Intensive care medicine: triage under resource scarcity

SAMS » Ethics » Topics A–Z » Intensive care medicine

As intensive care measures can be very stressful for all concerned, the SAMS in 2013 issued medical-ethical guidelines on «Intensive-care interventions» to support health professionals. Since 2020, the coronavirus (SARS-CoV-2) has created additional challenges for intensive care units (ICUs). Therefore, the SAMS prepared an annex on triage decisions under exceptional resource scarcity, supplementing the 2013 guidelines. The document has been updated several times and is meanwhile less strongly focused on Covid-19 patients.

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 or due to a natural hazard – 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.

 

The overarching goal is to ensure that, even under exceptional resource scarcity, as many lives as possible can be saved with the resources available, irrespective of the disease or injury leading to hospitalisation.

 

 

Guidelines

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

 

 

FAQs for interested members of the public

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 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

 

 

Background

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 for intensive care triage under exceptional resource scarcity offering practical guidance for decision-making. The guidelines were first published on 20 March 2020. They will be continuously adapted if experience in practice or new scientific findings so require. On this page, you can find the latest version. All previous versions can be found here.

 

 

SAMS Newsletter on the subject

For each version of the guidelines, the SAMS has published a Newsletter (German or French), highlighting the most important content or changes. The summaries of these Newsletters in English can be found on the chronology page.

 

23 September 2021: Intensive care triage: medical-ethical guidelines updated (Version 4)
German or French

 

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

 

A large ethical debate and public survey

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 (Versions 1 and 2) 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.

 

 

International comparison of guidelines

 

 

 

CONTACT

lic. theol., dipl. biol. Sibylle Ackermann
Head Department Ethics