Burn-specific triage guidelines in state-based crisis standards of care

Author(s):
Rabia Nizamani; Booker King; Felicia Williams

Background:

In times of crisis, medical institutions must utilize contingency plans to ensure the highest quality of patient care. When these plans are overwhelmed, crisis standards of care may be adopted, resulting in modifications in resource allocation. The current coronavirus pandemic has created tremendous strains on hospitals throughout the world, with periodic shortages in equipment, PPE, ICU beds, and personnel. These pressures have been great enough at times to result in several states implementing crisis standards of care to allow hospitals to triage patients and “do the most good possible for the largest number of people with limited resources”. However, these guidelines may not account for the unique needs of burn patients, whose care is often resource intensive.

Hypothesis:

We hypothesized that the majority of state-specific crisis standard of care guidelines would not provide guidance for appropriate triage of an acute surgical population, burn patients.

Methods:

Internet search engines were used to locate state-specific actionable “crisis standards of care” or “scarce resource allocation” policies available by December 15, 2021. Once identified, these guidelines were further examined to determine whether explicit information was provided to direct the triage of burn patients.

Results:

Of the 50 states and the District of Columbia, only 37 states (74%) were confirmed to have official crisis standards of care policies that could be implemented by healthcare institutions during the current pandemic. Additionally, guidelines from non-governmental entities were identified for 5 states (Florida Bioethics Network, Ohio Hospital Association, Maine Hospital Association, Missouri Hospital Association, and West Virginia Hospital Association). Of the 42 plans available, only 13 (31%) provide specific information regarding triage of burn patients during implementation of crisis standards of care. Thus, 74% of states and the District of Columbia do not provide any guidance for triage of burn patients when resource levels reach a critical stage.

Conclusions:

Crisis standards of care are heterogenous throughout the United States and have varying levels of specificity. The majority of states and the District of Columbia do not provide clear, actionable guidance on the triage of burn patients during the current coronavirus pandemic. Without specific criteria, burn patients may be mis-triaged by providers who lack experience in treating them.