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Table 1 The significant increase, and expected continued increase, in mechanically ventilated patients in medical departments. Policy recommendations

From: Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise?

No. Policy consideration Current situation Aim
1 An augmented care unit should be present in all departments of medicine. 90% of hospitals report presence, not necessary in all departments “(https://www.ima.org.il/mainsite/ScientificCouncil.aspx)”. All medical departments.
2 Residents in internal medicine should have a 3-month mandatory rotation in the ICU, preferable in their first year. Minority, almost none in their first year. All residents, preferably as part of their medical (rather than elective) program.
3 Attending (senior) physicians should receive appropriate training in mechanical ventilation, vaso-pressor support, point-of-care US and central Probably none. National workshops, possibly with a medical simulations course + mandatory US course.
4 Advance directives regarding end-of-life care, intubation and resuscitation, to be deposited in an accessible central data bank. Very, very few. Either by amendment of the law or as Ministry of Health directive: family physicians should be required to discuss and fill relevant forms for elderly and/or chronically ill patients.
5 Terminal extubation None For selected cases, setting an appropriate mechanism.
6 Co-payment by families demanding “every possible treatment” contrary to medical advice. So far families have the prerogative to demand tremendously costly medical care – even if medical advice is otherwise. Co-payment should be a policy consideration if families demand mechanical ventilation in spite of medical advice.