It may be unrealistic and impractical to expect that senior medical intensive care staff will make all decisions regarding instituting critical care and there will be a need to empower more referring general clinicians to do so. This is at odds with the need for decision making by the most senior person [32] and will require a change in practice for many clinicians; it is not current practice in the UK. The use of track and triage protocols will be essential to direct this decision making and ensure its consistency. Ardagh [38] has developed a set of pragmatic questions for the clinician facing acute problems of resource allocation; the only point lacking in his assessment process is a tool for the 'ranking' of patients in terms of likelihood of benefit from the limited resources.