The COVID-19 pandemic confronted Canadians with the fact that our health care systems may not always have enough to go around. Critical care resources, specifically, were stretched far beyond the limits of what was thought possible. In the spring of 2021, the exponential growth of patients with COVID-19 brought Ontario’s ICUs frighteningly near the breaking point. When a health system’s resources are overwhelmed by the demands placed upon them, allocation of scarce resources is typically performed by triage — a formalized system to determine who receives critical care resources and who does not. In this commentary, we will explain the rationale for the use of a formal triage protocol during times of resource scarcity; review the ethical foundations of an approach to resource allocation; outline the process of triage protocol development in Ontario during the COVID-19 pandemic, and highlight some lessons learned for the future.

Funding and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.