Fair Prioritization of Casualties in Disaster Triage: a Qualitative Study

Overview

Journal BMC Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2021 Oct 14

PMID 34645418

Citations 3

Authors

Vahid Ghanbari

Ali Ardalan

Armin Zareiyan

Amir Nejati

Dan Hanfling

Alireza Bagheri

Leili Rostamnia

Affiliations

Soon will be listed here.

Abstract

Background: Disasters may result in mass casualties and an imbalance between health care demands and supplies. This imbalance necessitates the prioritization of the victims based on the severity of their condition. Contributing factors and their effect on decision-making is a challenging issue in disaster triage. The present study seeks to address criteria for ethical decision-making in the prioritization of patients in disaster triage.

Methods: This conventional content analysis study was conducted in 2017. Subjects were selected from among Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis.

Results: Efficient and effective triage and priority-oriented triage were the main categories. These categories summarized a number of medical and nonmedical factors that should be considered in the prioritization of the victims in disaster triage.

Conclusion: A combination of measures should be considered to maximize the benefits of the prioritization of causalities in disasters. None of these measures alone would suffice to explain all aspects of ethical decision-making in disaster triage. Further investigations are needed to elaborate on these criteria in decision-making.

Citing Articles

Challenges of providing of special care services in hospitals during emergencies and disasters: a scoping review.

Masbi M, Tavakoli N, Dowlati M BMC Emerg Med. 2024; 24(1):238.

PMID: 39695959 PMC: 11657394. DOI: 10.1186/s12873-024-01160-1.

Nurses' Perception on the Hindrances of Triage System in Emergency Unit.

Olofinbiyi O, Makhado L Nurs Res Pract. 2024; 2024:8621065.

PMID: 39493891 PMC: 11530285. DOI: 10.1155/2024/8621065.

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review.

Ramirez C, Farmer Y, Bouthillier M Discov Health Syst. 2023; 2(1):16.

PMID: 37206881 PMC: 10169297. DOI: 10.1007/s44250-023-00027-9.

References

Kuschner W, Pollard J, Ezeji-Okoye S . Ethical triage and scarce resource allocation during public health emergencies: tenets and procedures. Hosp Top. 2007; 85(3):16-25. DOI: 10.3200/HTPS.85.3.16-25. View

Hsieh H, Shannon S . Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):1277-88. DOI: 10.1177/1049732305276687. View

Khankeh H, Nakhaei M, Masoumi G, Hosseini M, Parsa-Yekta Z, Kurland L . Life recovery after disasters: a qualitative study in the Iranian context. Prehosp Disaster Med. 2013; 28(6):573-9. DOI: 10.1017/S1049023X1300900X. View

Caro J, DeRenzo E, Coleman C, Weinstock D, Knebel A . Resource allocation after a nuclear detonation incident: unaltered standards of ethical decision making. Disaster Med Public Health Prep. 2011; 5 Suppl 1:S46-53. DOI: 10.1001/dmp.2011.14. View

Caro J, Coleman C, Knebel A, DeRenzo E . Unaltered ethical standards for individual physicians in the face of drastically reduced resources resulting from an improvised nuclear device event. J Clin Ethics. 2011; 22(1):33-41. View

Lin J, Anderson-Shaw L . Rationing of resources: ethical issues in disasters and epidemic situations. Prehosp Disaster Med. 2009; 24(3):215-21. DOI: 10.1017/s1049023x0000683x. View

Timbie J, Ringel J, Fox D, Pillemer F, Waxman D, Moore M . Systematic review of strategies to manage and allocate scarce resources during mass casualty events. Ann Emerg Med. 2013; 61(6):677-689.e101. PMC: 6997611. DOI: 10.1016/j.annemergmed.2013.02.005. View

Graneheim U, LUNDMAN B . Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2):105-12. DOI: 10.1016/j.nedt.2003.10.001. View

Gostin L . Medical countermeasures for pandemic influenza: ethics and the law. JAMA. 2006; 295(5):554-6. DOI: 10.1001/jama.295.5.554. View

10.

Barnett D, Taylor H, Hodge Jr J, Links J . Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues. Public Health Rep. 2009; 124(2):295-303. PMC: 2646457. DOI: 10.1177/003335490912400218. View

11.

Taurek J . Should the numbers count?. Philos Public Aff. 1977; 6(4):293-316. View

12.

Sprung C, Zimmerman J, Christian M, Joynt G, Hick J, Taylor B . Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic.... Intensive Care Med. 2010; 36(3):428-43. PMC: 7079971. DOI: 10.1007/s00134-010-1759-y. View

13.

Cookson R, Dolan P . Principles of justice in health care rationing. J Med Ethics. 2000; 26(5):323-9. PMC: 1733291. DOI: 10.1136/jme.26.5.323. View

14.

Christian M, Hamielec C, Lazar N, Wax R, Griffith L, Herridge M . A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic. Crit Care. 2009; 13(5):R170. PMC: 2784402. DOI: 10.1186/cc8146. View

15.

Levin D, Orfaly Cadigan R, Biddinger P, Condon S, Koh H . Altered standards of care during an influenza pandemic: identifying ethical, legal, and practical principles to guide decision making. Disaster Med Public Health Prep. 2009; 3 Suppl 2:S132-40. PMC: 10353013. DOI: 10.1097/DMP.0b013e3181ac3dd2. View

16.

Goransson K, Ehrenberg A, Marklund B, Ehnfors M . Accuracy and concordance of nurses in emergency department triage. Scand J Caring Sci. 2005; 19(4):432-8. DOI: 10.1111/j.1471-6712.2005.00372.x. View

17.

Petrini C . Triage in public health emergencies: ethical issues. Intern Emerg Med. 2010; 5(2):137-44. DOI: 10.1007/s11739-010-0362-0. View

18.

White D, Katz M, Luce J, Lo B . Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009; 150(2):132-8. PMC: 2629638. DOI: 10.7326/0003-4819-150-2-200901200-00011. View

19.

Kiani M, Fadavi M, Khankeh H, Borhani F . Personal factors affecting ethical performance in healthcare workers during disasters and mass casualty incidents in Iran: a qualitative study. Med Health Care Philos. 2017; 20(3):343-351. DOI: 10.1007/s11019-017-9752-7. View

20.

Matheny Antommaria A, Powell T, Miller J, Christian M . Ethical issues in pediatric emergency mass critical care. Pediatr Crit Care Med. 2011; 12(6 Suppl):S163-8. DOI: 10.1097/PCC.0b013e318234a88b. View