AHS to discuss COVID-19 triage framework with staff if faced with 'dire situation'

Alberta Health Services is meeting with some staff this week to discuss what to do and how to approach life-or-death decisions if COVID-19 patients overwhelm the system. Julia Wong has more on the triage framework.

The province’s health authority is meeting with certain staff this week to discuss what to do and how to approach life-or-death decisions if COVID-19 patients overwhelm the system.

This meeting comes as the province is in the midst of a third wave of the pandemic.

The invitation, which was shared with Global News, describes the Alberta Critical Care Triage Framework as protocol to be used if “a dire situation” were to occur where “the demand for life sustaining critical care support is greater than the available resources.”

The framework includes specific protocols for both adults and children.

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The aim of it, as stated in the email, is to help staff make “the difficult determination of how to allocate resources to critically ill patients when there are not enough critical-care resources for everyone.”

“It signals to me that the ICU capacity in the province is limited and that we could get into a situation like they have in Ontario in which life or death decisions have to be made,” said Alberta’s former chief medical officer of health Dr. James Talbot.

“This is what they’re talking about: ‘We have three beds left and we have five people who need to go into them, which three get the bed? We have a young person come in who is severely ill but is going to likely recover and all of our respirators are in use right now, who comes off the respirator?’

“It’s the kind of decision no physician ever wants to have to make in their life.”

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While the document is not controlled by Alberta’s chief medical officer of health, Dr. Deena Hinshaw talked about it during her update on Thursday.

“I know discussions of these protocols can create anxiety for many people.”

The document has been worked on since the pandemic began, Hinshaw said, and is based off lessons learned during the 2009 H1N1 pandemic.

“These protocols are a last resort and can seem scary, but it is important that this work be undertaken as a precaution and that the necessary health-care professionals have an understanding of what these protocols mean,” she said.

Hinshaw stressed Alberta is not at the point of needing this protocol and said she hopes the province never gets there, but said the planning needs to be done.

“Just as field hospital planning was underway in December and January, even though we didn’t end up needing those resources, this planning has been underway all year.”

As of Thursday’s update, there were 21,385 active cases of COVID-19 in the province, the highest number since the pandemic began in March 2020.

The province also set a new daily case record with 2,048 new cases of COVID-19 having been confirmed over the past 24 hours.

There were 632 people in hospital, with 151 of those people receiving care in the ICU.

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Global News reached out to AHS for comment Thursday morning about the meeting.

But AHS told Global News last week that it has not needed to use these protocols “at any time during the COVID-19 pandemic.”

“It is important to be ready and AHS is taking steps to ensure we are prepared today and for the future,” said spokesperson Kerry Williamson in a statement.

“These triage protocols provide a mechanism through which health-care professionals can make the difficult decision of how to allocate resources such as ventilators and ICU beds to critically ill adult and pediatric patients when there are not enough available for everyone.”

On Tuesday night, AHS announced it was reducing surgery capacity in the Calgary, Edmonton and North zones as a way to prepare the health-care system to ensure it can meet demand. Additional ICU beds have already been added in the Edmonton and Calgary zones.

“The stages between now and then are that as beds start to fill up with COVID patients, you need to clear out anybody who doesn’t have to be in those beds,” Talbot said about when the framework could be implemented.

“The bottom line is, as you try to bring on that surge capacity, it’s not going to match what you have. Once those two sources of beds – eliminating elective surgeries and surge beds – are gone, that’s the stage at which we’ll be in real trouble and that triage protocol may be necessary.”

The AHS statement further said triage would only be activated when all available critical-care resources have been used across the province, including transferring patients to where resources exist.

Earlier this week, Dr. Neeja Bakshi, a COVID unit physician at the Royal Alex Hospital, said this third wave is busier than the second wave. She said some patients may have been avoiding the hospital in previous waves but, more than a year into the pandemic, that may no longer be possible.

READ MORE: COVID-19 hospitalizations, ICU admissions climbing in Edmonton zone

“We haven’t seen the same slowdown of the non-COVID related illnesses that we saw in the fall,” she said. “We see so much of the backlogs of illnesses that we didn’t see in the last year.”

AHS said it has the ability to increase to 425 ICU beds for COVID-19 patients province-wide.

On Thursday, Hinshaw announced an additional 19 ICU beds had been added in the Edmonton zone. There are now a total of 102 ICU beds in that zone.

– With files from Kirby Bourne, 630 CHED

© 2021 Global News, a division of Corus Entertainment Inc.

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