The COVID-19 pandemic has drastically changed our world and caused huge loss of lives and resources. As of August 22, 2021, over 212 million persons have been infected in 223 countries and there have been more than 4.4 million deaths. Among those most affected are older persons, and research has repeatedly shown that older age and comorbidity are major risk factors for severe complications and mortality. Healthcare structures worldwide faced dire situations of resource scarcity in light of the unprecedented pace at which the illness spread. Triage guidelines were issued to help healthcare workers decide on the best use of scarce resources (e.g. ICU beds, ventilators). However, much less attention was given to drafting guidance on prehospital management under scarcity. There is evidence in Switzerland as well as worldwide that prehospital approaches used some forms of triage either spontaneously or in a more or less planned way, creating ethically questionable disparities.

This project fills an important existing research gap: given the disproportionate burden of mortality and morbidity carried by the elderly population, it is important to learn (1) about their experiences and perspectives concerning seeking and receiving healthcare in times of scarce resources, and (2) the perspectives of professionals who took care of these vulnerable patients and had to make relevant decisions.

Survey methodology – Objective A. We will gather solid data from the perspectives of patients (65 years) seeking care in Geriatrics hospitals/departments in Basel, Lausanne, Zurich and Geneva. The survey will mostly include closed-ended questions evaluating their satisfaction with medical care received during their current in-patient stay; whether they feared seeking treatment and for what reasons (e.g. fear of reduced quality of care); whether they made advance directives; and include a series of short case examples to understand their perspectives related to resource allocation (including prehospital triage).

Qualitative Interviews – Objective B. Study participants for this part of the project will include the variety of involved professionals as we intend to capture broad experiences to fully understand how the organization of care for older persons took place during the pandemic in the four cantons where the organization of nursing homes varies. A maximum variation sample of 15 participants from each canton will be recruited, totaling 60 participants for the project. During the interviews, we will, for example, explore the challenges that they faced (or not) in caring for older patients/residents during the different pandemic waves, what has been learned since then to prepare for upcoming waves, decisions that were taken to address situations of resource scarcity including prehospital triage and prehospital care decisions, advance care planning, how guidelines related to these decisions were made and communicated.

Medical-ethical analysis – Objective C. We will carry out an in-depth medical-ethical analysis based on existing national and international prehospital triage guidelines. The results from this review will be confronted with our findings from A. and B. relevant to pre-hospital ethical decisions, followed by in-depth multidisciplinary discussions with concerned stakeholders. Our medical-ethical analysis will help issue ethical recommendations to be discussed as well with members of the SAMW Central ethics committee (ZEK) for needed next steps in Switzerland.