Vahid Ghanbari1, Ali Ardalan2, Armin Zareiyan3, Amir Nejati4, Dan Hanfling5, Alireza Bagheri6. 1. Health in Disaster and Emergencies Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: V-ghanbari@razi.tums.ac.ir. 2. Health in Disaster and Emergencies Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Harvard University, Cambridge, USA. Electronic address: aardalan@tums.ac.ir. 3. Health in Disaster and Emergencies Department, School of Nursing, AJA University of Medical Sciences, Tehran, Iran. Electronic address: a.zareian@ajaums.ac.ir. 4. Health in Disaster and Emergencies Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: nejati.am@gmail.com. 5. Center for Health Security, Johns Hopkins Center for Health Security, Baltimore, MD, United States; Department of Emergency Medicine, George Washington University, Washington, DC, United States. Electronic address: Dan.Hanfling@inova.org. 6. Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, 16th Azar st, Keshavarz Boulevard, Tehran, Iran. Electronic address: bagheria@tums.ac.ir.
Abstract
INTRODUCTION: Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage. METHOD: Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients' prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included. RESULT: Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage. CONCLUSION: Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers' engagement, public education, and ongoing training are required to reach a fair decision.
INTRODUCTION: Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage. METHOD: Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients' prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included. RESULT: Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage. CONCLUSION: Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers' engagement, public education, and ongoing training are required to reach a fair decision.
Authors: Ajay K Gupta; Hani Jneid; Daniel Addison; Hossein Ardehali; Amelia K Boehme; Sanket Borgaonkar; Romain Boulestreau; Kevin Clerkin; Nicolas Delarche; Holli A DeVon; Isabella M Grumbach; Jose Gutierrez; Daniel A Jones; Vikas Kapil; Carmela Maniero; Amgad Mentias; Pamela S Miller; Sher May Ng; Jai D Parekh; Reynaldo H Sanchez; Konrad Teodor Sawicki; Anneline S J M Te Riele; Carol Ann Remme; Barry London Journal: J Am Heart Assoc Date: 2020-04-29 Impact factor: 5.501