Systematic Review of Strategies to Manage and Allocate Scarce Resources During Mass Casualty Events

• Published in: Annals of emergency medicine 2013-06, Vol.61 (6), p.677-689.e101
• Main Authors: Timbie, Justin W., PhD, Ringel, Jeanne S., PhD, Fox, D. Steven, MD, MSc, Pillemer, Francesca, PhD, Waxman, Daniel A., MD, Moore, Melinda, MD, MPH, Hansen, Cynthia K., PhD, Knebel, Ann R., PhD, Ricciardi, Richard, PhD, NP, Kellermann, Arthur L., MD, MPH
• Format: Article
• Language: English
• Subjects: Disaster Medicine - methods; Disaster Planning - methods; Emergency; Humans; Mass Casualty Incidents; Resource Allocation - methods; Triage - methods
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2013.02.005

Study objective Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. Methods Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. Results From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of distribution. Second, as a strategy to optimize use of existing resources, commonly used field triage systems do not perform consistently during actual mass casualty events. The number of high-quality studies addressing other strategies was insufficient to support conclusions about their effectiveness because of differences in study context, comparison groups, and outcome measures. Our literature search may have missed key resource management and allocation strategies beca