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Sion Hospital had to turn away intensive care patients. Image: keystone
Triage has begun: Spital Sion has to reject intensive care units for Covid patients
Complete intensive care units: who should get a bed? Doctors, nursing homes, and patients wonder what the best solution is. Many older people triage themselves and die at home.
It is one of the most difficult questions of all. “Nobody wants to have to decide something like that,” says Professor Tanja Krones. We are talking about triage. From the moment there is not enough space and staff for all the patients who need treatment.
The emergency room at Sion Hospital is experiencing a rush. Image: sda
As a report by NZZ am Sonntag from Wallis Hospital in Sion shows, this is already a reality. On Friday, doctors had to refuse a bed in the intensive care unit to an 80-year-old patient with severe Covid symptoms. “Normally we would have welcomed this person so that they would have at least a minimal chance of survival,” says Bienvenido Sánchez, chief physician of intensive care medicine. “In the current situation, however, I prefer to leave the last beds free for cases where there is more hope.” In fact, there would be room for four additional intensive care beds. But the hospital cannot operate these beds because it is understaffed.
Classifying patients is one of the most difficult decisions in medicine. Experts such as Krones, head of clinical ethics at the University Hospital Zurich are called in for this. They should help with the decision: “Who will get life support and who will not?”
Hospital occupancy increases to more than 90 percent
This week, the federal government’s coordinated medical service announced that intensive care beds in Switzerland are only enough for ten days without further measures. Friday’s data shows: in Schwyz, Solothurn or Freiburg the occupancy is already over 90 percent. This is reported by the Sunday newspaper.
But the hypnotized view of intensive care units only shows half of what is happening. Because just like spring, a large part of the Covid drama currently unfolds in nursing homes. More than half of the deaths in the first wave were due to its residents. And that is exactly what is being repeated now.
Caring for the dying is emotionally very hard on nursing staff, the newspaper reports, citing the manager of a Zurich nursing home. There is a close relationship between caregivers and residents, some of whom have lived at the center for years. And now the nursing staff have to accompany them until their death. With masks and protective suits.
Self-triage of the elderly
Who is the last when the hospitals are crowded? The Swiss Academy of Medical Sciences has developed guidelines for this. The age of 85 is also included as a criterion. What has already provoked harsh criticism. However, the specs will be reviewed next week, experts confirm.
However, for the vast majority of the elderly, there is no need for such guidelines. You decide on your own initiative against hospitalization – self-assessment occurs. Most of them still have the photos of Italy with overcrowded rooms, and that puts them off, says a winter doctor prostitute.
If more patients from homes came to hospitals, the situation would quickly escalate. Tanja Krones tells the “SonntagsZeitung”. There is a risk that outside the hospital it will be notified or decided that patients will not be transferred to the hospital, also to protect the system. Now that hospitals are full in some regions, one must jointly ensure that such “quiet” triage does not occur.
Hospitals try to transfer patients to nursing homes
Difficulty breathing. Many people infected with Covid complain about it. This scares the elderly, explains an expert in intensive medicine. With medication the fear of patients can be removed. It does not provide a cure, but it alleviates suffering. However, death would be accepted with approval under certain circumstances. On the other hand, artificial respiration also has serious consequences: depending on the previous disease, there is also a high risk of dying here.
So the elderly are not a burden for intensive care units, although among them are the majority of those killed by this pandemic. It is more likely to be the other way around. For them, there is a risk that hospitals will try to move Covid patients to nursing homes in the coming weeks. Exactly such a request has already been made in a retirement home in Zurich. But that’s dangerous and reminiscent of the first wave in Italy, says the doctor in charge.
It is understandable that hospitals have to create space. But the staff at the senior centers couldn’t do it either. Otherwise, there is a risk of collapse. (amü / cri / chmedia)
