title: Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza.
abstract: The purpose of this study was to identify supplementary criteria to provide direction when the Ontario Health Plan for an Influenza Pandemic (OHPIP) critical care triage protocol is rendered insufficient by its inability to discriminate among patients assessed as urgent, and there are insufficient critical care resources available to treat those in that category. To accomplish this task, a Supplementary Criteria Task Force for Critical Care Triage was struck at the University of Toronto Joint Centre for Bioethics. The task force reviewed publically available protocols and policies on pandemic flu planning, identified 13 potential triage criteria and determined a set of eight key ethical, legal and practical considerations against which it assessed each criterion. An online questionnaire was distributed to clinical, policy and community stakeholders across Canada to obtain feedback on the 13 potential triage criteria toward selecting those that best met the eight considerations. The task force concluded that the balance of arguments favoured only two of the 13 criteria it had identified for consideration: first come, first served and random selection. The two criteria were chosen in part based on a need to balance the clearly utilitarian approach employed in the OHPIP with equity considerations. These criteria serve as a defensible "fail safe" mechanism for any triage protocol.
authors.affiliation: Candidate in Health Policy in the Department of Clinical Epidemiology and Biostatistics at McMaster University, in Hamilton, Ontario, and a member of the Joint Centre for Bioethics, University of Toronto, in Toronto, Ontario.
authors.forename: Shawn
authors.initials: S
authors.lastname: Winsor
authors.affiliation: Researcher for the Canadian Program of Research on Ethics in a Pandemic (CanPREP), in Toronto, Ontario, and a member of the Joint Centre for Bioethics.
authors.forename: Cécile M
authors.initials: CM
authors.lastname: Bensimon
authors.affiliation: Ethicist at London Health Sciences Centre, in London, Ontario, and a member of the Joint Centre for Bioethics.
authors.forename: Robert
authors.initials: R
authors.lastname: Sibbald
authors.affiliation: Senior bioethicist at the University Health Network, in Toronto, Ontario, assistant professor in the Department of Occupational Science and Occupational Therapy at the University of Toronto, and a member of the Joint Centre for Bioethics.
authors.forename: Kyle
authors.initials: K
authors.lastname: Anstey
authors.affiliation: Director, research and corporate ethics for the William Osler Health System, in Brampton, Ontario, and a member of the Joint Centre for Bioethics.
authors.forename: Paula
authors.initials: P
authors.lastname: Chidwick
authors.affiliation: Neonatologist at the Children's Hospital - London Health Sciences Centre, associate professor in the Department of Paediatrics at the University of Western Ontario.
authors.forename: Kevin
authors.initials: K
authors.lastname: Coughlin
authors.affiliation: Intensivist at The Hospital for Sick Children, in Toronto, Ontario, and a member of the Joint Centre for Bioethics.
authors.forename: Peter
authors.initials: P
authors.lastname: Cox
authors.affiliation: Intensivist and senior scientist at Sunnybrook Health Sciences Centre, in Toronto, Ontario, assistant professor in the Department of Medicine at the University of Toronto.
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.affiliation: Senior ethicist with Trillium Health Partners, in Mississauga, Ontario, and a member of the Joint Centre for Bioethics.
authors.forename: Dianne
authors.initials: D
authors.lastname: Godkin
authors.affiliation: Ethicist at The Hospital for Sick Children, and a member of the Joint Centre for Bioethics.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Greenberg
authors.affiliation: Bioethicist, Director of the Bioethics Department at The Hospital for Sick Children, and a member of the Joint Centre for Bioethics.
authors.forename: Randi Zlotnik
authors.initials: RZ
authors.lastname: Shaul
mesh_terms: D026683:Advisory Committees; D002985:Clinical Protocols / Q000592:standards; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy*; D009864:Ontario; D058873:Pandemics; D040841:Resource Allocation / Q000458:organization & administration*; D014218:Triage / Q000379:methods*; D012122:Ventilators, Mechanical / Q000600:supply & distribution