Triage protocol for allocation of critical health resources during the COVID-19 health emergency. A review

Abstract

Background and aim of the work:Triage during the Covid-19 pandemic can impose difficult allocation deci-sions when demand for mechanical ventilation or intensive care beds greatly exceeds available resources. Tri-age criteria should be objective, ethical, transparent, applied equitably and publically disclosed. The aim of this review is to describe the triage tools and process for critical care resources in a pandemic health emergency. Methods:A narrative review was conducted of the literature on five electronic databases, namely PubMed, CINHAL, Web of Science, Cochrane and Embase, searching for studies published from 2006 to June 2020. Results:The results describe different triage tools. A gold standard of triage does not exist for the adult or paediatric population. Using probability of short-term survival as the sole allocation principle is problematic. In general, each triage protocol should be applied with a specific ethical justification, including transparency, duty to care, duty to steward resources, duty to plan, and distributive justice. Conclusions:Clinical triage deci-sions based on clinical judgment alone are prone to inconsistent application by triage officers in a pandemic. An ethical framework can inform decision-making and improve accountability. It remains difficult to connect clinical criteria and ethical criteria, because of the models on offer for health services.