• Michael D Christian, Laura Hawryluck, Randy S Wax, Tim Cook, Neil M Lazar, Margaret S Herridge, Matthew P Muller, Douglas R Gowans, Wendy Fortier, and Frederick M Burkle.
• Division of Infectious Diseases & Critical Care, Department of Postgraduate Medicine, McMaster University, Hamilton, Ont. michael.christian@utoronto.ca
• CMAJ. 2006 Nov 21;175(11):1377-81.

BackgroundThe recent outbreaks of avian influenza (H5N1) have placed a renewed emphasis on preparing for an influenza pandemic in humans. Of particular concern in this planning is the allocation of resources, such as ventilators and antiviral medications, which will likely become scarce during a pandemic.MethodsWe applied a collaborative process using best evidence, expert panels, stakeholder consultations and ethical principles to develop a triage protocol for prioritizing access to critical care resources, including mechanical ventilation, during a pandemic.ResultsThe triage protocol uses the Sequential Organ Failure Assessment score and has 4 main components: inclusion criteria, exclusion criteria, minimum qualifications for survival and a prioritization tool.InterpretationThis protocol is intended to provide guidance for making triage decisions during the initial days to weeks of an influenza pandemic if the critical care system becomes overwhelmed. Although we designed this protocol for use during an influenza pandemic, the triage protocol would apply to patients both with and without influenza, since all patients must share a single pool of critical care resources.

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