Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.
Bibliographical noteFunding Information:
Financial/nonfinancial disclosures: None declared. Other contributions: We thank Christie Martin, MN, MPH, RN, PHN, LHIT-HP, Henry Feldman, MD, Timur Alptunaer, MD, J. Christopher Farmer, MD, Kiersten Henry, DNP, ACNP-BC, CCNS, CCRN-CMC, Sarah Delgado, MSN, RN, ACNP, and Steven Simpson, MD, for their input and critical review of this manuscript and the members of the Task Force for Mass Critical Care for their tireless efforts and support. Additional information: Some of the authors are US government employees or military service members. This work was prepared as part of their official duties. Title 17 U.S.C. ?105 provides that ?Copyright protection under this title is not available for any work of the United States Government.? Title 17 U.S.C. ?101 defines a US government work as a work prepared by a military service member or employee of the US government as part of that person's official duties. The opinions and assertions contained herein are those of the authors and do not reflect the official views or position of the Department of the Navy, Department of Defense, Department of Veterans Affairs, the US Government, nor of the academic institutions with which the authors are affiliated.
- COVID-19 pandemic
- disaster preparedness
- scarcity of resources
- surge capacity
PubMed: MeSH publication types
- Journal Article