Prof. Silvia Camporesi

The pandemic has revealed the tragic reality of triage: in extraordinary situations, triage interventions may not be able to save all lives.

However, even in ordinary, non-disaster contexts, the principles underlying triage intervention demand careful consideration. First, triage remains a daily reality in various healthcare systems, particularly in the Global South, where resources are limited.

One of the many examples of triage classifications.

Second, triage criteria and procedures are seldom transparent, accessible, or justified to the public. Further, they are also rarely consistent across different countries, and even within the same country, different hospitals will often adopt a different triage system. That means that an ED patient in Bristol and an ED patient in Leeds, with the same condition, might be assigned different colours, corresponding to different priorities. Some of this variability is inherent in the system: different operators will rank patients differently within a certain expected margin. However, some of this procedural inconsistencies are avoidable. To this end, the criteria used to rank patients should be made publicly accessible, and transparent. Therefore, an in-depth conceptual and empirical exploration of ED triage in ordinary circumstances is needed to promote fair and legitimate ED triage in everyday life.

Our paper (doi: jme-2023-109188) addresses this need by proposing five requirements that should be respected to ensure a fair triage from the point of view of procedural fairness, building on the seminal work of “accountability for reasonableness” proposed by Daniels and Sabin, and applying it to the context of EDs. We also outline conceptual and empirical research questions to determine whether ED triage meets the five requirements of procedural fairness, particularly in specific national or state contexts. This is a vastly under-researched area in bioethics, at the convergence of emergency medicine, theories of justice, and democratic theory. We hope that, like us, you will find it important and fascinating and will decide to contribute to its development.

The paper can be accessed here:

https://jme.bmj.com/content/early/2023/08/24/jme-2023-109188

If you’d like to read the paper however don’t have institutional access to the journal please drop me a note to request the PDF –> silvia.camporesiATunivie.ac.at

#emergencydepartments #ED #triage #fairness #resourceallocation #justice #bioethics #medicalethics