Triage is one of the most difficult decisions a hospital has to make. In view of the increasing corona numbers, however, it could soon become everyday life.
Frankfurt – The corona crisis is getting worse. The number of corona cases in Germany is rising steadily and the occupancy rate in hospitals is worse than ever. Every day, new Covid 19 patients are sent to intensive medical treatment and bring the hospital staff and the infrastructure of the German health system to their limits.
In many places, adequate treatment can no longer be guaranteed. In some federal states, triage is already threatening. More and more people are being transferred to the normal ward earlier “as medically justifiable”. “We can no longer offer all patients the best possible treatment […] that we usually have available,” explained the chairman of the board of the German Hospital Association, Gerald Gaß. This is already a form of triage.
Corona: Triage in the intensive care unit – a decision about life and death
Coming from the French military, the term triage during the corona pandemic describes the decision about which people get access to intensive care treatment and which not. In principle, a triage decision should be based on the patient’s chances of success. This represents an enormous emotional and moral challenge for the treating team. To date, no generally accepted or even binding triage scheme has emerged that supports the decision about life and death.
There are still a few clues. “Unless otherwise avoidable, those patients who have very little chance of survival are not treated in intensive care. In contrast, intensive care is given to those patients who have a higher probability of survival as a result of these measures, ”says a document written by several medical societies on the subject of triage during the corona pandemic. All patients must be included in the selection to be made. A selection only among Covid 19 sufferers is not justifiable. Social characteristics, age or underlying diseases should also not play a role. The role of vaccination status has also already been discussed.
Corona pandemic: Triage does not only affect people with Covid-19
According to the German Hospital Association, three quarters of all clinics nationwide are no longer in normal operation. Thousands of operations are postponed, patients in critical condition sometimes have to be transported over long distances to get a free intensive care bed. People in whose favor the triage decision was made will be saved for a long time to come. According to the Hamburg intensive care doctor Stefan Kluge, the mortality rate with Covid-19 in the intensive care unit is between 30 and 50 percent. More than one in two people with an artificially attached lung does not make it.
The occupancy of the intensive care beds also affects non-corona sufferers. “100,000 Covid-19 deaths are not the only deaths from this pandemic,” criticized the medical lawyers association. This refers, for example, to inadequately treated cancer patients or people for whom tumor operations have been postponed.
Large clinics “are currently working through lists of priorities,” explained Jürgen Graf, medical director of the Frankfurt University Hospital. He also heads the planning team for the inpatient care of Covid 19 patients in Hesse. Most of the treatment cases in his home are emergencies and acute cases. As always, they would be treated according to urgency. “We are now entering an area where we have to prioritize which services we can still provide and which not.” It is expressly not about the fact that a clinic cannot or does not want to accept Covid 19 patients.
Corona case numbers are increasing: is triage imminent?
If the infection process continues to develop as it has in the past few weeks, triage soon seems to be inevitable. “We are slowly but surely walking into a kind of disaster medicine,” said the President of the German Hospital Association Gerald Gaß. Intensive care physician Christian Karagiannidis also sees it that way. In a podcast of the NDR he spoke of a “bankruptcy of the German health care system”. In view of the hospital capacities, triage should simply not happen. “Triage would mean ending the life of one patient in favor of another patient.” However, two human lives should not be weighed against each other. “But what can happen – and what happens – is that there is a certain prioritization.”
“We are all preparing for a triage,” said Frank Ulrich Montgomery, Chairman of the World Medical Association, to the Morgenpost. According to Gass, there is only one escape route from the triage, and that should not please many: “We urgently need a real decline in the number of infections – and that can only be achieved through an extensive lockdown, which is probably not just the ones Will affect the unvaccinated, but will also affect the vaccinated. ”Because regardless of whether triage is already necessary or not: Every day costs human lives. (aa / dpa)
