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Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency
- Michael D. Christian, MD;
- Christian E. Sandrock, MD, MPH;
- Asha Devereaux, MD, MPH;
- James Geiling, MD;
- CAPT Dennis E. Amundson, MC, USN; and
- Lewis Rubinson, MD, PhD
- From Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada; University of California, Davis, School of Medicine, Sacramento, CA 95817; Coronado, CA 92118; Veterans Affairs Medical Center, White River Junction, VT 05009; Naval Medical Center San Diego, San Diego, CA 92134; and Harborview Medical Center, University of Washington, Seattle, WA 98104.
TO THE EDITOR:
The perfect tertiary triage protocol for a pandemic or mass casualty event has not yet been published. We welcome and congratulate White and colleagues (1) on their contribution to the ongoing dialogue related to tertiary triage. However, just as triage is always a balance between available resources and demand, one must also attempt to strike the right balance among ethical doctrine, evidence, usability, and functionality when developing a triage score. The triage score proposed by White and colleagues leans in favor of addressing the issues most important in the conceptual world of ethics at the expense of a solution that could be translated into action in the stark reality of a pandemic or disaster.
In an effort to arrive at a very “basic solution,” White and colleagues have lost many of the components essential for application of a triage protocol in a disaster. A triage protocol must be easy to use at the bedside (the front end of the protocol), which often requires the back end of its development and design to be very complex. In the current proposal by White and colleagues, the score is not anchored and no action is directed. When a triage officer evaluates a patient, what does a score of 4, 6, …
