those who might have the greatest chance of surviving their immediate illness because saving them would be a more efficient means of doing goods and drawing on the principle that everyone deserves equal rights to live through all of the stages of life.
    Their weakness was that they thought about using age as the primary basis for allocating resources in a disaster when young lives are saved and the senior citizens were cut in half that would alter the society and many participants thought it was unacceptable for medical professionals to withdraw life-sustaining care, as called for in many of the pandemic triage plans, in part because doing so would erode trust in the medical system, others did not like the idea but were willing to accept it in certain circumstances.
    Fink means in a disaster, triage is about deciding what the goals of dividing resources should be for the larger population whether maximizing the number of lives saved, years of lives saved, quality of life, fairness, social trust, or other factors. The larger community may emerge with ideas different from those held by small groups of medical professionals.
    4. This story impacted my feeling positively about the AMA, considering whether and how normal medical standards should be altered in disasters, and planned to vote on a proposed campaign for state laws that would make doctors automatically immune from liability in disaster unless they acted maliciously.
    5. Yes, I agree with the statement, democracy is the power of the people and a way of governing which depends on the will of the people, we must value them and make good use of the people. As he said, we don’t make good efforts to access public wisdom on public policy choices.
    6. I described this story as an eyes opener that educates and prepares me for making the right decisions in such situations.
    Firstly, I would say the public should be involved in the development of guidelines for dividing medical resources in disaster and patients need to be treated fairly in all situations.
    Secondly, I should decide in a way that is transparent, consistent, proportional, and accountable.

    The wisdom the story offers is that our goal is always to provide the highest standard of care under the circumstances and the idea to plan before a disaster.

    I will make use of the lessons I learned from the beginning to the end of the story.

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