A 2007 report from the North Carolina Institute of Medicine estimated that a severe influenza pandemic in North Carolina might result in as many as 290,000 hospital visits in eight weeks.

Many resources (physicians, nurses, pain medications, ventilators) would be scarce -- so scarce that it may not be possible to provide all of the essential services that an individual patient would receive under normal circumstances. Such an event would precipitate some tough decisions, so many states, including North Carolina, have begun drafting plans to guide those choices.

The North Carolina Medical Society has crafted a plan that is now under consideration in the North Carolina governor’s office, says Philip M. Rosoff, MD, MA, who helped draft the plan. The details of this and other plans are still apt to change, and at some point are likely to come up for public debate. Here are some examples of issues these plans address:

• Many plans encourage physicians to help care for patients even if that means operating outside their areas of expertise. Most plans include language similar to many states’ “Good Samaritan” laws, which protect such practitioners from legal prosecution or lawsuits as a result of their actions, providing they are acting in good faith.
• When lifesaving resources such as ventilators are in short supply, health care workers would need a system to guide them in allocating those resources. That system would need to assess how likely the patient is to survive if he receives the resource.
  
  That assessment may be similar to the Sequential Organ Failure Assessment (SOFA) score, which measures the extent to which six different organ systems are functioning. It would also take into account patient age, but being older would not necessarily make the patient less likely to receive the resource.

• Some preexisting conditions may make people ineligible for lifesaving interventions when resources are very scarce. These conditions may include chronic renal failure, terminal cancer with less than a year of life left, severe chronic pulmonary disease, or severe chronic heart failure.
• To be cost-efficient, most hospitals stock no more than a three-day supply of medications and other items. But caring for patients with severe illness who are determined ineligible for lifesaving care might require a larger supply of palliative care items, such as pain medications and the equipment needed to administer them.