Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis.

Area of Science:

• Public Health
• Healthcare Ethics
• Health Systems Management

Background:

• The coronavirus disease 2019 (COVID-19) pandemic highlighted the potential need for rationing scarce medical resources.
• Existing ethical frameworks require practical and legal operationalization for effective implementation during public health catastrophes.
• Hospitals need standardized, yet adaptable, protocols for allocating critical resources when demand outstrips supply.

Purpose of the Study:

• To develop operational scarce resource allocation processes for public health catastrophes, specifically addressing the COVID-19 pandemic.
• To create a framework for resource allocation that integrates public values and expert consensus.
• To develop specific allocation schemas for critical medical resources including ventilators, ICU beds, and novel therapeutics.

Main Methods:

• Formation of a consortium of five Maryland health systems representing over half the state's hospitals.
• Leveraging a prior statewide community engagement process to identify public and professional values regarding resource allocation.
• Developing iterative, legally vetted, and tested allocation algorithms for various scarce resources.

Main Results:

• A comprehensive scarce resource allocation framework was developed, informed by citizen values and expert consensus.
• Specific allocation schemas were created for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies.
• Unique challenges in operationalizing algorithms for each resource were identified due to their varying nature and benefit data.

Conclusions:

• Operational scarce resource allocation processes must be iterative, legally vetted, and tested to be effective.
• The developed framework and processes offer a model for other regions facing healthcare resource rationing during public health emergencies.
• Integrating public values with expert consensus is crucial for ethically sound and practically implementable resource allocation strategies.