title: Principles of scarce medical resource allocation in natural disaster relief: a simulation approach.
abstract: BACKGROUND
  A variety of triage principles have been proposed. The authors sought to evaluate their effects on how many lives can be saved in a hypothetical disaster.
  
  
  OBJECTIVE
  To determine an optimal scarce resource-rationing principle in the emergency response domain, considering the trade-off between lifesaving efficiency and ethical issues.
  
  
  METHODS
  A discrete event simulation model is developed to examine the efficiency of four resource-rationing principles: first come-first served, random, most serious first, and least serious first. Seven combinations of available resources are examined in the simulations to evaluate the performance of the principles under different levels of resource scarcity.
  
  
  RESULTS
  The simulation results indicate that the performance of the medical resource allocation principles is related to the level of the resource scarcity. When the level of the scarcity is high, the performances of the four principles differ significantly. The least serious first principle performs best, followed by the random principle; the most serious first principle acts worst. However, when the scarcity is relieved, there are no significant differences among the random, first come-first served, and least serious first principles, yet the most serious first principle still performs worst.
  
  
  CONCLUSIONS
  Although the least serious first principle exhibits the highest efficiency, it is not ethically flawless. Considering the trade off between the lifesaving efficiency and the ethical issues, random selection is a relatively fair and efficient principle for allocating scarce medical resources in natural disaster responses.
authors.affiliation: Department of Industrial Engineering, Tsinghua University, Haidian District, Beijing, China. caohui@tsinghua.edu.cn
authors.forename: Hui
authors.initials: H
authors.lastname: Cao
authors.forename: Simin
authors.initials: S
authors.lastname: Huang
mesh_terms: D002681:China; D003198:Computer Simulation; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D004189:Disaster Planning / Q000191:economics / Q000592:standards*; D004190:Disasters / Q000191:economics* / Q000706:statistics & numerical data; D019468:Disease Management; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D018803:Models, Economic; D012044:Regression Analysis; D040841:Resource Allocation / Q000191:economics / Q000706:statistics & numerical data*; D013995:Time; D014218:Triage / Q000191:economics / Q000706:statistics & numerical data