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Development of a triage protocol for critical care during an influenza pandemic

From the Division of Infectious Diseases and Critical Care, Department of Postgraduate Medicine, McMaster University, Hamilton, Ont. (Christian); the Division of Critical Care, Department of Medicine, University of Toronto (Hawryluck, Wax, Herridge), and University Health Network (Hawryluck, Lazar, Herridge), Toronto, Ont.; the Program for Resuscitation Education and Patient Safety, Department of Medicine, Mount Sinai Hospital, Toronto, Ont. (Wax); Medcan Travel Clinic, Medcan Health Management Inc., Toronto, Ont. (Cook); the Faculty of Medicine and Joint Center for Bioethics (Lazar), the Division of Infectious Diseases, Department of Medicine, and the Department of Health Policy, Management and Evaluation (Muller), University of Toronto, Toronto, Ont.; the Divisions of Acute Services and Community Health, Ontario Ministry of Health and Long-Term Care, Toronto, Ont. (Gowans); the Ottawa Hospital, Ottawa, Ont. (Fortier); and the Asia-Pacific Center for Biosecurity, Disaster and Conflict Research, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii (Burkle)

Correspondence to: Dr. Michael D. Christian, Rm. 2U, McMaster University Medical Centre, 1200 Main St. W., Hamilton ON L8N 3Z5; fax 905 523-1224; michael.christian{at}utoronto.ca

Background: The recent outbreaks of avian influenza (H5N1) have placed a renewed emphasis on preparing for an influenza pandemic in humans. Of particular concern in this planning is the allocation of resources, such as ventilators and antiviral medications, which will likely become scarce during a pandemic.

Methods: We applied a collaborative process using best evidence, expert panels, stakeholder consultations and ethical principles to develop a triage protocol for prioritizing access to critical care resources, including mechanical ventilation, during a pandemic.

Results: The triage protocol uses the Sequential Organ Failure Assessment score and has 4 main components: inclusion criteria, exclusion criteria, minimum qualifications for survival and a prioritization tool.

Interpretation: This protocol is intended to provide guidance for making triage decisions during the initial days to weeks of an influenza pandemic if the critical care system becomes overwhelmed. Although we designed this protocol for use during an influenza pandemic, the triage protocol would apply to patients both with and without influenza, since all patients must share a single pool of critical care resources.

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