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

Area of Science:

• Medical Ethics
• Public Health Policy
• Critical Care Medicine

Background:

• Healthcare facilities face surges in critically ill patients during emergencies.
• Demand for life-saving resources can exceed supply, necessitating scarce resource allocation (SRA) protocols.
• Existing SRA protocols lack federal standardization, leading to significant variations across states and healthcare systems.

Purpose of the Study:

• To investigate disparities in SRA protocols.
• To analyze the impact of these protocols on patient outcomes.
• To inform preparation for future public health emergencies.

Main Methods:

• A simulation was conducted using mock patients with limited ventilator availability.
• Nine diverse mock adult patient profiles were generated.
• Six SRA protocols from the COVID-19 pandemic were reviewed and applied to the patient population.

Main Results:

• Significant differences were observed in SRA protocols, including scoring, exclusion criteria, and tie-breaking methods.
• Protocol variations influenced the outcomes of life-saving treatments.
• No two state algorithms yielded the same ventilator allocation results for the mock patients.

Conclusions:

• SRA protocols rely on scoring systems or ambiguous lottery systems, burdening physicians and patients.
• Federal standardization of SRA protocols is advocated.
• Standardization aims to ensure equal access to critical care and eliminate chance-based allocation.