Abstrakt

In major emergencies or health system crises with real or imminent scarcity of resources, medical decisions must be made consistently, transparently, and without discrimination along the entire continuum of care. This article describes a coherent model that links the ex-ante prioritization in pre-hospital medicine and in the emergency room according to treatment urgency with additional success-oriented resource allocation in the intensive care unit (ICU). Preclinically and at the entry to the emergency department, the following applies for the conduct of triage: algorithm-driven triage, based on the limited data available, using established triage categories (T), clear patient identification, re-evaluation, and priority-oriented handover. The allocation of T4 (blue) is excluded in the initial sorting in hospital and is expressly limited to locally confirmed, decompensated crisis situations with absolute resource shortage. In the ICU – with the continued primacy of medical indication and the patient’s will – the clinical prospect of success becomes the central prioritization criterion, as urgency loses discriminative power in this setting. Key criteria for success-oriented allocation include baseline health status (prior to the current treatment episode), comorbidities, and age, but these may only be used in a non-discriminatory manner. Clinical scores and machine-learning models can support cohort and trend assessments, but they are not decision criteria on their own; their use requires local performance monitoring and bias checks. Simulation data show that ex-post triage procedures based on medical evidence lead to substantially lower mortality than random or first-come-first-served allocation principles. SAPS II–based ex-post triage, for example, substantially reduced ICU mortality across all scenarios. The allocation is supported by a standardized re-evaluation process integrating clinical course, organ function, treatment effect, complications, and the resource situation. Ultimately, the aim is to enable as many patients as possible to participate fairly in scarce medical treatment options along the entire continuum of patient care by establishing an evidence-based, transparent, verifiable, and at the same time practical approach.

Autoreninformation

Autoren

• A.R. Heller¹
• A. Michalsen²

Abteilungen

• ¹ Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Augsburg,
• ² Klinik für Anaesthesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz

Adresse

Prof. Dr. med. Axel R. Heller
Direktor der Klinik für Anästhesiologie und Operative Intensivmedizin
Medizinische Fakultät an der Universität Augsburg
Stenglinstr. 2
86156 Augsburg
Email: [email protected]

Citation