A theory of triage.

Area of Science:

• Public Health
• Medical Ethics
• Critical Care Medicine

Background:

• Public health emergencies, exemplified by the COVID-19 pandemic, necessitate robust frameworks for intensive care unit (ICU) admission triage.
• Existing triage guidelines often grapple with complex ethical considerations, including resource allocation and patient prioritization.
• The need for a clear, ethically sound, and practical approach to ICU triage during crises is paramount.

Purpose of the Study:

• To develop a general framework for conceptualizing ICU admission triage in public health emergencies.
• To apply this framework to analyze existing COVID-19 pandemic triage guidelines.
• To address and provide recommendations on controversial aspects of triage, such as the role of age and quality of life.

Main Methods:

• Conceptual framework development based on ethical principles of resource allocation.
• Analysis and critique of selected ICU triage guidelines issued during the COVID-19 pandemic.
• Ethical argumentation regarding the use of life years, age, and quality of life in triage protocols.

Main Results:

• The proposed framework emphasizes maximizing the number of life years saved as the primary objective for ICU triage.
• Age can be considered as a proxy in triage decisions, reflecting its correlation with life expectancy.
• Quality of life considerations should be excluded from triage protocols to maintain objectivity and equity.

Conclusions:

• Triage protocols for public health emergencies should prioritize maximizing life years saved.
• Age can be ethically incorporated into triage frameworks as a proxy for life-years.
• Excluding quality of life from triage decisions ensures a more equitable and consistent approach to ICU admissions during crises.