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The good, the bad and the ugly: pandemic priority decisions and triage.
Flaatten, Hans; Van Heerden, Vernon; Jung, Christian; Beil, Michael; Leaver, Susannah; Rhodes, Andrew; Guidet, Bertrand; deLange, Dylan W.
  • Flaatten H; Department of Anaesthesia, Haukeland Universitetssjukehus, Bergen, Norway hans.flaatten@uib.no.
  • Van Heerden V; Intensive Care and Department of Clinical Medicine, Haukeland Universitetssjukehus, Bergen, Norway.
  • Jung C; General Intensive Care Unit, Hadassah Medical Center, Jerusalem, Jerusalem, Israel.
  • Beil M; Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany.
  • Leaver S; General Intensive Care Unit, Hadassah Medical Center, Jerusalem, Jerusalem, Israel.
  • Rhodes A; Intensive Care and Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, London, UK.
  • Guidet B; St George's University Hospitals NHS Foundation Trust, London, London, UK.
  • deLange DW; Assistance Publique, Hôpitaux de Paris, Hôpital Saint­Antoine, Service de Réanimation Médicale, Paris 75012, France.
J Med Ethics ; 2020 Jun 10.
Article in English | MEDLINE | ID: covidwho-595707
ABSTRACT
In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Language: English Year: 2020 Document Type: Article Affiliation country: Medethics-2020-106489

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Language: English Year: 2020 Document Type: Article Affiliation country: Medethics-2020-106489