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INTRODUCTION Pandemics generate such significant demand for care that traditional triage methods can become saturated. Secondary population-based triage (S-PBT) overcomes this limitation. Although the COVID-19 pandemic forced S-PBT into operation internationally during the first year of the pandemic, Australian doctors were spared this responsibility. However, the second wave of COVID-19 provides an opportunity to explore the lived experience of preparing for S-PBT within the Australian context. OBJECTIVE To explore the lived experience of preparing to operationalize S-PBT to allocate critical care resources during Australia’s second wave of COVID-19 in 2020. METHODS Intensivists and emergency physicians working during the second Victorian COVID-19 surge were recruited by purposive non-random sampling. Semi-structured interviews were hosted remotely, recorded, transcribed and coded to facilitate qualitative phenomenological analysis. RESULTS Six interviews were conducted with an equal mix of intensivists and emergency doctors. Preliminary findings from thematic analysis revealed four themes: (1) threat of resources running; (2) informed decision requiring information; (3) making decisions as we always do; and (4) a great burden to carry. CONCLUSION This is the first description of this novel phenomenon within Australia and, in doing so, identified a lack of preparedness to operationalize S-PBT during the second wave of COVID-19 in Australia.

The COVID-19 pandemic brought attention to scarce clinical resource allocation via secondary population-based triage (S-PBT) throughout the international healthcare community. Experiences overseas highlighted the importance of coordinated and consistent approaches to allocating resources when facing overwhelming demand, particularly for critical care. Noting the importance of consistency and the system of devolved governance deployed in Australia, this study aimed to identify and analyse sources of high-level policy that affect Australia’s health system preparedness for the operationalisation of S-PBT. Of the 39 documents reviewed, 17 contained potential references to S-PBT. There was a lack of clear recommendations and guidance to inform S-PBT operationalisation and, where provided, advice conflicted between documents. Many jurisdictions did not detail how S-PBT would be operationalised and failed to delineate stakeholder responsibilities. These results are important as they reveal a lack of high-level jurisdictional policy preparedness for coordinated and consistent S-PBT operationalisation. These results offer insights and opportunities for enhanced disaster preparedness as clinicians, policymakers and academics critically reflect on pandemic responses. The results show a need for enhanced preparedness around the management of overwhelming demand and clinical resource management in Australia.