The KNMG Doctors' Federation and the Federation of Medical Specialists (FMS) have published a scenario in 2020 stating how Dutch intensive care beds should be distributed in the event of extreme scarcity due to a possible revival of the coronavirus.

Doctors hope the script will never be necessary.

The Health and Youth Care Inspectorate uses the scenario when monitoring any code black.

It also meets the standards of the Care Quality, Complaints and Disputes Act (Wkkgz), according to the organizations.

The scenario should prescribe how intensive care units determine which patient will be allocated a bed and which will not, should intensive care beds become scarce.

If this were the case, it would be referred to as 'Code Black'.

In the case of 'Code Black', the script requires doctors to act based on three ethical principles: "equality, justice and wanting to save as many lives as possible".

All patients should be treated equally everywhere in the Netherlands.

In the case of extreme emergency, the medical status of a patient is no longer looked at, but a number of non-medical principles:

Short stays are given priority

Physicians will continue to try to provide first aid to patients who present themselves first during the emergency protocol.

However, it is not certain whether this will work in times of enormous crowds.

If statuses have to be compared with each other, priority will initially be given to people who only need to be in ICU for a short period of time.

Doctors do this because then more people can be helped.

If there is a suspicion that a Dutch person will have to spend longer in the IC, that person will be given less priority.

Healthcare workers first

If the expected length of stay of a patient makes no difference, the bed to be allocated will in principle go to a healthcare worker.

This only applies if this employee would have had "a lot of risky contact" with corona patients and they could not protect themselves properly due to a lack of protective equipment.

Younger generations for the elderly

If the first two points have not yet led to an assignment, doctors should look at a patient's age.

A patient from a younger generation will be given preference over someone from an older generation.

Generations are subdivided into periods of twenty years.

Patients should then have an approximately equal length of stay and an approximately equal chance of survival.

Patients who were already on ICs before code black should not suddenly get rid

of that

However, it is not the case that if code black is proclaimed, older IC patients will always have to make way for younger generations who need an IC bed.

"This would ensure that treatment of an IC patient could be discontinued at any time, on grounds that have nothing to do with this patient," the script describes.

A patient can also present himself at any time with a higher score than patients who are already being treated in the ICUs at that time.

"If they can be replaced, it could undermine the intensive care provided to patients."

To be lucky

If the bed in question is still not assigned, then the patients must be lucky.

If they come in at the same time, for example, a lottery can be done.

If they are brought to the IC one after the other, the bed goes to whoever entered first.

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