Chest
Original Research: Disaster MedicineScarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study
Section snippets
Study Approach
The study used a constructivist theoretical outlook and a deliberative democracy methodology based on the assessment that how best to apportion limited life-saving resources in a disaster is a potentially divisive policy issue, as well as one in which technical and normative aspects are tightly interwoven.9 Democratic deliberation provides a structured process through which citizens can learn relevant facts about a public policy matter and explore their own views and those of their peers in an
Results
We convened eight lay forums, including two pilot forums, and seven health-care and disaster worker forums. Of the total 324 forum participants, demographic data were available for 311 (Table 4). Of note, when appropriate we have included the responses of the pilot meeting participants in the overall analysis of findings included here. Key forum themes gleaned from the qualitative portion of our study are summarized in the following section.
Discussion
This novel application of deliberative democratic methods in exploration of a challenging sensitive health policy issue allowed identification of key principles from which to build a functional framework that would have a high likelihood of broad acceptability. Moreover, it generated a nuanced qualitative understanding of citizens’ perspectives on key principles, demonstrating places and ways in which those perspectives vary across one diverse state. This understanding is essential to building
Conclusions
Our effort to engage the community in a discussion about key principles prior to drafting a framework for allocating scarce life-saving resources in a disaster represents an important shift. We believe that listening to the values of the community that an allocation framework intends to serve will strengthen its development. Eliciting and incorporating community input should also have the practical benefit of enhanced public “buy-in” and support for the framework, which will be especially
Acknowledgments
Author contributions: E. L. D. B. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. E. L. D. B., H. G., M. S. S., A. R., R. F., C. J., and E. T. contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.
Financial/nonfinancial disclosures: None declared.
Other contributions: The authors would like to acknowledge Jacquie Toner, PhD, for her efforts as
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FUNDING/SUPPORT: This study was funded by the Maryland Department of Health and Human Services through the Hospital Preparedness Program. Johns Hopkins Medicine Institutional Review Board IRB-X approved this project (protocol numbers NA_00070411 and IRB00065482).