Intensive care medicine: triage under resource scarcity

As long as sufficient (human and material) resources are available, all patients requiring intensive care are admitted and treated according to established criteria. If an emergency arises in which large numbers of severely ill patients require ICU treatment – for example, during a pandemic – rationing decisions will be necessary, placing considerable burdens on medical staff. This makes it all the more important that uniform criteria for ICU admission and continued occupancy should be applied throughout Switzerland.

In the spring of 2020, at the start of the COVID-19 pandemic, the SAMS, together with the Swiss Society of Intensive Care Medicine (SSICM), prepared guidelines offering practical guidance for decision-making under such difficult conditions. This document supplements the existing SAMS guidelines on «Intensive-care interventions» and thus concerns only a small proportion of patients infected with the coronavirus, namely the group of severely ill patients requiring intensive care. Patients with COVID-19 and other patients requiring intensive care are treated according to the same principles.

The guidelines on triage for intensive-care treatment under resource scarcity were published on 20 March 2020. They will be continuously adapted if experience in practice or new scientific findings so require. Below, you can find the latest version. All previous versions can be found here. For each version, the SAMS has published a Newsletter (German or French), highlighting the most important content or changes (see below).

You can find all the medical-ethical guidelines published by the SAMS in the Publications menu.

Since the «Triage guidelines» were first issued in March 2020, they have received attention well beyond the original target group and in some cases have given rise to broad media coverage. Therefore, our new website with FAQs puts the widely discussed criteria into context and explains their background both for interested members of the public and for journalists; the list of questions is being continuously updated.

FAQs in German

FAQs in French

ethix, Lab for Innovation Ethics, has also helped to broaden the debate on triage decisions. In a blog post (German/French), you can find a document presenting the key elements of the guidelines as well as a questionnaire that submits various triage scenarios for discussion.

The results of the survey (in German or French) provide information on how the ethical considerations underlying triage recommendations are evaluated by the population.

17 December 2020: ICU triage: Version 3.1 of the guidelines, including clarifications on ethical and legal aspects
German or French

4 November 2020: Updated guidelines on triage for intensive-care treatment under resource scarcity
German or French

16 April 2020: Covid-19 pandemic: interim report on patient triage in intensive care units
German or French

25 March 2020: Covid-19 pandemic: updated guidelines for triage in intensive care units
German or French

20 March 2020: Covid-19 pandemic: guidelines for triage in intensive care units
German or French

 

The coronavirus infection threatens the entire population but elderly people, who are often multimorbid and frail, are the most vulnerable to serious and fatal outcomes. Severe diseases with an unfavourable prognosis and dying situations require good palliative care for those affected. The current pandemic and the publication of the guidelines for triage decisions have prompted the Association for Geriatric Palliative Medicine (FGPG) to draw up additional practice-oriented recommendations. The SAMS welcomes this initiative.

Here you will find interviews and publications that shed light on various aspects of triage under resource scarcity in intensive care units.

Recommendations on Covid-19 triage: international comparison and ethical analysis (Bioethics, 25 September 2020)

Ethics guidelines on Covid-19 triage – an emerging international consensus (Universität Zürich, May 2020)

Covid-19: Occupancy in Swiss intensive care units between April and June 2020 (SGI, July 2020), available in German or in French.