January 4, 2022

Who should get the last bed in a hospital’s intensive care unit? As the COVID-19 pandemic continues to push hospitals to the brink of capacity, the question of triaging patients has become a common topic in public discourse. Results of new research from UNC-Chapel Hill suggest that Americans believe scarce intensive care unit (ICU) beds should be given to COVID-19 patients who have the best chance of survival, regardless of age.

Helena Cardenas

Helena Cardenas

Dr. Dale Whittington

Dr. Dale Whittington

The study, published today in Emergency Medicine Journal, was co-authored by Helena Cardenas, a doctoral student in city and regional planning at the UNC College of Arts and Sciences, and Dale Whittington, PhD, professor of environmental sciences and engineering at the UNC Gillings School of Global Public Health and professor of city and regional planning. They worked with fellow co-authors Richard Carson, PhD, professor of economics at the University of California San Diego; Michael Hanemann, PhD, Julie A. Wrigley Chair in Sustainability at Arizona State University; and Jordan Louviere, PhD, professor emeritus of marketing at the University of South Australia.

“Current guidance on triage choices is largely focused on the ethical principles that should be used,” Whittington explained. “Physicians are advised to concentrate on both the number of lives saved and the number of life-years saved. The American public does not support triage policies that would put less weight on saving the lives of older adults.

“Patient triage during the COVID-19 pandemic is different from other emergency or disaster situations for two reasons,” said Whittington. “First, COVID-19 is more dangerous for older patients. Second, emergency department physicians have had to deal with the COVID-19 crisis for a much longer time than is typical for other disasters. There is thus more time for physicians to reflect on the rules they use for making triage decisions.”

The study aimed to put average members of the American public in the shoes of an emergency department health care provider faced with a decision regarding which COVID-19 patient should receive the last available ICU bed. Understanding the mindset of the average citizen on this issue is important because it can give public health leaders insight into the kinds of triage policies in the United States that are supported by the public and therefore easier to implement.

In a survey sent to more than 2,000 households across the U.S., respondents were asked to choose which of three hypothetical COVID-19 patients – each of whom was almost certain to die without ICU treatment — should receive an ICU bed if only one was available. The three patients were different in age, gender, the presence or absence of an Alzheimer’s-like disability and the patient’s probability of survival if they received an ICU bed.

Probability of survival was the deciding factor for a majority of respondents. The age of the patient was moderately important to some respondents. For example, survey respondents under the age of 30 were more likely to choose young patients and old patients, and less likely to select patients aged 40-60 years old.

Such evidence suggests that the majority of the American public does not support a triage practice that gives lower priority to older patients or patients with disabilities.

This is perception is impactful for providers in emergency care settings, according to Whittington. “Physicians in emergency settings such as the COVID-19 pandemic can make rapid judgments based on a simple heuristic of ‘what patient has the highest probability to survive if they get the ICU bed,’ without having to consider a host of other ethical considerations.”

The team is now continuing this research in seven developing countries to understand if these results are applicable in low-income settings.

Read the full article online.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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