Review: Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation

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Review: Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation

Review: Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation

This forthcoming report (currently in pre-proof) from an expert panel of the Task Force for Mass Critical Care and the American College of Chest Physicians discusses the operational steps necessary for preparation and implementation of a triage system to allocate scarce resources during a public health crisis.

The potential that clinical demands will exceed supplies of critical care resources requires preparation of a triage system to allocate resources in order to maximize benefit for the greatest number of people should the need to do so arise after exhausting all attempts to surge, move patients, or shift resources. Lack of an adequate triage system may result in unnecessary deaths, increased moral distress for front-line clinicians, and lack of public confidence in the fairness of resource allocation. Enactment of an appropriate triage plan requires a support protocol, infrastructure, processes, legal and regulatory protections, and training, all of which, the report argues, are lacking in most institutions and regions.

The report, which builds on a series of CHEST consensus statements from 2014 regarding preparedness and triage, provides operational steps and accompanying justifications and rationales for implementation of a triage system within a state, county, or jurisdiction. It also highlights applicable stakeholder responsibilities for specific actions, including:

  • Inventory potential ICU resources for demand surge
  • Establish identification triggers for and initiation of triage
  • Preparation of a triage system
  • Agreement on a triage protocol
  • Consideration of changes to allow limits to the delivery of life-sustaining measures in times of crisis care
  • Standards of care
  • Family and societal support
  • Health care worker support
  • Pediatric considerations.
|2020-04-16T16:27:18-04:00April 16th, 2020|COVID-19 Literature|Comments Off on Review: Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation

About the Author: Daniel Orenstein

Daniel Orenstein
Daniel G. Orenstein, JD, MPH, is Visiting Assistant Professor of Law at the Indiana University Robert H. McKinney School of Law in Indianapolis. He teaches in the areas of administrative law, public health law, and health care law and policy. His research focuses on public health law, policy, and ethics, and he was previously Deputy Director of the Network for Public Health Law Western Region, where much of his work centered on emergency preparedness and response, including resource allocation and government authority during declared emergencies, as well as vaccination policy.

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