The Triage of Adult Patients Requiring Intensive Care during Pandemics

Abstract

A future pandemic could overwhelm intensive care resources. Triage systems can be used to prioritise the order in which patients are treated in a pandemic, when the demand for intensive care services exceeds the availability of intensive care resources. However, there were many ethical issues involving triage systems and little evidence to guide their use. Consequently, this thesis was started. The objective was learn more about the public’s views on intensive care triage, in order to optimise the allocation of intensive care resources in a future pandemic.

This thesis consisted of three studies.

A cross-sectional survey in Australia and New Zealand, using the Australian Electoral Commission (AEC) and New Zealand Electoral Commission electoral rolls, was used to determine public opinion on how ICU beds should be allocated in an influenza pandemic, and the public perception of fairness of the different methods. The study demonstrated that respondents considered both the use of a senior doctor or pre-determined health department criteria to be the fairest way to triage ICU patients.

The results led to a multicentre survey in Australia, of surrogate decision-makers of patients in the ICU, to determine the fairness of triage criteria to allocate intensive care resources in an influenza pandemic. The completion of this study has been delayed by the COVID-19 pandemic. The interim results demonstrated that respondents had four contradictory viewpoints on the fairness of triage criteria, with no clear majority view.

A further survey in Australia using the AEC electoral roll was used to determine which of four theoretical methods to triage intensive care patients in a pandemic using chronic comorbidity was perceived to be the fairest by the general public. The majority of respondents perceived all four of the methods to be fair. However, there was a sizable minority who perceived each of the four methods to be unfair.