Priority Rules and Triage¶

Why It Matters¶

Scarcity requires rationing. The question isn't whether to prioritize but which priority rule to use. Different rules advantage different groups and generate different outcomes. Making priority rules explicit enables evaluation and accountability.

The Key Move¶

When demand exceeds supply, identify the implicit priority rule: Temporal (first-come)? Need-based (sickest first)? Outcome-based (best prognosis)? Contribution-based (essential workers)? Random (lottery)? Evaluate whether the rule matches the context and values at stake.

Classic Application¶

Emergency medicine triage. Classic system: immediate care for survivable urgent cases, delayed care for non-urgent, expectant care for likely non-survivable. Explicitly prioritizes where intervention makes most difference, not greatest need or equality.

Surprising Application¶

Code review queues. What priority rule? Temporal (oldest first)? Impact (critical path)? Contributor status (core vs. external)? Difficulty (easy wins first)? Teams often use implicit inconsistent rules, generating frustration. Making rules explicit enables optimization and fairness evaluation.

Failure Modes¶

• Using first-come-first-served when other priorities are more important (organ allocation)
• Optimizing for average outcomes when distribution matters (triage favoring survivable cases may abandon most critical)
• Treating all priority rules as ethically equivalent when they encode different values
• Failing to communicate priority rules, causing perceived unfairness

Go Deeper¶

Roth, "Who Gets What and Why" on matching markets and priority rules; Persad et al., "Principles for Allocation of Scarce Medical Interventions" (2009).