Triage is a process routinely used in medicine, generally under conditions of crisis — in the wake of battles, or when disaster strikes — when the number of patients in peril overtakes the capacity to treat everyone to the optimal level. A system of priorities is brought to bear on the allocation of resources, with the aim of securing the survival of the most people possible.

Most regular folks outside the health-care system never had to contemplate this grim decision-making process, until COVID-19 brought it out, front and center. This is indeed a global disaster, a battle that put hospitals worldwide under extreme duress. The state has settled on its “crisis standards of care,” guidance for rationing care, should that become necessary.

Despite a recent easing in hospitalizations, state health officials assert that intensive-care beds are still in short supply, so the issue of what to do if hospitals become overwhelmed is still relevant.

However, the public remains shaken by the way the guidance was presented, particularly regarding specific age thresholds.

The updated Crisis Standards of Care Triage Allocation Framework (posted on the state Department of Health website: bit.ly/398XbXB), states that age 65-plus would be considered for prioritizing treatment in a “tie-breaking situation,” when two patients have otherwise equivalent health conditions.

The reasoning, according to the document, is that evidence from the pandemic shows age of 65 or older is an “indicator for poor prognosis in COVID-19 patients.”

Understandably and unfortunately, some people 65 and older now fear their birthday will be enough to deny them access to medical care in a crisis.

State leaders — headed by the team of 21 medical professionals who developed the guidance — should take the opportunity now to amend it so it does not draw such a bright line at a specific age. Many states have such guidance for this pandemic, but not all are as pointed about age.

In the Honolulu Star-Advertiser’s Wednesday “Spotlight Hawaii” webcast, Dr. Libby Char, state health director, noted that the age factor was applied early in the pandemic: The vulnerability of seniors to COVID-19 put them in front of the vaccination line. An outbreak at the nursing facility Care Center of Honolulu, which came to light this week, reminds us that our kupuna remain at heightened risk.

The question is how specifically age should be applied in allocating health care resources. Two advocacy groups for seniors, AARP-Hawaii and Kokua Council, want age removed as a factor.

Char countered that the framework does not weigh age as an independent factor in sorting through cases, but only considers it in decisions among patients with the same triage score. Given all the health data the hospital is assessing, that would be a rare instance.

This is not the only example of a “life-cycle” factor in medical decision-making. Age figures into selecting a patient to receive an organ transplant; when such a scarce resource is being allocated, survivability does matter.

However, the guidance here could incorporate age more generally among the tie-breakers without marking the boundary specifically. The decision should be based on metrics of health condition, and the doctor in charge should make the call on that basis. Still, it’s difficult to see how age can automatically be excluded from an otherwise thorough medical calculus.

And whether or not the patients have been vaccinated should enter into the matter only to the extent that its added layer of protection affects the individual’s condition at that point.

Hawaii may not have to use what Char called a “disaster plan.” But the furor over triage standards signals that the state should do what it can to avoid unnecessary alarm. The public has enough to worry about.