New ICU admission model proposed

Its proposal is based on five ethical criteria to use in the triage for admission in ICUs when healthcare resources are limited, such as in the COVID-19 pandemic.Emilio Garcia Sanchez

The emergency triage protocol is used in catastrophic medicine situations, when the needs surpass healthcare resources, in the event of natural disasters, multiple accidents or terrorist attacks. The development of consensual clinical assessment criteria that substantiates the medical decisions during triage in these situations is still an open issue, despite several protocols being described in this regard. The current COVID-19 pandemic has posed a new scenario for the use of emergency triage for the admission of patients in ICUs. Researchers from 28 healthcare centres and universities from several countries have developed a new proposal, based on five ethical criteria, for this type of triage. Among the expert authors of the study, of the model, published in Frontiers in Public Health, is Bioethics professor from the Healthcare Sciences Faculty of the CEU Cardenal Herrera University of Valencia, Emilio García Sánchez.

As the authors of the model explain, the first of the five ethical criteria of this proposal is based on taking into account the three general principles of disaster medicine: the well-being of the patient must be considered in the context of the common good; nobody shall be abandoned or discriminated against for any reason; and before rejecting an ICU admission, alternatives must be provided, both for said individual and for future patients, based on medical experience.

The second of the five ethical criteria establishes that determining the care priority in intensive care units, when it cannot be given to all those who need it, “must take into account the urgency and severity of the clinical situation of the patient, considering as the objective to offer the greatest benefit possible to the largest number of patients. And without discriminating against anyone beforehand and without seeking a utilitarian and quantitative compensation of the deaths through the number of people saved, as explained by the authors of this protocol in the article that was recently published in Frontiers in Public Health.

Case-by-case triage

For professor Emilio García Sánchez, as for the rest of authors, the third criterion of the model is essential in the case of future outbreaks of COVID-19: “The third criterion establishes that triage to admission to ICUs must be conducted case by case and never based on standardised criteria, such as age. This analysis of each case must take into account the clinical situation of the patient, as well as the resources available at the hospital. And it must consider the possibility of transferring patients to ICUs in other centres when possible.”

The ethical model of admission is completed with two more principles: inadequate treatments are not acceptable under any circumstance, and palliative care, both physical and spiritual, most be guaranteed when necessary. Regarding this last criterion, professor Emilio García Sánchez explains that: “This pandemic has arrived when the debate on euthanasia was beginning in Spain, and the healthcare world was talking about the importance of improving palliative care so that euthanasia is not the option that anybody wants.”

International team

The co-authors of this proposal are professors and researchers from the bioethical, medical and legal field from centres such as the National Health Institute of Italy, the Bio-Medical Campus of the University of Rome, the Bambino Gesú Children’s Hospital of the Italian capital, the University of Insubria, in Varese, the University of Camerino in Maserata, and the Sacred Heart Catholic University in Rome (Italy); the Karolinska Institute of Stockholm (Sweden); the University Hospital of Strasbourg (France); the Medicine Faculties of the Universities of Yale, Pittsburgh and the Virginia Commonwealth University (USA); the Medicine department of the McGill University of Montreal (Canada); the St. Mary’s University of London (United Kingdom); the Pontifica Argentinian Catholic University in Buenos Aires; the Panamerican University of Mexico; the Strathmore University of Nairobi (Kenya); the International University of Catalonia, the University of Valladolid and the CEU Cardenal Herrera University of Valencia (Spain).

More information on the article:

“Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic”, in Frontiers in Public Health.

https://www.frontiersin.org/articles/10.3389/fpubh.2020.00284/full