When the ambulances don’t turn up: implications of the COVID-19 hospital triage protocols for nursing homes in Madrid

As reported in a previous post about the situation in care homes in Madrid, triage protocols used by hospitals mean that care home staff find that ambulances are not turning up to care homes.

This article from El Pais, 26th March 2020, discusses how the protocol currently being used by hospitals in Madrid has created a wall for care homes with COVID19 outbreaks, as the hospitals are refusing to take in severely ill residents. The protocol rules out treatment for those with advanced dementia, high functional dependency and terminal conditions (including cancer).

The implication is that care homes are left to deal with outbreaks on their own. As of the 25th March, the only outside help they have had so far are isolation and infection control guidelines and practical disinfection support from the army. They had not received any personal protection equipment, medicines, test kits or any support from doctors and nurses.


The protocol used looks to be based on the Critical Fraily Scale, which, in the UK, is used in the NICE COVID-19 rapid guideline: critical care in adults. It is very important to note that in the UK this is to be used for escalation to critical care, and not for admission to hospital.

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