title: Informing the gestalt: an ethical framework for allocating scarce federal public health and medical resources to states during disasters.
abstract: During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters.
authors.affiliation: National Institute for Nursing Research, Bethesda, Maryland.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Knebel
authors.affiliation: National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Sharpe
authors.affiliation: Clinical Center Department of Bioethics, National Institutes of Health, Bethesda, Maryland.
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, US Department of Health and Human Services, Washington, DC.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Toomey
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, Office of Emergency Management, US Department of Health and Human Services, Washington, DC.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Knickerbocker
mesh_terms: D003657:Decision Making; D004189:Disaster Planning / Q000458:organization & administration* / Q000592:standards; D004190:Disasters; D035082:Federal Government; D015276:Health Care Rationing / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D011634:Public Health; D040841:Resource Allocation / Q000458:organization & administration* / Q000592:standards; D013219:State Government; D035862:Vulnerable Populations