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Abstract
The threat of a catastrophic public health emergency causing life-threatening illness
or injury on a massive scale has prompted extensive federal, state, and local preparedness
efforts. Modeling studies suggest that an influenza pandemic similar to that of 1918
would require ICU and mechanical ventilation capacity that is significantly greater
than what is available. Several groups have published recommendations for allocating
life-support measures during a public health emergency. Because there are multiple
ethically permissible approaches to allocating scarce life-sustaining resources and
because the public will bear the consequences of these decisions, knowledge of public
perspectives and moral points of reference on these issues is critical. Here we describe
a critical care disaster resource allocation framework developed following a statewide
community engagement process in Maryland. It is intended to assist hospitals and public
health agencies in their independent and coordinated response to an officially declared
catastrophic health emergency in which demand for mechanical ventilators exceeds the
capabilities of all surge response efforts and in which there has been an executive
order to implement scarce resource allocation procedures. The framework, built on
a basic scoring system with modifications for specific considerations, also creates
an opportunity for the legal community to review existing laws and liability protections
in light of a specific disaster response process.