Triage Decisions in the Context of COVID-19: Old Burden, New Challenge—The Structured Approach for Intensive Care Unit Triage (SAINT) Protocol

Abstract

Introduction The medical treatment facilities (MTF) represent the equivalent of the healthcare system in the home countries, but they face the limitations of an outpost at the end of the supply chain. The capabilities are limited, and the necessary effort to extend the treatment capacity is tremendous. Algorithms based on scientific evidence or at least profound medical expertise are a tool to facilitate the decision-making process in triage under difficult circumstances. The aim of this article is to present a protocol that regards the specific entities military MTF abroad have to deal with in context of the COVID-19 pandemic. Material and Methods To prepare our own health system within the Resolute Support mission, an interdisciplinary team of consultants and nurses located at the multinational role 2E, Camp Marmal, Mazar-e-Sharif, Afghanistan, individually reviewed medical databases and the current literature concerning triage on intensive care units. The identified literature was evaluated by all authors. In the next step, an adapted flow chart for triage on intensive care unit in MTF abroad was set up on the basis of existing triage tools found in the reviewed literature. Results The authors created the “Structured Approach for Intensive Care Unit Triage (SAINT)” protocol. It is an approach that fits to the specific entities (e.g., limited medical resources in the whole system, limited intensive care unit capabilities for long-term stay or organ replacement therapy, etc.) that determine the framework of the special military health system abroad. Conclusions The presented triage protocol may be a tool for medical personnel to facilitate the difficult task of triaging. It provides guidance along patient-centered criteria like individual medical, ethical, and legal issues while taking into account the available resources. Future studies are needed to investigate the effectiveness of the SAINT protocol.

Revisión sobre aspectos bioéticos en las decisiones de triaje en la Unidad de Cuidados Intensivos durante la pandemia por COVID-19

“…En el campo de la medicina militar se creó una propuesta con un algoritmo de valoración con el objetivo de estandarizar el proceso de atención. En dicha propuesta de atención, se recomiendan periodos de espera de 24 horas para evaluar la respuesta del paciente al tratamiento y contrastar ello con la disponibilidad de recursos (camas, personal, equipo, medicamentos) de forma que pueda optarse por el alta del paciente, en cuanto arribe otro con un cuadro más grave y, por lo tanto, con mayor necesidad de atención médica (17).…”

Multi-Factor Triage Algorithm (MUFTA): Quantitative and Qualitative Ethical Factors on Triage Decisions During COVID-19

“…In contrast, the algorithm [56] provides a general framework for local health systems, ministries of health, hospital administrators, and health workers working on planning COVID-19 patient triage, management, and referral. Jänig et al [57] presented SAINT for the Intensive Care Unit Triage algorithm. It is an approach that fits the specific entities that determine the framework of the particular military health system abroad.…”

Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review

“…Lastly a protocol theme was identified surrounding how to evaluate staffing levels to ensure that areas in high need of staff were assisted by areas with a lighter workload. Triaging staff was needed to help maintain quality care for patients and for the staff to be able to safely care for an increased patient care load [20,29,41,42]. Overall, there was a positive experience in the development of protocols during the COVID 19 pandemic.…”