Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study

Published by Biddison, MD, MPH, et al., in CHEST Journal, Official Publication of the American College of Chest Physicians

Abstract
Background: During a catastrophe, health care providers may face difficult questions regarding who will receive limited life-saving resources. The ethical principles that should guide decision-making have been considered by expert panels but have not been well explored with the public or front line clinicians. The objective of this study was to characterize the public’s values regarding how scarce mechanical ventilators should be allocated during an influenza pandemic, with the ultimate goal of informing a statewide scare resource allocation framework.

Methods: Adopting Deliberative Democracy practices, we conducted 15 half-day community engagement forums with the general public and health-related professionals. Small group discussions of 6 potential guiding ethical principles were led by trained facilitators. The forums consisted exclusively of either members of the general public or health-related or disaster professionals and were convened in a variety of meeting places across the State of Maryland. Primary data sources were pre- and post- deliberation surveys and notes of small group deliberations compiled by trained note takers.

Results: 324 individuals participated in 15 forums. Participants indicated a preference for prioritizing short and long-term survival, but they indicated that these should not be the only factors driving decision-making during a crisis. Qualitative analysis identified 10 major themes that emerged. Many, but not all, themes were consistent with previously issued recommendations. The most important difference related to withholding versus withdrawing ventilator support.

Conclusions: The values expressed by the public and front-line clinicians sometimes diverge from expert guidance in important ways. Awareness of these differences should inform policy-making.