SCCM Resource Library-SCCM Crisis Standard of Care Recommendations for Triaging Critical Resources During the COVID-19 Pandemic

Pdf Summary

The Society of Critical Care Medicine's guidelines address the equitable allocation of scarce resources during the COVID-19 pandemic. The recommendations cater to situations where crisis standards of care are implemented due to resource scarcity. The guidelines cover different phases of capacity:<br /><br />1. **Conventional Capacity**: Resources are managed carefully while the hospital operates normally but prepares for potential scarcity.<br />2. **Contingency Capacity**: Resources are used unconventionally, marking the start of extreme scarcity. The hospital transitions to a triage system, prioritizing patients most likely to benefit based on the "greatest good for the greatest number" principle. Life-sustaining treatments may be withheld to prioritize resource allocation.<br />3. **Crisis Capacity**: Standards of care are significantly adjusted. Withholding and withdrawing life-sustaining treatments from patients with worsening conditions is ethically permissible to benefit those more likely to survive.<br /><br />Special considerations include handling CPR attempts and the controversial prioritization of healthcare workers for resources. The process must be transparent and fair, involving a designated triage committee and an appeals process for contested decisions. The triage committee includes senior clinicians, ethicists, and possibly community representatives.<br /><br />Patients are categorized based on their critical care needs:<br />- **Category 1**: Those not needing critical care yet.<br />- **Category 2**: Unsurvivable conditions even with treatment; focus on palliative care.<br />- **Category 3**: Critically ill patients with likelihood of benefiting from care.<br /><br />All triage decisions should be reviewed regularly, and an algorithm must be developed prospectively to ensure fairness. Patients' allocation should be free from biases related to demographic or socioeconomic factors, focusing solely on clinical criteria.

Asset Subtitle

Crisis Management, 2020

Asset Caption

The purpose of these recommendations is to provide a transparent, equitable, and consistent approach to allocation of
scarce resources during a COVID-19-declared emergency in which crisis standards of care have been implemented.
The development of hospital policies ideally reflects the values, voices, and perspectives of multiple communities,
both within and outside the institution. These guidelines will be updated as our understanding of the spread,
pathophysiology, treatment, and outcomes of COVID-19 infection evolves.

Meta Tag

Content Type Guidelines

Knowledge Area Crisis Management

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag COVID-19

Tag Resource Allocation

Year 2020

Keywords

COVID-19

critical care

resource allocation

crisis standards

triage system

ethical guidelines

capacity phases

palliative care

healthcare workers

clinical criteria

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