alberta faces growing risk of activating triage protocol, doctors say
'there are more critical care physicians and icu physicians who are really worried this could become a possibility'
4 minute read
the rockyview hospital as hospitals are seeing an increase in covid patients in calgary. photo taken on wednesday, september 8, 2021.
darren makowichuk/postmedia
by: jason herring
alberta currently faces a greater risk than ever of having to triage care for critical-care patients, according to the doctor at the head of the alberta medical association’s section of emergency medicine.
dr. paul parks said staffing strains in alberta intensive-care units coupled with a surging fourth wave of covid-19 infections mean there is a growing possibility the province will have to activate its critical care triage framework.
“i think we’re coming closer to it than we ever have come to it,” said parks, who is also an emergency physician.
“we don’t want to fear-monger. we don’t want to engage in these difficult conversations if there’s never going to be a need for it, if it’s all theoretical. but i think the reason it’s coming up more now is there are more critical-care physicians and icu physicians who are really worried this could become a possibility.”
alberta unveiled its triage framework this april, during the pandemic’s third wave. the document outlined how health-care workers would be asked to prioritize patient care if covid-19 overwhelmed the hospital system. the protocol could be triggered if 90 per cent or more of the province’s critical care surge beds are in use.
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that scenario never materialized during the third wave, but parks and other emergency doctors are raising alarm that triaging is a grim possibility during the ongoing fourth wave, driven by the ultra-contagious delta variant. as of friday, there were 169 albertans in icu with covid-19, a number that is fast approaching the third-wave high of 182 icu patients.
alberta health services said as of friday, the last day for which data is available, it had added 50 icu spaces across the province over the previous week, bringing the province’s total capacity to 268 icu beds. as of friday, there were 231 patients in icu, counting both covid-19 patients and those requiring other treatment.
“ahs continues to do all it can to ensure we have enough icu capacity to meet patient demand, including opening additional spaces and redeploying staff,” the health authority said in a statement.
alberta’s icus, including surge beds, were at 89 per cent capacity on average over the past week. but parks said these capacity stats don’t necessarily reflect the reality of icus, saying some have resorted to double-bunking patients.
he added he worries fatigue and burnout among health-care staff means there won’t be the personnel to staff further surge beds.
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“since the last wave we’ve lost a lot of senior nurses and we’ve lost a lot of our surge capacity,” he said. “on paper, it seems like there’s plenty of beds and spaces … but there’s real concern we wouldn’t necessarily have the real human beings and the staff, and specifically the nurses to staff that.”
the ahs triage policy describes itself as an “objective process to guide health-care professionals in making the difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical-care resources for everyone.” it aims to outline how to make these decisions in an ethical and unbiased manner.
it adds that doctors should base care priority only on medical assessments, not on personal characteristics like age, race, sex or disability.
parks said an “open discussion” needs to be had about how immunization status against covid-19 factors into the triaging protocol. the ahs document does not make reference to vaccine status.
parks added premier jason kenney has described alberta’s fourth wave as a “crisis of the unvaccinated.”
“it gets complicated because some people are not vaccinated because they don’t have access, and there are others who are not vaccinated because they’re anti-vax and opposed and will not change their minds,” he said, while acknowledging covid-19 patients in icu have a better chance of surviving if they are fully immunized against the virus.
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“in the end i think it does have to be discussed and proactively added to the algorithm in the sense of, what is the math on survivability?”
when reached sunday, ahs said they could not immediately provide comment on whether they were considering any revisions to its triage framework to address vaccine status.
last week, doctors with protect our province, a group that is hosting press conferences on covid-19 independently from the province, gave their prognosis for alberta’s hospitals during the fourth wave.
“our health-care system truly is at the brink of collapse right now,” said dr. ilan schwartz, an infectious disease professor at the university of alberta, during the briefing.
“there is continued exponential spread of the virus in the community. cases are going to continue to inundate our system, and predictably, people are going to die. and at this point, the cause is negligence.”
alberta has recently postponed surgeries to create icu capacity to cope with the surge in covid-19 patients, including in the ahs calgary zone, where the province delayed all scheduled elective surgeries in the latter half of last week.
the province is also planning to move some of its hospital patients to continuing-care and home-care beds to further free up space for covid-19 patients.
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on friday, alberta reported 1,437 new cases of covid-19, the second-highest count of the fourth wave. the province will next provide updated case counts monday.
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