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Intensive care physician: Health system fully utilized, triage is imminent

In terms of the seven-day incidence, Austria overtook the Czech Republic and Switzerland on Friday. 567 Covid sufferers were in intensive care units. Capacities are slowly being exhausted, Vorarlberg is on the verge of triage – the selection of patients based on urgency. Before the top government announced the hard lockdown at 4.30 p.m., two experts appeared before the press.

The intensive care physician Klaus Markstaller, President of the Austrian Society for Anesthesia, Resuscitation and Intensive Care Medicine (ÖGARI), Herwig Ostermann, Managing Director of Health Austria (GÖG) and Susanne Rabady, from the Society for General Medicine, declared from 1 p.m.how our health system is doing.

“We are right on the border”

One was “in serious concern in the meantime,” said Markstaller and named rough framework conditions. Intensive care medicine is designed so that 85 to 90 percent of the intensive care beds are always occupied – regardless of the pandemic. Another model is too expensive. “So in principle they are very busy.” If you need more beds, “then this is perfectly covered in this health system,” says Markstaller. Ten percent fluctuations, i.e. 200 beds more, can be made available without any problems. But: The pandemic is an exceptional situation.

“When more than a third of all available intensive care beds are no longer available,” then triage begins, said Markstaller. 550 of 2,000 intensive care beds are currently occupied. In this area one must already consider “how we should divide this resource”. If this will increase in the coming days – which is likely based on the current figures – triage will be inevitable. You cannot simply increase capacities. “Intensive care medicine is complex,” said Markstaller. Intensive care physicians, whether doctors or nurses, need years of training and experience. “This means that this resource is limited per se.” Hence his “really serious” appeal: “Please live the measures.”

The process of triage is a “creeping” one. “It is becoming increasingly difficult to get patients in intensive care beds who need them,” said Markstaller. “We are exactly at the limit. We will have to start over the next few days to decide to what extent we can treat which patients with intensive care medicine.” As soon as “hard triage” occurs, prognostic factors, the patient’s will, the environmental conditions and the comparison with other patients would determine who is treated and who is not. That must be an “ethical decision”.

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