Identifying Prioritization Criteria to Supplement Critical Care Triage Protocols for the Allocation of Ventilators during a Pandemic Influenza

Triage

“…Further complicating matters is that ethical perspectives vary at the societal level around the world on many topics, including their views on the role of clinicians in decision making and use of "lotteries" rather than triage for the allocation of scarce resources. 26,60,69,89 Effective governance of triage requires a legal basis authorizing its application as well as infrastructure mechanisms to ensure it is conducted appropriately (Box 4). Several publications by public health legal experts explore in detail the issues surrounding the legislative framework and other legal issues related to disaster triage.…”

Ethical considerations in the allocation of critical care resources when capacity is overwhelmed

“…Subsequent work has shown these guidelines maximize benefits but may need additional ethical considerations to enhance equity and fairness. 8 International commentaries and triage guidelines have been released in response to the current crisis. 9,10 While Canadian physicians can learn important lessons from these, they should be aware that differences in healthcare systems, healthcare cultures, and national values may limit or alter the applicability of these guidelines.…”

Supporting decision-making on allocation of ICU beds and ventilators in pandemics

“…Table 3. Ethical, legal, practical and clinical considerations when allocating ICU care ventilator treatment What to consider in ensuring fair rationing of resources Ethical, legal and practical considerations • Make triage policy and rationing criteria transparent to staff and the public to ensure understanding of the reasons for access restrictions [2,15,79,80] • Establish local/regional partnerships to effectively manage resource shortages and triage pathways [2,15,75,80] • When resources cannot be maintained, unequal treatment may be justified and choice determined on the basis of medical need and likely benefit[12] by using a proportionately lower amount of resources [81] • People making decisions about resource allocation should not be the treating clinicians but preferably a central triage committee of senior clinicians and legal officers [15,79,86] • First come first served or lottery/ random assignment if two patients with same level of risk present at the same time [81] • Decision-makers should not be aware of patients' identity [19] • Revise existing laws and develop liability protection for clinicians using scoring systems for decisionmaking about allocation of scarce resources [15,29] • Priority to be given to those who have had less opportunity to live their lives [2,29] • Align patients values and preferences with decisions to admit or remain in ICU [87] • [3]. For patients on mechanical ventilation for 14+ days, clinicians should have a discussion with the family about the poor prognosis and goals of care [39] • Refer to palliative care from ED if risk of death is very high (i.e.…”