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Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement Online Only ArticlesEthical Considerations: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement
Section snippets
Triage and Allocation
1. We suggest resources not be held in reserve once a mass disaster protocol is in effect.
2. We suggest disaster and pandemic policies reflect the broad consensus that there is no ethical difference between withholding and withdrawing care and that education regarding such policies be incorporated into training.
3. We suggest triage systems based even on limited evidence are ethically preferable to those based on clinical judgment alone.
4. We suggest critical care resources be allocated based on
Materials and Methods
We followed the CHEST Guidelines Oversight Committee's methodology to develop suggestions (see the “Methodology” article by Ornelas et al9 in this consensus statement). Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions (e-Appendix 1 for key questions list and corresponding search terms and results). Searches were limited from 2002 to 2012, and only English-language papers were included. The detailed literature reviews produced
Triage/Allocation
1. We suggest resources not be held in reserve once a mass disaster protocol is in effect.
Once a triage/allocation protocol is in effect, patients who require and meet criteria for resources should be provided care in accordance with the protocols in effect at the time. Government agencies and health-care institutions should stockpile resources that are essential during or after a mass casualty event (eg, ventilators, antibiotics, vaccines, ICU beds).10 Although these stocks are scarce and may
Areas for Research
New evidence-based triage tools that predict survival, resource consumption, and quality-of-life outcomes with a high degree of accuracy for individual patients in specific circumstances would add significantly to current efforts to fairly allocate scarce critical care resources during public health disasters. All current tools fall short of this goal, despite major efforts on the part of many researchers. Pediatric research in developing triage tools lags significantly behind even that
Conclusions
Ethics issues permeate virtually all aspects of disaster and pandemic response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. We have not covered areas and issues conclusively addressed in prior documents but instead have focused on questions for which debate, controversy, or inadequate information
Acknowledgments
Author contributions: L. D. B. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. L. D. B., K. A. B., B. C., M. J. D. J., A. V. D., N. K., B. E. R., C. L. S., J. R. D., M. D. C., and T. P. contributed to the development of PICO questions; L. D. B., K. A. B., B. C., M. J. D. J., A. V. D., B. E. R., C. L. S., and T. P. conducted the literature review; L. D. B., K. A. B., B. C., M. J. D. J., A. V. D., N. K.,
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Ms Roxland is currently at the Office of the Chief Medical Officer, Johnson & Johnson (New Brunswick, NJ).
Funding/Support: This publication was supported by the Cooperative Agreement Number 1U90TP00591-01 from the Centers of Disease Control and Prevention, and through a research sub award agreement through the Department of Health and Human Services [Grant 1 - HFPEP070013-01-00] from the Office of Preparedness of Emergency Operations. In addition, this publication was supported by a grant from the University of California–Davis.
COI grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.
DISCLAIMER: American College of Chest Physicians guidelines and consensus statements are intended for general information only, are not medical advice, and do not replace professional care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this consensus statement can be accessed at http://dx.doi.org/10.1378/chest.1464S1.
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