{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T18:15:54Z","timestamp":1761156954387},"reference-count":42,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T00:00:00Z","timestamp":1594684800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec id=\"S1935789320002323_as1\"><jats:title>Objectives:<\/jats:title><jats:p>During an influenza or coronavirus disease 2019 (COVID-19) pandemic that results in acute respiratory distress, the number of available ventilators will not meet demand. In 2007, the New York State Task Force on Life and the Law and Department of Health released draft Guidelines for ethical allocation of ventilators for adults. In 2015, updated guidelines were released to ensure that: (1) revisions reflect the public\u2019s values and (2) the triage protocol is substantiated by evidence-based clinical data. We summarize the development and content of the 2015 Guidelines compared with the 2007 version, emphasizing new\/revised aspects of the ethical considerations and clinical protocol.<\/jats:p><\/jats:sec><jats:sec id=\"S1935789320002323_as2\"><jats:title>Methods:<\/jats:title><jats:p>We compared the 2007 and 2015 guidelines, with particular emphasis on the ethical issues and clinical protocols.<\/jats:p><\/jats:sec><jats:sec id=\"S1935789320002323_as3\"><jats:title>Results:<\/jats:title><jats:p>The 2015 Guidelines retained much of the ethical and clinical framework of the 2007 draft. The triage protocol was revised using evidence-based clinical data. Patients with the highest likelihood of short-term survival with ventilator therapy have priority access. Protocol consists of exclusion criteria, the sequential organ failure assessment (SOFA) score, and periodic clinical assessments. Guidance is provided on secondary triage criteria. Other forms of medical intervention\/palliative care and review of triage decisions are discussed.<\/jats:p><\/jats:sec><jats:sec id=\"S1935789320002323_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>The 2015 Guidelines reflect advances in medicine and societal values and provide an evidenced-based framework to save the most lives. The framework could be adapted in other emergencies, such as the COVID-19 pandemic, that require ventilators.<\/jats:p><\/jats:sec>","DOI":"10.1017\/dmp.2020.232","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T06:03:51Z","timestamp":1594706631000},"page":"e35-e44","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and Ethical Considerations in Allocation of Ventilators in an Influenza Pandemic or Other Public Health Disaster: A Comparison of the 2007 and 2015 New York State Ventilator Allocation Guidelines"],"prefix":"10.1017","volume":"14","author":[{"given":"Susie A.","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie Gutmann","family":"Koch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"S1935789320002323_ref30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb2005114"},{"key":"S1935789320002323_ref8","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2020.25.11.2000285"},{"key":"S1935789320002323_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"S1935789320002323_ref27","unstructured":"27. Montana Department of Public Health and Human Services and the Montana Hospital Association. Scarce resource management & crisis care guidance. https:\/\/mtha.org\/wp-content\/uploads\/2020\/04\/Montana-Crisis-Care-Guidance-Final.pdf. Accessed May 22, 2020."},{"key":"S1935789320002323_ref37","unstructured":"37. Cummings, MJ , Baldwin, MR , Abrams, D , et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. Published online May 19, 2020. https:\/\/www.thelancet.com\/pdfs\/journals\/lancet\/PIIS0140-6736(20)31189-2.pdf. Accessed May 22, 2020."},{"key":"S1935789320002323_ref4","unstructured":"4. World Health Organization. Coronavirus disease (COVID-2019) situation reports \u2013 50. March 10, 2020. https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200310-sitrep-50-covid-19.pdf?sfvrsn=55e904fb_2. Accessed March 11, 2020."},{"key":"S1935789320002323_ref7","unstructured":"7. Italian Society of Anesthesia. Analgesia, Resuscitation and Intensive Care (Societ\u00e0 Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva [SIAARTI]). Clinical Ethics Recommendations for the Allocation of Intensive Care Treatment, in Exceptional, Resource-Limited Circumstances, Version n.1, March 16, 2020. http:\/\/www.siaarti.it\/SiteAssets\/News\/COVID19%20-%20documenti%20SIAARTI\/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf. Accessed March 26, 2020."},{"key":"S1935789320002323_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.09.025"},{"key":"S1935789320002323_ref40","unstructured":"40. World Health Organization. Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 disease is suspected, interim guidance. May 27, 2020. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/332196\/WHO-2019-nCoV-clinical-2020.5-eng.pdf?sequence=1&isAllowed=y. Accessed June 1, 2020."},{"key":"S1935789320002323_ref36","unstructured":"36. Tang, X , Du, R , Wang, R , et al. Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1. Chest. Published online March 26, 2020. https:\/\/journal.chestnet.org\/article\/S0012-3692(20)30558-4\/pdf. Accessed May 22, 2020."},{"key":"S1935789320002323_ref31","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.5046"},{"key":"S1935789320002323_ref9","unstructured":"9. McKinley, J. New York City Region is now an epicenter of the coronavirus pandemic. N.Y. Times. March 22, 2020. https:\/\/www.nytimes.com\/2020\/03\/22\/nyregion\/Coronavirus-new-York-epicenter.html. Accessed March 26, 2020."},{"key":"S1935789320002323_ref23","unstructured":"23. Baker, M , Fink, S. At the top of the Covid-19 curve, how do hospitals decide who gets treatment? N.Y. Times. March 31, 2020. https:\/\/www.nytimes.com\/2020\/03\/31\/us\/coronavirus-covid-triage-rationing-ventilators.html?searchResultPosition=6. Accessed March 31, 2020."},{"key":"S1935789320002323_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"S1935789320002323_ref10","unstructured":"10. Rosenthal, BM , Goldstein, J . N.Y. May Need 18,000 Ventilators Very Soon. It is Far Short of That. N.Y. Times. March 17, 2020. https:\/\/www.nytimes.com\/2020\/03\/17\/nyregion\/ny-coronavirus-ventilators.html?action=click&module=RelatedLinks&pgtype=Article. Accessed March 26, 2020."},{"key":"S1935789320002323_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30079-5"},{"key":"S1935789320002323_ref39","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820929640"},{"key":"S1935789320002323_ref16","unstructured":"16. World Health Organization. WHO Director-General\u2019s Opening Remarks at the Media Briefing on COVID-19. March 11, 2020. https:\/\/www.who.int\/dg\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Accessed March 11, 2020."},{"key":"S1935789320002323_ref14","unstructured":"14. New York State Workgroup on Ventilator Allocation in an Influenza Pandemic. Allocation of ventilators in an influenza pandemic: planning document. March 15, 2007. https:\/\/www.cidrap.umn.edu\/sites\/default\/files\/public\/php\/196\/196_guidance.pdf. Accessed July 11, 2020."},{"key":"S1935789320002323_ref32","unstructured":"32. Auriemma, CL , Molinero, AM , Houtrow, AJ , et al. Eliminating categorical exclusion criteria in crisis standards of care frameworks. Am J Bioeth. Published online May 18, 2020. doi\/full\/10.1080\/15265161.2020.1764141. Accessed May 22, 2020."},{"key":"S1935789320002323_ref41","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202003-0741ED"},{"key":"S1935789320002323_ref3","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med."},{"key":"S1935789320002323_ref26","unstructured":"26. University of Pittsburgh, Department of Critical Care Medicine, School of Medicine. Allocation of scarce critical care resources during a public health emergency. April 15, 2020. https:\/\/ccm.pitt.edu\/sites\/default\/files\/UnivPittsburgh_ModelHospitalResourcePolicy_2020_04_15.pdf. Accessed May 18, 2020."},{"key":"S1935789320002323_ref22","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0736"},{"key":"S1935789320002323_ref19","unstructured":"19. Ontario Health Plan for an Influenza Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge, and Triage Criteria. Critical Care During a Pandemic. April 2006. http:\/\/www.cidrap.umn.edu\/sites\/default\/files\/public\/php\/21\/21_report.pdf. Accessed March 10, 2020."},{"key":"S1935789320002323_ref17","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2006.06.032"},{"key":"S1935789320002323_ref5","unstructured":"5. Mounk, Y. The extraordinary decisions facing Italian doctors. The Atlantic. March 11, 2020. https:\/\/www.theatlantic.com\/ideas\/archive\/2020\/03\/who-gets-hospital-bed\/607807\/. Accessed March 11, 2020."},{"key":"S1935789320002323_ref18","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060911"},{"key":"S1935789320002323_ref25","unstructured":"25. Pennsylvania Department of Health and The Hospital + Healthsystem Association of Pennsylvania. Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines. March 22, 2020. https:\/\/int.nyt.com\/data\/documenthelper\/6850-pennsylvania-triage-guidelines\/02cb4c58460e57ea9f05\/optimized\/full.pdf. Accessed May 22, 2020."},{"key":"S1935789320002323_ref13","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/DMP.0b013e3181620794","article-title":"Allocation of ventilators in a public health disaster","volume":"2","author":"Powell","year":"2008","journal-title":"Disaster Med Pub Health Prep."},{"key":"S1935789320002323_ref34","unstructured":"34. US Department of Health and Human Services, Office for Civil Rights. OCR reaches early case resolution with Alabama after it removes discriminatory ventilator triaging guidelines. April 8, 2020. https:\/\/www.hhs.gov\/about\/news\/2020\/04\/08\/ocr-reaches-early-case-resolution-alabama-after-it-removes-discriminatory-ventilator-triaging.html. Accessed May 22, 2020."},{"key":"S1935789320002323_ref29","article-title":"COVID-19 pandemic: triage for intensive-care treatment under resource scarcity","volume":"150","year":"2020","journal-title":"Swiss Med Wkly."},{"key":"S1935789320002323_ref20","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1001\/jama.286.14.1754","article-title":"Serial evaluation of the SOFA score to predict outcome in critically ill patients","volume":"286","author":"Ferreira","year":"2001","journal-title":"JAMA."},{"key":"S1935789320002323_ref33","unstructured":"33. US Department of Health and Human Services, Office for Civil Rights. Bulletin: Civil rights, HIPAA, and the coronavirus disease 2019 (COVID-19). March 28, 2020, Updated April 3, 2020. https:\/\/www.hhs.gov\/sites\/default\/files\/ocr-bulletin-3-28-20.pdf?fbclid=IwAR351WokrC2uQLIPxDR0eiAizAQ8Q-XwhBt_0asYiXi91XW4rnAKW8kxcog. Accessed May 22, 2020."},{"key":"S1935789320002323_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30627-9"},{"key":"S1935789320002323_ref11","doi-asserted-by":"crossref","first-page":"18S","DOI":"10.1378\/chest.07-2690","article-title":"Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity","volume":"133","author":"Rubinson","year":"2008","journal-title":"Chest."},{"key":"S1935789320002323_ref12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2005689"},{"key":"S1935789320002323_ref21","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0742"},{"key":"S1935789320002323_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.03.063"},{"key":"S1935789320002323_ref15","unstructured":"15. New York State Task Force on Life and the Law and New York State Department of Health. Ventilator allocation guidelines. November 2015. https:\/\/www.health.ny.gov\/regulations\/task_force\/reports_publications\/docs\/ventilator_guidelines.pdf. Accessed March 10, 2020."},{"key":"S1935789320002323_ref38","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2004500"},{"key":"S1935789320002323_ref42","first-page":"467","article-title":"Unique proposals for limiting legal liability and encouraging adherence to ventilator allocation guidelines in an influenza pandemic","volume":"14","author":"Koch","year":"2013","journal-title":"DePaul J Health Care Law."}],"container-title":["Disaster Medicine and Public Health Preparedness"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1935789320002323","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T13:15:05Z","timestamp":1617974105000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1935789320002323\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,14]]},"references-count":42,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["S1935789320002323"],"URL":"https:\/\/doi.org\/10.1017\/dmp.2020.232","relation":{},"ISSN":["1935-7893","1938-744X"],"issn-type":[{"value":"1935-7893","type":"print"},{"value":"1938-744X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,14]]}}}