When disaster strikes, effective management of resources can significantly influence the overall outcome of the response. If the number of victims and the complexity of their injuries are low and resources are abundant, resource allocation will have little impact on the disaster outcome. However, if there is a high number of victims with complex injuries and available resources are limited, how those resources are used will determine the outcome for some individuals.
Historically, decisions regarding disaster resource allocation and triage have largely been in the domain of emergency medicine; however, Roccaforte and Cushman observe, “The pinnacle of the medical response to any disaster takes place in definitive care areas [DCA] (operating rooms, intensive care units). Thus, a critical component of disaster planning must be the preservation of DCA capability and effectiveness” (1). Given this, it is essential that critical care physicians understand and are skilled in resource management during surges in demand for critical care.
This chapter from SCCM's Fundamental Disaster Management, Third Edition seeks to:
- Describe the types and characteristics of surges.
- Summarize key events in the history of triage.
- Identify what critical care resources may have to be allocated or triaged during a disaster.
- Explain the differences between resource allocation, rationing, and triage.
- Describe the types of triage.
- Discuss the impact of triage.
- Identify important considerations in developing and implementing a triage protocol.
- Discuss the ethical issues related to triage and allocation of scarce resources.
Michael D. Christian, MD, FRCP(C)
J. Christopher Farmer, MD, FCCM
Brian P. Young, MD