Intensive care medicine: triage in case of bottlenecks

As long as sufficient resources are available, all patients requiring intensive care are admitted and treated according to established criteria. If an emergency situation occurs with a large number of seriously ill patients, rationing decisions will be necessary, placing considerable burdens on medical staff. This makes it all the more important that uniform criteria for intensive-care unit (ICU) admission and continued occupancy should be applied throughout Switzerland.

The SAMS, together with the Swiss Society for Intensive Care Medicine (SGI), has drawn up guidelines that form the basis for such serious decisions. The guidelines supplement the SAMS Guidelines «Intensive-care interventions» and thus concern 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 criteria.

The guidelines on the 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. You can find the latest version with publication date on this page. The previous versions can be found here.

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

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

The new guidelines on the triage for intensive-care treatment are arousing great interest both in professional circles and among the public. ethix, Lab for Innovation Ethics, aims to broaden the debate. 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 provide information on how the ethical considerations underlying triage recommendations are evaluated by the population. Thus, the majority of the participants agree in principle with the SAMS guidelines. The vast majority agree with the principle of non-discrimination. Nationality, insurance status and social value have proven to be irrelevant criteria for setting priorities. However, the age of a person who is sick with Covid-19 seems to have some influence. For 24.7% of the participants, age is a factor in their decision. 90% of the participants felt that priority access to treatment cannot be purchased, as it would violate the principle that «every life has equal value». 

On the ethix website you can find the results of the survey in 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.

SAMS President Daniel Scheidegger, himself an intensive care physician, comments on the challenges that intensive care units face during a pandemic in an interview with the Tages-Anzeiger on 18 March 2020 (article in German).

Also worth reading on this topic: the interview with Bernhard Rütsche, Professor of Public Law and Philosophy of Law, in the NZZ of 19 March 2020 (article in German).