Manifesto for people with a spinal cord injury facing triage due to the COVID-19 pandemic

1 December 2020

The SARS-CoV-2 pandemic (COVID-19 pandemic) could result in hospitals no longer being able to provide adequate resources in intensive care units. In the case of limited resources, doctors would have to use the more stringent triage criteria of the Swiss Academy of Medical Sciences (SAMW) to decide who will be admitted to the intensive care unit and who will not.

In the currently revised triage recommendation, the SAMW guidelines explicitly state that people with disabilities must not be discriminated against when the available resources are being distributed. The decisive factor here is expected “short-term prognosis”.

To support decision-making, the SAMW has listed, in particular, an advance health care directive (if available) and individual factors such as unobserved circulatory arrest, metastatic solid tumours with a life expectancy of < 12 months, serious neurodegenerative diseases, severe dementia and irreversible neurological damage. In addition, the SAMW discussed the topic of frailty and has provided a “clinical frailty scale” to help with decision-making. According to this scale, dependence on a third party is a criterion for a higher ranking, which is a reason for non-treatment in the case of limited resources. This will result in people with a spinal cord injury, and others, being disproportionately excluded from treatment in an intensive care unit, even if the short-term prognosis (with good knowledge of their medical and life situation) would place them firmly in the group of people eligible for treatment. Mortality in people with a well-managed spinal cord injury is only insignificantly higher than that of a person without a spinal cord injury.

Along with the WHO, the United Nations and the Council of Europe, the Swiss Society of Paraplegia (SSoP) is extremely concerned about possible effects on the care of people with a disability. This is why the SSoP is giving its full support to the brief assessment and requirements of Inclusion Handicap.

Urgent recommendation of the SSoP

The Swiss Society of Paraplegia encourages everyone affected to discuss their wishes with their relatives and to record these in writing in an advance health care directive.

If questions arise during treatment in an intensive care unit, in particular during triage, spinal cord medicine centres have offered to provide additional information on the patient's medical and personal situation as well as advice relating to the further procedure. People with a spinal cord injury are often connected to a spinal cord medicine centre, where comprehensive medical and personal information is held about them. If patients would like this support, they should record this in the advance health care directive or ensure that their relatives know to mention this option. The intensive care units can then contact the spinal cord medicine centre in question.

The following wording could be used in the advance health care directive:

If I am incapable of judgement, I request that in the event of triage, a medically unstable situation or a state of diminished responsibility, my spinal cord medicine centre (name & address of the spinal cord centre) is contacted with regards to my general condition.”