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.