Swiss Air Rescue’s command centre (Rega)

Another type of command centre operating on a national level was the Swiss Air Rescue’s command centre (Rega) [1]. During the first wave of COVID-19, the Swiss Society of Intensive Medicine decided to open up the remaining or reserve capacity of the ICUs at every hospital in the country for those patients who would only receive basic hospital treatment instead of intensive care due to a lack of local ICU capacity. This measure ensured that patients were not transferred to neighbouring hospitals or connected ICUs, which was the regular strategy for temporary overflows of local ICUs. This new strategy depended on real-time data and accurate information, which both had to be scaled up from pre-COVID-19 level to the required crisis management level. The army-lead Swiss civil and military coordinated medical services were responsible for extending the existing information systems from that tracked only emergency department and hospital bed capacity to collecting numbers of COVID-19 and non-COVID-19 patients, ICU (and intermediate care) beds, with and without ventilation, as well as beds occupied and beds free (differentiating fully certified and partially equipped ICU beds). Twice a day, hospitals and ICUs were obliged to enter this data. While 70–80% accuracy was obtained in 1–2 weeks, it took numerous reminders and 3–4 weeks to attain the necessary 90–95% data reliability.

Rega was mandated to monitor and analyse the national ICU patient data and to act as an intermediator for patient transfers between the 76 ICUs in the country.

• When the average ICU occupation rate was up to 80% (based on an average ICU occupation of 75%), Rega monitored the country’s 7 regions only.
• When the average ICU occupation was between 80 and 90%, Rega monitored all the ICUs in the region. These hospitals (if more than 20% COVID-19 patients) were asked if they wanted to transfer patients out.
• When the average ICU occupation was over 80% (if more than 50% COVID-19 patients), Rega would propose that a hospital transfer patients out.

In the relevant cases, Rega identified hospitals with remaining and reserve ICU capacities in other regions, sought consent from the receiving hospital’s ICU and organised helicopter or ambulance transfer transports.

So far, the affected transfers have contributed to preventing any region from surpassing the 90% ICU occupation threshold (except for some single days). This strategy has been well accepted (legitimate). There has been a dynamic collaboration across organisations and levels (interdependent), a sharing of information that would normally be out of reach (knowledge) and this allowed them to cope with an unprecedented situation (uncertainty).