Learning from COVID-19 triage schemes to face the next public health emergency.
Learning from COVID-19 triage schemes to face the next public health emergency.
复制标题
学习 COVID-19 分类计划以应对下一次公共卫生紧急情况。
DOI：
10.1111/jgs.18765
复制
发表时间：
2024
影响因子：
6.3
通讯作者：
Sulmasy,DanielP
中科院分区：
文献类型：
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作者：
DeMartino,ErinS;Ennis,JacksonS;Wolf,SusanM;Sulmasy,DanielP
Traditionally, triage under crisis conditions has been understood to mean striving to save the most lives while ensuring fairness and avoiding discrimination. Ethicists have long debated how to be fair in a crisis demanding a choice between competing patients' needs and which clinical characteristics should be considered in prioritizing some patients over others. Guided by influential work from the Institute of Medicine (IOM), many states had developed so-called crisis standards of care plans before the COVID-19 pandemic (many focused on H1N1 influenza), outlining ethical frameworks and clinical triage instructions for allocating life-saving care in the event a public health emergency created acute scarcity. With the eruption of the COVID pandemic in 2020, physicians, public health officials, and ethicists scrambled to prepare for the very real possibility of rationing care. The infectiousness and lethality of COVID-19 observed in China, Italy, and New York made clear the scale of the challenge. Although states turned to preexisting documents or developed new plans rapidly, experts issued competing recommendations for schemes to save the most lives when severe shortages forced a departure from conventional patient care. 1–3 As states unveiled their triage instructions for COVID-19, the resulting protocols shared many fundamentals, including nondiscrimination clauses, clinical triage algorithms, and process protections. State plans differed, however, in whether they considered life expectancy beyond hospital discharge, comorbidities, and quality of life.Many of these initial schemes provoked intense pushback. They were criticized as discriminating against older adults and persons with disabilities, who would be de-prioritized because they had fewer expected life-years to live. 4 Severity of organ dysfunction scores, which many state protocols used to allocate scarce critical care resources, were heavily criticized. They were not designed for triage, do not accurately predict survival in respiratory failure, and were especially suspect when applied to minoritized racial and ethnic populations. 5, 6 The US Office for Civil Rights (OCR) investigated a number of state protocols and demanded changes.
