Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis

Chest. 2021 Mar;159(3):1076-1083. doi: 10.1016/j.chest.2020.09.246. Epub 2020 Sep 28.


The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium-with diverse expertise and representation-representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens' values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource's varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes.

Keywords: COVID-19; disaster planning; healthcare rationing; medical ethics; triage.

MeSH terms

  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • COVID-19* / therapy
  • Change Management
  • Civil Defense / organization & administration*
  • Disaster Planning
  • Health Care Rationing* / methods
  • Health Care Rationing* / standards
  • Health Workforce*
  • Humans
  • Intersectoral Collaboration
  • Maryland / epidemiology
  • Public Health / trends*
  • Resource Allocation* / ethics
  • Resource Allocation* / organization & administration
  • SARS-CoV-2
  • Triage / ethics
  • Triage / organization & administration