Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis

Michael R. Ehmann, Elizabeth K. Zink, Amanda B. Levin, Jose I. Suarez, Harolyn M.E. Belcher, Elizabeth L. Daugherty Biddison, Danielle J. Doberman, Karen D'Souza, Derek M. Fine, Brian T. Garibaldi, Eric A. Gehrie, Sherita H. Golden, Ayse P. Gurses, Peter M. Hill, Mark T. Hughes, Jeffrey P. Kahn, Colleen G. Koch, Jason J. Marx, Barry R. Meisenberg, Jeffrey NattermanCynda H. Rushton, Adam Sapirstein, Stephen R. Selinger, R. Scott Stephens, Eric S. Toner, Yoram Unguru, Maureen van Stone, Allen Kachalia

Research output: Contribution to journalArticlepeer-review


The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium—with diverse expertise and representation—representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens’ values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource's varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes.

Original languageEnglish (US)
Pages (from-to)1076-1083
Number of pages8
Issue number3
StatePublished - Mar 2021


  • COVID-19
  • disaster planning
  • healthcare rationing
  • medical ethics
  • triage

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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