Phase 2D means that critical planable care is scaled down nationally. These are surgeries and treatments that should be performed within six weeks, such as chemotherapy or kidney transplants. Defense and the Red Cross can also be deployed.
Criteria
It is not yet the final phase for the dreaded code black, the spokesperson emphasizes. “Because this involves the possibility of scaling up to 1350 IC beds. We are not there yet.”
Following the request, outgoing care minister Hugo de Jonge will check whether all the criteria for this have been met and he will officially announce that phase. His predecessor Tamara van Ark also did the same in January of this year.
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It has already been shown that a growing number of hospitals are no longer always able to provide critical, planable care on time. 14 hospitals in the Netherlands have problems, it turned out on Tuesday an overview of the Dutch Healthcare Authority (NZa). That was two more than the Thursday before.
Regular plannable care, which includes all care that can wait a while without causing permanent damage to the patient, has been under pressure for some time. 49 of the 73 hospitals are no longer able to deliver these in full. In the phase in which the hospitals found themselves recently, 2C, the regular planable care was already scaled down.
Upscaling plan
In connection with the pandemic, the LNAZ and the hospitals have drawn up the scaling up plan in case the care is overloaded by the influx of corona patients. In this way, staff is released to help with corona care.
The final phase, crisis phase 3, is known as code black. Hospitals then only provide acute care and sometimes have to make choices in this regard. That phase in turn is divided into three phases, namely 3A, 3B and 3C.
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Step-by-step plan for code black: who gets priority?
Only when the pressure on the ICs becomes so great that a distinction can no longer be made on the basis of medical considerations between who does and who does not need an IC bed, do doctors switch to a script drawn up by the KNMG medical federation and the Federation. Medical specialists. Then selection takes place on the basis of non-medical considerations.
Stap A
Only patients who meet certain medical criteria are still admitted to the intensive care unit. Patients with a very small chance of survival are no longer admitted to the ICU.
Stap B
The admission criteria are becoming stricter. For example, CPR is no longer given to patients in the IC. If that is not enough, patients are compared before admission. Only if doctors consider one patient’s chance of survival at least 20 percent greater than that of another, will the patient with the highest chance of survival be included.
Step C
If even the above criteria are not enough, it gets even stricter. In that case, a switch is made to ‘non-medical admission criteria’ when two or more patients are entitled to an IC bed. Then successively:
- Priority is given to the patient with the shortest expected length of stay,
- If both patients have approximately the same expected length of stay, healthcare personnel take precedence,
- Then the age group is considered. Patients aged 20-40 then take precedence over patients between 40-60,
- If no distinction can be made in this either, a lottery will eventually be drawn.
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