Canadian emergency medicine and critical care physician perspectives on pandemic triage in COVID-19


  • Ali Mulla, MD, MSc
  • Blair L. Bigham, MD, MSc, DTMH
  • Andrea Frolic, MA, PhD
  • Michael D. Christian, MD, MSc, FRCPC



psychological stress, surge capacity, triage, health policy, COVID-19


Introduction: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic.

Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes toward triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.

Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65 percent), as well as fears of psychological distress if required to triage scarce resources (77 percent). Only 49 percent of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 versus 2.9/5 p = 0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 versus 4.0/5 p = 0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medicolegal protection, additional tools for therapeutic communications, and healthcare provider psychological support.

Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.

Author Biographies

Ali Mulla, MD, MSc

Emergency Medicine Physician, Trillium Health Partners, Mississauga, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Blair L. Bigham, MD, MSc, DTMH

Emergency Medicine Physician, Critical Care Fellow, Stanford University, Stanford, California; Stanford University Medical Centre, Palo Alto, California

Andrea Frolic, MA, PhD

Director of the Program for Ethics and Ecologies of Care, Hamilton Health Sciences, Hamilton, Canada; Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, Canada

Michael D. Christian, MD, MSc, FRCPC

Research & Clinical Effectiveness Lead, London’s Air Ambulance, Barts NHS Health Trust, London, United Kingdom


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How to Cite

Mulla, MD, MSc, A., B. L. Bigham, MD, MSc, DTMH, A. Frolic, MA, PhD, and M. D. Christian, MD, MSc, FRCPC. “Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19”. Journal of Emergency Management, vol. 18, no. 7, July 2020, pp. 31-35, doi:10.5055/jem.2020.0484.