Disaster-planning strategy should be fair, engage stakeholders

The results of disaster-planning drills and simulations suggest that commonly used triage systems may not perform consistently in actual mass casualty events, according to a new report from Agency for Healthcare Research and Quality.

Although previous studies found that some triage processes, such as Sacco, were promising, studies generally have included small population sizes or can't validate health outcomes from real events, the report notes.

Facing events like 9/11, Hurricane Katrina, SARS, H1N1 and earthquakes around the globe in recent years, policymakers generally still have little to go on, lacking hard evidence of how to best allocate resources during mass casualty events.

"The predominant belief among authorities is that it is only a matter of time before a major natural or man-made disaster outstrips the capacity of our healthcare system to respond," the report states. "When an MCE occurs, first responders, physicians, nurses and other healthcare providers will be forced to make extremely difficult decisions about the delivery of care in the most demanding of circumstances with significant clinical, legal and ethical ramifications."

Although there's no one superior approach to allocating resources, the AHRQ found the public believes that the allocation system should save the greatest number of people, reducing death and hospitalization, and treat people fairly and equitably. In addition, the public stresses a broad, inclusive and systemic process for the nation to respond to such events.

"The public believes that resource allocation guidelines should be simple and consistent across healthcare facilities but should allow facilities some flexibility to make allocation decisions based on the specific demand and supply situation."

In addition to being fair, the process should engage all major stakeholders, which seems to work better than those that don't. Systemic processes that include experts also produce more robust products, such as critical planning or a consensus plan, the report found.

For more information:
- check out the report (.pdf)

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