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The title of the document is Intensive Care Decisions in the Event of a Disproportion Between Care Needs and Available Resources During a COVID-19. Translated it means that here are the criteria that doctors, particularly anesthesiologists, must follow in case they find themselves choosing who to admit to intensive care first. Only in an extremely dire situation, therefore.
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The protocol
It was developed by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care and by the Italian Society of Forensic Medicine and Insurance. A document according to which the person with the longest life expectancy must be attended first. As it happens during disasters. As is the case in many ICUs in which we are often faced with an imbalance between the supply and demand of care. The patient, he continues, must still have his rights guaranteed and ensure that he will be treated with “the possible means”.
“Without prejudice to constitutional principles (right to protection of health and self-determination, principle of equality, duty of solidarity – read the text published on the website of the National System of Guidelines of the Higher Institute of Health) – it is necessary to resort to resource allocation options. ”For the two companies, given the situation, it is necessary to create an ad hoc triage in the hospitals.
An assessment center aimed at determining which patients have priority for treatment. For resuscitation, anesthesiologists explain, it means determining who “is more or less likely to overcome the critical condition with the support of intensive care.” Age, therefore, is not in itself a sufficient criterion to determine who can benefit from therapies.
Obviously, all the parameters have also been identified, there are twelve that are being examined by the Institute of Health, and all the possible conditions to follow before reaching the election. Choice that doctors, always in case of overcrowding, whenever possible, also intend to present the patient. Some, as the broad debate over the living will reminds us, may not even want to undergo intensive care. In any case, wishes must be respected if the patient has written or, at that time, informs the attending physician.
Means
“The scenario in which we find ourselves in March is regrettably returning to our days with an intensity and duration that cannot yet be quantified – says the president of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care Flavia Petrini – selection criteria due to a possible lack of beds in intensive care. Anesthetists-resuscitators are among the healthcare professionals most involved, in Italy as in other countries, in the treatment of patients affected by the virus. The scarcity of resources produced by the pandemic affects us in a particular way. We have done and are doing everything possible to ensure the best possible cure in often dramatic circumstances. As we have seen in so many videos ».
Medical deontology, as Carlo Maria Petrini, director of the Bioethics Unit and president of the Ethics Committee of the Higher Institute of Health, writes in the introduction to the document, places the patient at the center, favoring therapeutic criteria. “However – these are Petrini’s words – there are situations in which it is impossible to treat everyone. In these cases, Hippocratic ethics alone are insufficient. Triage should be applied. And like any medical procedure, it must be based in the first place on criteria of adequacy and proportionality.
Meanwhile, the first effects of the generalized contraction are beginning to be seen in the country. In fact, the increase in patients admitted to intensive care for Covid-19 is slowing down. According to yesterday’s data from the Ministry of Health: ten people entered the resuscitation rooms, bringing the total to 3,758. In contrast, the threshold of 34,000 has been exceeded in ordinary departments.
Last updated: 11:23
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