This article reports on hospital preparations in Indiana to address the anticipated peak of COVID-19 cases. Current estimates suggest that case surge in the state will not overwhelm critical resource supplies due to the impact of social distancing and other measures, but Indiana hospitals are preparing for potentially difficult allocation decisions should the need arise.

When supplies of critical resources, such as ventilators, are overwhelmed by demand, allocation decisions shift from a focus solely on the interests and wishes of the individual patient to a focus on the needs of the population. If necessary, this shift to “crisis standards of care” may require rationing of scarce resources, often based on who is most likely to recover with intervention. This change in focus and the difficult choices required create significant ethical tensions, and most guidance recommends that allocation decisions be made by triage officers or teams that are separate from the frontline, bedside caregiver team.

Indiana hospitals report that they have resource allocation policies in place that have been developed over time with input from clinicians and ethicists and through consultation with other health systems. Under current predictions, Indiana hospitals expect that cases may be reach 2-3 times normal capacity for critical care (and potentially more for mechanical ventilation), but measures to stretch existing resources, such as converting bi-pap and anesthesia machines into ventilators, are projected to keep resource usage below maximum system capacity.