Reflections from the field regarding the clinical commentary for augmentation therapy in the MZ phenotype.

causing numerous medically critically ill victims. The composition of our group was deliberately conceived to bring medicine, ethics, and public health experts together to collaboratively develop pragmatic, optimal clinical guidance. We knew that future work on critical care surge capability and triage for pediatric and trauma issues would be necessary, and work by Subbarao and colleagues7 has advanced additional, essential elements of triage planning. The challenges of optimal triage across the entire health-care system spectrum are many. Even the goals of triage, such as mortality vs life-years saved or other outcomes, have not received sufficient professional consideration or input from community members. Furthermore, health system situational awareness (ie, patient needs and resource availability) needs much more realtime and detailed clinical information to optimally inform centralized triage recommendations. The capability to rapidly understand the course of a disease, identify prognostic variables, and determine treatment effectiveness across the entire health-care system remains elusive for most communities. This information will be essential for sustained-response events such as epidemics, when data-driven revisions of triage guidance would be expected to ensure that our community members get the best possible care in resource-limited circumstances. Finally, regional coordination of health-care system triage will require input from many different clinical specialties and professions as well as from nonclinical community members, such as elected officials, community advocates, and at-large community members, among whom are many of the same people who must provide consultation during responses. The majority of communities must still further develop their regional health-care system coordination infrastructure to assure such clinical expert involvement.