Allocating mechanical ventilators during mass respiratory failure: Kudos to New York State, but more work to be done.

In this issue of Disaster Medicine and Public Health Preparedness, Powell et al1 summarize the efforts of the New York State Workgroup on Allocation in an Influenza Pandemic to develop guidance for allocation of scarce mechanical ventilators during a severe influenza pandemic. In the United States, a core societal expectation is nearly limitless provision of critical care to those who want it and who have acute organ failure.2–5 Provision of usual critical care for the many additional patients anticipated during disasters such as a severe influenza pandemic poses an insurmountable challenge for most communities.6 When efforts to augment critical care are insufficient to meet need, and there is no fair and just system to allocate scarce life-sustaining interventions, then community trust in the broader health care delivery system may cease, thereby compromising the entire medical and public health response.