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Simulating crisis triage: a methodological framework for evaluating ventilator allocation under crisis standards of
B Corbett Walsh1,2,3, Jianan Zhu4, Yang Feng4
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA. BCWalsh@mednet.ucla.edu.
BMC Medical Research Methodology
|May 27, 2026
Summary
This study developed a simulation platform to evaluate ventilator triage strategies during public health emergencies. The model compares different Crisis Standards of Care (CSC) policies for resource allocation and patient outcomes.
Area of Science:
- Computational modeling
- Health systems research
- Public health preparedness
Background:
- Crisis Standards of Care (CSC) may necessitate rationing of life-sustaining resources like mechanical ventilators during public health emergencies.
- Simulation modeling offers a scalable and transparent method for evaluating triage frameworks prior to implementation.
- Few ventilator triage frameworks have been rigorously compared using real-world data under realistic surge conditions.
Purpose of the Study:
- To develop and validate a computational simulation platform for evaluating ventilator triage strategies.
- To compare the clinical, operational, and ethical performance of various CSC triage frameworks.
- To assess the impact of different triage criteria, reassessment frequencies, and resource constraints.
Main Methods:
- Developed a computational simulation platform using retrospective data from intubated adults during the Spring 2020 COVID-19 surge in a New York City health system.
- Simulated a crisis cohort based on 95% ventilator supply utilization, evaluating eight different CSC strategies.
- Incorporated daily ICU census and ventilator availability to simulate resource strain and drive triage decisions, including patient expiration simulation.
Main Results:
- The platform simulated 10,000 iterations per strategy, encompassing 2,365 intubated patients.
- Detailed comparative analyses of survival, resource utilization, and prognostic accuracy are forthcoming.
- The simulation framework allows for the evaluation of operational constraints and clinical trajectories.
Conclusions:
- The developed platform offers a scalable and reproducible method for assessing ventilator triage strategies under pandemic conditions.
- Integrating front- and back-end triage logic, operational constraints, and clinical data enables comprehensive strategy evaluation.
- Computational modeling can enhance health system preparedness, inform evidence-based triage protocols, and bolster public trust.
Keywords:
COVID-19Computational simulationCrisis standards of careDecision MakingEthicsResource AllocationSimulation modelingTriage protocolsVentilatorVentilator allocationMore Related Videos
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