Switzerland | |
How | What |
Planning ahead | Depending on the development of pressure on care facility capacity and the scale of the patient influx, two stages can be distinguished in relation to the criteria for triage decisions: stage A—ICU beds available but capacity limited, and stage B—no ICU beds available. For each stage there are criteria for admission to ICU beds. |
Proportionate care | For admission, highest priority is to be accorded to those patients who will benefit most from IC. |
Distributive justice and triage procedures: | Consideration of additional criteria as lotteries, «first come, first served» and prioritisation according to social usefulness are not to be applied. Available resources are to be allocated without discrimination—that is, without unjustified unequal treatment on grounds of age, sex, residence, nationality, religious affiliation, social or insurance status, or chronic disability. |
Preserving as many lives as possible | If ICU capacity is exhausted, the short-term prognosis is decisive for the purpose of triage. The aim is then to maximise benefits for the individual patient and for patients collectively—to save the largest possible number of lives. Age in itself is not to be applied as a criterion. Age is, however, indirectly taken into account under the main criterion «short-term prognosis», since older people more frequently suffer from comorbidity. In stage A, the triage criteria are clinical, related to the basal morbid condition; in stage B age >85 is an exclusion criterion, such as age >75 and the presence of liver cirrhosis or stage II chronic kidney disease or NYHA >I heart failure. All patients COVID-19 and non-COVID-19 requiring IC are treated according to the same criteria. |
Protection of professionals | Reference to the protection of the professionals since if they are unable to work more deaths will occur under scarcity. They are to be protected as far as possible against infection, but also against excessive physical and psychological stress. Professionals whose health is at greater risk are to be especially protected and should not be deployed in the care of patients with COVID-19. |
Precaution | The decision-making process must be managed by experienced professionals, whenever possible, within a multidisciplinary team. Ultimately, however, responsibility is borne by the most senior person present. |
Respect for patient autonomy | It is important to discuss in advance—with all patients capable of doing so—the patients’ wishes in the event of possible complications. |
Transparency | Individual clinical decisions must be documented in writing, including a statement of reasons and the name of the person responsible. Any deviation from the specified criteria must be documented. All mechanisms should be in place for subsequent review of conflicts. |
IC, intensive care; ICU, intensive care unit.