On Thursday, corona patients were moved from clinics in Karlsruhe and Pforzheim to other federal states.

Hospitals in Alsace should now also accept patients from Baden-Württemberg.

The situation is dire, also with regard to the care of normal patients.

It was different in the first wave of pandemics at the beginning of 2020: At that time, the Freiburg University Clinic helped the French clinics.

Due to the overload in the intensive care units and the “intermediate care wards” (IMC), an ugly term that doctors actually only know from war missions and disaster medicine: triage is coming back into the discussion.

Rudiger Soldt

Political correspondent in Baden-Württemberg.

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The word comes from the French verb “trier” (to sort) and describes the procedure with which military doctors at the front decide which seriously injured soldier is still worth transporting to a hospital. The transition from “prioritizing” to hard “triage” is fluid.

"In the fourth wave of the pandemic, we are now feeling that we are also reaching the limits of our workload in a university clinic in intensive care", says the director of the intensive care department of the Ulm University Clinic, Bettina Jungwirth.

“Unfortunately, we still do not know when the plateau of new infections with corona will be reached in this wave.

That worries us very much.

We react to this uncertain situation by prioritizing surgical interventions and preparing for a possible triage situation. ”There are 200 patients on the waiting list for urgent heart operations at the Robert Bosch Hospital in Stuttgart - two of them died this week, probably because of it. because they were not operated on in time.

Clinics need advice

The situation in the clinics, for example in Saxony, is so bad that in fact triage is already being made there. Florian Steger, medical ethicist at the University of Ulm, advises intensive care physicians at Saxon hospitals and during this week prepared them for triage situations. “The triage is no longer just a theoretical construct, it is more important to prioritize carefully and fairly. Many clinics in Saxony are reaching their limits in terms of supply options. You need advice, because the risk of triage alone unsettles chief physicians. They want to know what to do in an emergency. "

Ideally, a clinic forms a small ethics committee made up of doctors, nurses and a medical ethicist. They should find an answer to the following questions: “What is the patient's will? Is there a clinical chance of success? How seriously ill is the patient? Is there a threat of organ failure? What underlying illnesses does he have? ”It would be helpful if elderly patients in particular in old people's or nursing homes have determined whether they want intensive medical therapy at all by means of an advance directive, health care proxy or care directive.

In Germany, medical professionals are breaking new ground with triage decisions in peacetime. How well university clinics, large city hospitals or small district clinics are prepared for such situations is so far no reliable data. Intensive care physicians estimate that around half of all German hospitals have prepared for such a situation, but not every university has a chair in medical ethics, and not every hospital with 600 beds has an ethics committee.

Even less is known whether the structures created for triage situations will work in an emergency.

The establishment of a nationwide support network that offers medical ethical advice and also provides psychosocial support to the clinics is currently under discussion.

"We are currently setting up a clinical ethics committee that supports us clinicians in questions of prioritization and provides advice on further steps," says Bettina Jungwirth.

“We are also examining whether we can support smaller clinics via video conferences in such situations.

It would also be good if the necessary legal certainty were created for triage situations. "