*The degree of functioning should only be considered for short-term survival, especially for the disabled.

† An acute cardiac arrest or with significant brain damage.

Tie-breaking: Triage is based on saving the most lives considering acute and chronic illnesses. If there is still a tie, proceed based on medical considerations – use first come, first served.

ASA, American Society of Anesthesiologists; FiO₂, fraction of inspired oxygen; ICU, intensive care unit; ECOG, Eastern Cooperative Oncology Group

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Adapted from Figure 1 of Sprung et al.² Used with permission. The Creative Commons license does not apply to this content. Use of the material in any format is prohibited without written permission from the publisher, Wolters Kluwer Health, Inc. Please contact permissions@lww.com for further information.

• The triage decision is a complex clinical determination made when ventilators or ICU beds are limited and are not sufficient for all patients who need them. Structured decision-making is important to maximize transparency and improve consistency in decision-making. To do this, it is essential to assess the expected benefit to the patient and to compare it to the expected benefit to another patient (for example, comparing outcomes of ventilation or ICU admission versus the expected outcome if the patient remains on the ward or without ventilation). This applied algorithm outlines a recommended process for individual triage measurements without any reference to group affiliation as a valid medical tool.
• The physician should refer to all the measurements, especially at the ECOG Performance Score solely based on the relevant medical assessment for the success of treatment and the likelihood of survival and weaning from the ventilator. No other consideration should be taken into account that distinguishes between individuals, such as age itself, disability per se, or disease per se, but only insofar as the variable medically predicts chances of survival. It must be remembered that all human beings are equal and their value of life is equal. Under no circumstances should medical triage decisions in extreme situations be interpreted as a judgment on the value of a person’s life.
• The triage process begins with exclusion criteria:
• The initial exclusion criteria are based on exclusion criteria used under ‘normal’ conditions.
• If no exclusion criteria are met, patients must meet one of the inclusion criteria which means their condition is severe enough to require intensive care or ventilation.
• Once a patient does not meet the exclusion criteria and meets the inclusion criteria, he is eligible to be admitted to the ICU or connected to a ventilator.
• The criteria for a ventilator or ICU admission are next individually inspected according to the priorities in the flow chart and ranking tables.
• Prioritization is based on priority ranking from 1 to 4 (Priority 1 followed by Priority 2 followed by priority 3 and finally Priority 4).
• The selected triage tools are multidimensional. They include Performance Score (ECOG), Comorbidities (ASA), organ system failure and an overall assessment of the short-term survival chances. The medical literature shows that using a number of different tools increases the accuracy of predictability compared to using a single tool. In addition, the selected measurements are those that enable rapid assessment, which is essential in emergency situations.

Re-assess priority every 24h for patients waiting for ventilation or ICU admission.

Re-assess ICU patients at day 10–14 or in the event of significant worsening of the patient’s condition, consideration should be given to transferring the patient to a regular ward or restrict treatment.