• James Downar, Maxwell J Smith, Dianne Godkin, Andrea Frolic, Sally Bean, Cecile Bensimon, Carrie Bernard, Mary Huska, Mike Kekewich, Nancy Ondrusek, Ross Upshur, Randi Zlotnik-Shaul, and Jennifer Gibson.
• Division of Palliative Care, Department of Medicine, University of Ottawa, 43 Rue Bruyère St. 268J, Ottawa, ON, K1N 5C8, Canada. jdownar@toh.ca.
• Can J Anaesth. 2022 Jun 1; 69 (6): 774781774-781.

AbstractDuring the COVID-19 pandemic, many jurisdictions experienced surges in demand for critical care that strained or overwhelmed their healthcare system's ability to respond. A major surge necessitates a deviation from usual practices, including difficult decisions about how to allocate critical care resources. We present a framework to guide these decisions in the hope of saving the most lives as ethically as possible, while concurrently respecting, protecting, and fulfilling legal and human rights obligations. It was developed in Ontario in 2020-2021 through an iterative consultation process with diverse participants, but was adopted in other jurisdictions with some modifications. The framework features three levels of triage depending on the degree of the surge, and a system for prioritizing patients based on their short-term mortality risk following the onset of critical illness. It also includes processes aimed at promoting consistency and fairness across a region where many hospitals are expected to apply the same framework. No triage framework should ever be considered "final," and there is a need for further research to examine ethical issues related to critical care triage and to increase the extent and quality of evidence to inform critical care triage.© 2022. The Author(s).

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