Corona in the clinics: is Germany threatening triage?



FAQ

Status: 11/30/2021 4:21 am

With daily corona record values, the number of serious illnesses is also increasing: More than 4,300 Covid patients are currently in intensive care units. What if the beds are no longer enough?

By Lilly Zerbst and Antonia Weise, SWR

What does triage mean and is it already taking place?

According to Michael Hallek, ambulances have to go to several clinics in some places to find an intensive care place. Hallek is Director of Clinic I for Internal Medicine at Cologne University Hospital. It also happens that interned intensive care patients have to be transferred to other hospitals or wards. According to the German Hospital Association, predictable operations are currently being postponed in more than three quarters of hospitals. In particular, operations with subsequent intensive treatment are now on the decline, according to the German Society for Anesthesiology and Intensive Care Medicine (DGAI).

Strictly speaking, this is not yet triage. Triage means that doctors have to prioritize patients according to their likely chances of recovery. You then have to decide who to give ICU beds to. However, all acute intensive cases can still be treated, albeit under difficult circumstances. Many therefore speak of a “soft” or “latent” triage.

But if the infection escalates further, a triage situation will arise, warns the chairman of the World Medical Association, Frank Ulrich Montgomery: “We are all preparing for triage.” Even the president of the professional association of German anesthetists, Götz Geldner, sees no hope of relieving the clinics for the time being.

The shortage of nurses in Germany has an additional impact on the number of intensive care beds. Many nurses quit their jobs in hospitals or work less because the stress is too high. According to doctors, Germany has lost around 4,000 intensive care beds since the beginning of the year.

What criteria are used to prioritize in an emergency?

Doctors now have to prepare for an emergency: If a triage situation arises, they decide which people are given priority treatment. At least three doctors must be involved in a triage decision. The only thing that counts is the “criterion of the clinical prospect of success”, i.e. the survival probability of the individual patient. This is determined by the clinical-ethical recommendations of seven German professional associations for intensive care and rescue medicine.

According to the “Guideline for prioritization and triage in the event of an acute shortage of resources”, the following applies: Vaccinated and unvaccinated persons are treated equally. This complements the principle of equality, according to which all patients are treated equally regardless of age and social criteria. The type of illness, the cause of the illness and the previous behavior of the patient should also not play a role in the treatment.

According to the guideline, patients for whom postponing treatment does not worsen the prognosis or cause irreversible damage to health have a low priority. The recommendation is: Plannable operations should be postponed when the intensive workload is high. The German Foundation for Patient Protection has sharply criticized this: the ability to plan operations is defined as “vague”. It calls for clear criteria for which operations should be postponed in an emergency. Until now, every hospital had to determine this itself, criticized the foundation’s board member Eugen Brysch in relation to the AFP news agency.

Where is the situation particularly critical?

The corona-related exposure of the intensive care units in Bavaria, Thuringia and Saxony is particularly high. More than 30 percent of the intensive care beds there are occupied by Covid patients. The situation is currently critical (as of November 29, 2021) in southeast Bavaria on the border with Austria and in northern Thuringia in the Kyffhäuserkreis and in Sömmerda. Some of the intensive care beds there are occupied.

To relieve the burden, the first seriously ill Covid patients were relocated from Thuringia to Lower Saxony last Thursday. On Friday, the Bundeswehr moved more sick people from Bavaria to North Rhine-Westphalia. A total of 80 patients are to be relocated nationwide for the time being, of which 50 are expected from Bavaria.

A nationwide transfer of intensive care patients is still possible at the moment, as the situation in the intensive care units in northern and western Germany is comparatively less critical.

As a rule, hospitals should keep an immediately available intensive care bed free for emergencies. In order to relieve the clinics in the long term, relocations abroad must also take place in the future, demands the head of the World Medical Association, Montgomery.


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