ICU · Ethics

Disaster/Pandemic Ethics — Resource Allocation & Triage

Also known as Disaster ethics · Pandemic triage · Resource allocation · SOFA score triage · Maximise lives saved · Fair innings · Triage committee · Crisis standards of care · Conventional contingency crisis surge · START triage · Mass casualty triage · Ventilator allocation framework · Multiprinciple allocation · Reverse triage · Duty to care · Withdrawal to reallocate

Disaster/pandemic ethics — the shift from individual focus (standard ICU) to population focus (maximise good across all) when demand exceeds supply. Mass casualty triage (START — simple triage and rapid treatment; reverse triage for burns/electrical). Surge capacity tiers: conventional → contingency → crisis, with crisis standards of care. Resource allocation principles: maximise lives saved (utilitarian), maximise life-years (fair innings), instrumental value (healthcare workers), random lottery tie-breaker. Ethical frameworks compared (utilitarian, egalitarian, prioritarian). Ventilator allocation frameworks: SOFA-based single-principle vs multiprinciple (SOFA + comorbidity + age caps + exclusions). SOFA score as the objective prognosis tool, re-triaged dynamically. Crisis standards of care must be DECLARED. Triage committee SEPARATE from the treating team. Withdrawal to reallocate: defensible only under declared crisis standards, ex ante framing, never ad hoc. Duty to care versus duty to self, set by reciprocity.