CHEST Guidelines-Triage

Triage_chest
Pdf Summary
The "CHEST Consensus Statement" on triage amid pandemics and disasters emphasizes the need for a structured, ethical approach to critical care triage as a last resort. This document outlines key concepts for handling situations where the number of critically ill patients surpasses available healthcare resources. Despite reviewing literature and previous recommendations, the panel found insufficient quality studies to support evidence-based guidelines, hence, it offers expert opinion-based suggestions derived through a Delphi process.<br /><br />The consensus outlines 11 core suggestions for triaging critically ill patients during emergencies. It advises the implementation of a uniform triage process in hospitals within a geographical region to ensure equitable resource allocation. Critical care should only be rationed when resources are, or soon will be, overwhelmed, and a legally authorized regional authority must declare an emergency.<br /><br />Furthermore, oversight of triage decisions is recommended to ensure adherence to validated processes, involving documentation and periodic updates to protocols based on new information. Establishing a formal legal framework to guide triage operations in emergencies is also highlighted.<br /><br />The statement prioritizes triage based on the potential for improved survival rather than on a first-come, first-served basis, advocating for trained triage officers to make informed resource allocation decisions. When feasible, clinical decision support systems (CDSS), supplemented with technologies like telemedicine, should be used to enhance the triage process.<br /><br />Crucially, the document calls for the development of inclusion and exclusion criteria tailored to the scale of the incident, ensuring efficient resource use. It stresses the necessity of frequent reassessments to refine the allocation of resources, and it suggests maintaining an appeals mechanism to address deviations or new clinical information impacting triage decisions. Overall, this CHEST consensus statement provides a foundational framework for critical care triage planning, underscoring the importance of readiness and ethical prioritization during healthcare system surges.
Keywords
triage
pandemics
disasters
critical care
resource allocation
Delphi process
triage officers
clinical decision support
telemedicine
ethical prioritization