Winning the Lottery: A Simulation Study Comparing Scarce Resource Allocation Protocols in Crisis Scenarios

Introduction In times of crisis, such as natural disasters, pandemics, or other emergencies, healthcare facilities often experience an unprecedented surge in critically ill or severely injured patients. When the demand for life-saving resources surpasses the available supply, healthcare leaders must implement scarce resource allocation (SRA) protocols, which are defined by state governments or hospital committees. Due to the lack of federal standardization and the wide variations in these protocols across states and healthcare systems, researchers aimed to investigate the disparities in SRA protocols and their impact on patient outcomes in preparation for future emergencies. -- Methods Researchers created a simulation involving mock patients admitted to a hospital with limited ventilator availability, where they were required to implement an SRA protocol. Nine mock adult patient profiles were generated, each varying in age, biological sex, past medical history, social history, and illness acuity and severity. Researchers also comprehensively reviewed SRA protocols implemented across the United States during the COVID-19 pandemic. Six protocols were selected and applied to the mock patient population. Variations in the methodology of allocation and outcomes of resource stewardship were observed. Results Significant differences were found among the six SRA protocols, including differences in objective scoring categories, exclusion criteria, considerations for age and pregnancy, tie-breaking methods, and the use of lottery systems. These protocol differences influenced the outcomes of life-saving treatments received by different patients. In this simulation, no two state algorithms provided the same ventilator allocation results for the nine patients. Conclusion SRA protocols either emphasized scoring systems or employed an ambiguous lottery system, placing an unnecessary burden on physicians and patients. As a result, the researchers advocate for federal standardization of SRA protocols, to ensure equal access to critical medical care for all individuals, regardless of location, and to eliminate the element of chance that currently varies by state.