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Triage Management, Survival, and the Law in the Age of Ebola

  • Frederick M Burkle (a1) and Christopher M Burkle (a2)

Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. (Disaster Med Public Health Preparedness. 2014;0:1-6)

Corresponding author
Correspondence and reprint requests to Frederick M. Burkle, Jr, MD, Harvard Humanitarian Initiative, 14 Story Street, 2nd Floor, Cambridge, MA 02138 (e-mail:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. FM Burkle Jr. Triage. In Antosia RE, Cahill JD, eds. Handbook of Bioterrorism and Disaster Medicine. Springer Science; 2006:11-17.

2. KL Koenig , N Dinerman , AE Kuehl . Disaster nomenclature--a functional impact approach: the PICE system. Acad Emerg Med. 1996;3(7):723-727.

3. FM Burkle Jr. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am. 2002;20(2):409-436.

12. AE Yamin . The right to health under international law and its relevance to the United States. Am J Public Health. 2005;95(7):1156-1161.

15. FM Burkle Jr, AD Redmond , DF McArdle . An authority for crisis coordination and accountability. Lancet. 2012;379(9833):2223-2225.

16. FM Burkle Jr. Population-based triage management in response to surge-capacity requirements during a large-scale bioevent disaster. Acad Emerg Med. 2006;13(11):1118-1129.

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Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
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