North Carolina Protocol for Allocating Scarce Inpatient Critical Care Resources in a Pandemic

News | January 19, 2021



The COVID-19 pandemic has necessitated the revival of efforts by North Carolina experts to develop a statewide protocol for the allocation of scarce critical care resources, to be effective only during a Governor’s declared state of emergency (NCGS §166A) due to a pandemic, and when demand for critical care resources exceeds supply. To this end, on Thursday, March 26, 2020, the North Carolina Institute of Medicine (NCIOM), the North Carolina Medical Society (NCMS), and the North Carolina Healthcare Association (NCHA) convened a Scarce Critical Care Resource Allocation Advisory Group (advisory group) to raise awareness, obtain stakeholder input, and synthesize feedback on a draft revised protocol for allocating scarce inpatient critical care resources during the crisis stage of a pandemic. On March 31, 2020, NCIOM, NCMS, and NCHA convened an additional group (health care stakeholder group), comprised of representatives from most major health systems in the state, for additional discussion and review.


Representatives from NCIOM, NCMS, and NCHA revised the draft protocol in January 2021 at the request of, and in partnership with, the U.S. Department of Health and Human Services Office of Civil Rights (OCR). On January 14, the NC Department of Health and Human Services adopted and posted the protocol on its website ( after receiving approval from OCR, and the protocol has been incorporated into the NCEM North Carolina Emergency Operations Plan. The OCR issued a media release following the revision of the protocol.


The protocol is being shared with health systems throughout the state. While current conditions do not necessitate use of the protocol, thanks to the collaborative work of this diverse group of stakeholders the state is better prepared should such a situation present itself.


The protocol was developed in extensive consultation with state experts in several clinical specialties (including intensive care, pediatrics, palliative care, emergency medicine, family medicine, psychiatry, infectious disease, nephrology, and anesthesiology), nursing, spiritual care, ethics, law, and public health. Advisors also included representatives from community and advocacy groups representing racial and ethnic minorities, vulnerable populations, people with disabilities, older adults, and faith communities. The role of the convening organizations (NCIOM, NCMS, and NCHA) was to facilitate discussion and synthesize feedback from these groups to inform the development of a recommended protocol consistent with other state and federal protocols for allocating scarce critical resources during a pandemic.