Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

Intensive Care Med. 2010 Apr;36 Suppl 1(Suppl 1):S55-64. doi: 10.1007/s00134-010-1765-0.


Purpose: To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage.

Methods: Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical care triage.

Results: Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resources; (2) developing fair and equitable policies may require restricting ICU services to patients most likely to benefit; (3) usual treatments and standards of practice may be impossible to deliver; (4) ICU care and treatments may have to be withheld from patients likely to die even with ICU care and withdrawn after a trial in patients who do not improve or deteriorate; (5) triage criteria should be objective, ethical, transparent, applied equitably and be publically disclosed; (6) trigger triage protocols for pandemic influenza only when critical care resources across a broad geographic area are or will be overwhelmed despite all reasonable efforts to extend resources or obtain additional resources; (7) triage of patients for ICU should be based on those who are likely to benefit most or a 'first come, first served' basis; (8) a triage officer should apply inclusion and exclusion criteria to determine patient qualification for ICU admission.

Conclusions: Judicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic.

Publication types

  • Guideline

MeSH terms

  • Critical Care / methods
  • Critical Care / organization & administration
  • Critical Care / standards*
  • Disaster Planning / methods
  • Disaster Planning / organization & administration
  • Disaster Planning / standards*
  • Disease Outbreaks*
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / standards
  • Humans
  • Influenza A Virus, H1N1 Subtype*
  • Influenza, Human / epidemiology*
  • Intensive Care Units / organization & administration
  • Intensive Care Units / standards*
  • Mass Casualty Incidents
  • Triage / methods
  • Triage / organization & administration
  • Triage / standards*