When I was a registrar in Edinburgh in early 1990's we helped train SAS medics in Emergency Medicine over a few months in the department on placement. Thread 1/-

They used to ask brilliant thought-provoking "hypothetical" questions about use of scarce medical resources in the field with limited resupply and medical evacuation impossible. 2/-

One was about splitting limited supplies of plasma expander () across several injured personnel with severe haemorrhage (at that time treatment as per ATLS): all to one key individual or a bit to several? 3/-

Another was about giving half courses of antibiotics for two or more personnel with badly infected wounds, versus full courses for either most serious, most indispensable, or most salvageable casualties. 4/-

30 years of EM later, utilitarianism informs career defining paradigms: triage at the door, major incident priorities, doing the most for the most, perfect is the enemy of good, in charge of a whole department not just any one patient. 5/-

So now, with limited supplies of vaccine, do you half treat many staff and potential patients outside of the evidence base using a brand new drug, against a brand new pathogen that already is rapidly mutating to become more infectious in an uncontrolled pandemic? 6/-

Or do you fully treat most vulnerable groups and those staff exposed to greatest risk according to the evidence supplied by scientists who have worked at extraordinary pace to come up with a very specific regime that seems to actually work? 7/-

Feels like those hypothetical SAS scenarios just became real life. Front line health staff sacrificing some of their protection to help vulnerable others for the greater good, which may, or may not, save more lives overall. End.