Table 2:

Special populations

PopulationRationaleIncorporation into the Saskatchewan Critical Care Resource Allocation Framework
Older adultsEvidence suggests that risk for poor ICU outcomes is not defined exclusively by age.13 Instead, frailty (defined as CFS ≥ 5) is associated with higher in-hospital and long-term mortality.14 In octogenarians, frailty is predictive of short-term ICU mortality.15,16 Although frailty may portend a poorer outcome in younger patients who are critically ill, the validity of applying the CFS more broadly is still being investigated.17A combination of age and frailty is used as exclusion criteria in stage 3 (Table 1).
Chronically ventilatedPalliation for patients on long-term ventilation is not justifiable, even if it allows a greater number of healthier patients to survive. This policy would risk inappropriate quality-of-life judgments and could be seen as disadvantaging vulnerable patients.Patients who are already receiving life-sustaining treatments in long-term care settings or at home are considered to be a different population altogether from the medical patient who is acutely ill. However, should patients receiving long-term ventilation require treatment in an acute care facility, they should be considered part of the acute care cohort and subject to the resource allocation framework.2
Patients with disabilitiesPatients with intellectual, physical or developmental disabilities are considered vulnerable populations and at risk for discrimination within the health care system.18 Patients with stable, nonprogressive conditions will not be excluded solely on the basis of these conditions.The structure and process of the triage team is meant to form a system of checks and balances to eliminate discrimination based on disability.
Pregnant patientsA patient who is pregnant and her potentially viable fetus should be considered as 2 separate lives, and therefore these patients can be prioritized based on the life-cycle principle.19Pregnancy with a potentially viable fetus is included as a tiebreaker in stage 4 (Figure 1).
Health care workersHealth care workers have instrumental value (i.e., a health care worker who is healthy can save the lives of more patients).10,20 However, during a stage of critical illness, it is unclear whether the health care worker, if saved, would be able to return to work in a timely fashion to help others. Instrumental value is a potentially subjective concept that lends itself too easily to other, potentially extraneous, considerations of social worth.Health care workers are included as tiebreakers in stage 4 (Figure 1).
  • Note: CFS = Clinical Frailty Score, ICU = intensive care unit.