Who will they save and whom will they let die? The manual has to help doctors with a difficult dilemma. Check it out – TVNOVINY.sk

Slovakia is approaching a humanitarian catastrophe. The number of hospitalized patients with covid reached 3,182. A consortium of experts warns that if we exceed 3,200 patients, hospitals will stop “white medicine”. However, some have already hit the ceiling of their capacity and doctors have to decide which patient they are hospitalized in the intensive care unit.

During the second wave in March, the Ministry of Health developed methodological guidelines for doctors on how to proceed in a critical situation. Former Minister of Health Marek Krajčí also signed it.

Age is not a decisive criterion. It is the overall condition of the patient and any associated diseases. If a person has had a heart attack in the last three years or severe dementia or chronic lung disease, his chances of going to bed are lower than a person without further diagnoses. The reason is that a sick person has a worse prognosis of covid recovery.

The Ministry of Health has prepared this document in cooperation with specialists and the Ethics Committee of the Ministry.

“The reason for issuing this technical guide is the imminent risk of an adverse development of the COVID-19 pandemic in the Slovak Republic, which, despite the implementation of all available measures to avert it, could lead to a situation of exhaustion and subsequent temporary reduction of JIS / OAIM capacities to provide intensive health care. care. Such a situation usually leads to an objectively given need to decide on the indication of intensive care associated with the selection of patients to be provided with such care, “the ministry writes in the document.

The Minister of Health gives an instruction to hospitals to limit health care because they do not have sufficient capacity. For this to happen, a state of emergency must be declared. However, according to tvnoviny.sk, individual doctors already follow this manual. From the second wave, they have a document at their disposal, thanks to which they can make objective decisions about whom they will provide a bed for the intensive care unit. The whole process is called patient triage.

The head of the Department of Anaesthesiology and Intensive Care (UNB), Jakub Hložník, explains that healthcare professionals are already assessing the patient’s general condition and his cure options. Although they do not take age into account, older people usually have associated diseases. Even today, they do not give artificial lung ventilation to all people who are not helped by oxygen therapy. An elderly and chronically ill person with a severe infection would probably not even recover from ventilation.

Hospitals are not yet allowed to disconnect the patient from the device and place another one instead.

At least two doctors must decide

The fate of the patient can be decided by the head of the emergency medical service crew in cooperation with the Regional Operations Center, the emergency physician on the emergency department, the emergency physician in the hospital ward or the physician in the JIS or OAIM department. At least two physicians must decide not to provide or suspend intensive care for a patient and at least one of them cannot be the patient’s attending physician.

“The reasons for each decision that is the result of the triage process must be recorded in the patient’s medical records in a way that identifies the patient’s compliance with the conditions assessed under this professional guide,” the ministry warns.

Priority is given to police officers, paramedics and firefighters

According to the document, doctors decide whether to provide the patient with intensive care, conservative care or palliative care. Intensive care focuses on replacing or supporting a patient’s failing vital signs, and their subsequent recovery is expected. This is, for example, a bed where the patient needs artificial lung ventilation, extracorporeal circulation, dialysis or circulatory support.

Conservative care is routine care that a patient needs, for example, before surgery. Palliative care is the final stage when the goal is only to improve the patient’s quality of life and alleviate suffering. In this case, doctors are no longer starting a new treatment and ending an ongoing one. The patient should have met mental or spiritual needs.

The most important decision criterion is usefulness. Healthcare professionals should provide the bed and human resources to the patient who has the highest chance of recovery. However, priority is given, for example, to paramedics, firefighters, police, soldiers and hospital volunteers.

The worst are people after a heart attack, with high blood pressure, diabetes or lung diseases

The ministry has compiled a list of diseases that worsen the patient’s health and reduce his prognosis for cure. These include cardiac arrest, chronic illness that required hospitalizations in the last year, chronic heart failure with symptoms, chronic lung disease with symptoms, severe arterial hypertension, severe and irreversible neurological disease or severe dementia, severe hepatic insufficiency, severe renal insufficiency treatment, diabetes mellitus, uncontrolled or active malignancy.

Doctors also take into account the so-called fragility. They judge it according to whether a person is active in sports, whether he needs help with walking, hygiene or food preparation, or has an incurable disease in the terminal stage. Each parameter is assigned a specific number of points. After assessing the patient’s condition, doctors calculate a “score” that determines what care the patient will receive.

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