Triage in intesive care medicine

As long as sufficient (human and material) resources are available, all patients requiring intensive care are admitted and treated according to established criteria. If an emergency arises in which large numbers of severely ill patients require ICU treatment – for example, during a pandemic or due to a natural hazard – rationing decisions will be necessary, placing considerable burdens on medical staff. This makes it all the more important that uniform criteria for ICU admission and continued occupancy should be applied throughout Switzerland.

 

The overarching goal is to ensure that, even under exceptional resource scarcity, as many lives as possible can be saved with the resources available, irrespective of the disease or injury leading to hospitalisation.

 

 

You can find all the medical-ethical guidelines published by the SAMS in the Publications menu and on the respective topic pages, e.g. Intensive care medicine.

 

 

The appendix on managing resource scarcity in ICUs has become commonly known as the «Triage guidelines». Since its publication in March 2020, the document has attracted attention far beyond its intended audience and has been widely covered in the media. Our FAQ page provides context and background information for a broader audience. 

 

FAQs in German or FAQs in French

 

 

Medical triage has moved into general awareness with the pandemic. In an article in the Swiss Medical Journal (04.10.2023), the SAMS, the President of the Swiss Society for Intensive Care Medicine and a board member of the Society for Emergency and Rescue Medicine look back on the pandemic period. They discuss the importance of triage and the value of recognised guidelines as guidance in extraordinary situations.

 

During the pandemic, the SAMS could quickly provide guidance on triage only because its existing «Intensive Care Measures» guidelines provided the basis for it. This allowed an annex to the guidelines to be developed promptly, while taking great care to ensure that the process did  not compromise quality: new findings and ongoing feedback from science and practice were incorporated into each new version. For other areas - such as triage in emergency medicine - there was no comparable basis. The development of a fundamentally new medical-ethical guidelines always follows a process lasting at least two years (cf. here).

 

Article in German: Beim Begriff «Triage» läuten die Alarmglocken (SÄZ, 04.10.2023)

 

Article in French: Le terme de «triage» suscite la controverse (Bulletin des médecins suisses (BMS), 04.10.2023)

 

 

 

In the spring of 2020, at the start of the Covid-19 pandemic, the SAMS, together with the Swiss Society of Intensive Care Medicine (SSICM), published an appendix regarding the implementation of the chapter on triage in case of resource scarcity (chap. 9.3. «Intensive-care measures») with directions for its implementation, which provides practical guidance for involved health professionals. This appendix was first published on 20 March 2020 and has since regularly continuously been adapted to reflect experiences from practice or and new scientific findings. On this page, you can find the latest version. All previous versions can be found here.

 

 

For each version of the appendix, the SAMS has published a Newsletter (German or French), highlighting the most important content or changes. The summaries of these Newsletters in English can be found on the chronology page.

 

10 December 2021: Vaccination status per se is not a triage criterion: Response to the open letter from Oncosuisse
German or French

 

23 September 2021: Intensive care triage: medical-ethical guidelines updated (Version 4)
German or French

 

17 December 2020: ICU triage: Version 3.1 of the guidelines, including clarifications on ethical and legal aspects
German or French

 

4 November 2020: Updated guidelines on triage for intensive-care treatment under resource scarcity
German or French

 

16 April 2020: Covid-19 pandemic: interim report on patient 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

 

20 March 2020: Covid-19 pandemic: guidelines for triage in intensive care units
German or French

 

 

ethix, Lab for Innovation Ethics, has also helped to broaden the debate on triage decisions. In a blog post (German/French) contains a document presenting the key elements of the appendix (Versions 1 and 2) as well as a questionnaire that submits various triage scenarios for discussion.

The results of the survey (in German or French) provide information on how the ethical considerations underlying triage recommendations are evaluated by the population.

 

 

Recommendations on Covid-19 triage: international comparison and ethical analysis (Bioethics, 25 September 2020)

 

Ethics guidelines on Covid-19 triage – an emerging international consensus (University of Zürich, May 2020)

 

 

Response of the SAMS to the open letter of Oncosuisse (in German or French)

 

Solidarity and responsibility in the pandemic (Swiss Medical Journal, February 3, 2021) (in German or French)

 

Appeal «Protection and quality of life of people in long-term care» (Swiss Medical Journal, July 1, 2020) (in German or French)