Hospitals throughout Alabama would only supply ventilators to patients with the “best chance” of survival under a controversial state plan that lays out the worst-case scenario for a “mass-casualty respiratory emergency” like the coronavirus pandemic.

The 18-page plan, created in 2009, advises doctors on which patients should receive access to the state’s reported 1,344 ventilators during an event in which a sudden influx of critically ill patients causes a severe shortage of life-saving medical supplies.

Patients suffering from end stage organ failure due to a wide range of underlying health conditions, from “severe burns” to metastasised cancer and Aids, would not be offered ventilator support under the plan.

Experts have warned the state’s supply of ventilators may not be enough to handle a potential surge of Covid-19 patients in the coming weeks, as the number of total confirmed cases nationwide soared to nearly 75,000 on Thursday.

The plan, reviewed by The Independent, should be used by state hospitals during a mass casualty event “characterised by frequent, widespread cases of respiratory failure occurring in sufficient volume to quickly exhaust available mechanical ventilator resources”, according to its guidelines.

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Those guidelines specifically indicate that an example of a case in which the state plan should be used might include “a virulently aggressive form of pandemic influenza”.

Instead of receiving ventilator support, many patients under the plan would be moved to home palliative or in-patient care.

The coronavirus pandemic has already forced doctors in other countries to make the harrowing decision of which patients should receive ventilator assistance, including in Italy, where hospital staff have said they chose people based on their age and other health conditions.

The state plan’s guidelines also said it should only be used in the event of a “public health emergency”, which Alabama Governor Kay Ivey declared on 13 March.

It’s meant to serve as a “measure of last resort” with the goal of providing “aggressive treatment to those with the greatest chance of survival even if that requires removal of supportive care from others”, the document stated.

The little-known plan was detailed in an Al.com report on Tuesday, as the state confirmed nearly 450 cases of the novel virus.