Alberta's triage protocols not implemented, but doctors are already rationing care

The head of emergency medicine for the Alberta Medical Association says major components of triage have already begun in Alberta.

Dr. Paul Parks said that in recent days some critically ill COVID-19 patients who should be on ventilators are not getting them. That's on top of previously announced mass cancellations of surgeries, along with patient transfers, as doctors balance medical need with available space, he said.

Parks said it has become routine in hospitals in the last two weeks to have some critically ill patients — most of them unvaccinated COVID-19 cases — kept on main wards rather than in intensive care units on ventilators because they don't have the resources.

"We already are in positions in many hospitals across Alberta where the doctors know that it would be best for this patient to be in ICU and be on a ventilator, but we're not providing that option until they absolutely deteriorate to the point of crashing," Parks said Friday in an interview.

"We already are implementing some of these things that are drastic and we wish we never would have.

"People will suffer and will die by this."

Triage protocol not in effect, AHS says

A 52-page critical care triage protocol developed by Alberta Health Services (AHS) describes how the health-care system will cope if intensive care units no longer have the resources to care for every critically ill patient.

The decision to use the triage policy would be made by the CEO of Alberta Health Services in consultation with the organization's senior leadership team — and would apply to all health-care facilities.

While Parks said components of triage are being used, a spokesperson for Alberta Health Services said Friday the official protocol has not been brought into effect.

"The critical care triage has not been implemented, and our hope is that we will not have to implement it," AHS spokesperson Kerry Williamson said in a statement.

"It will only be implemented if all efforts to increase ICU capacity are exhausted – that has not happened yet."

Williamson said 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."

As of Friday afternoon, Alberta hospitals were operating at 83 per cent surge capacity,  Williamson said. Without the additional surge spaces, provincial ICU capacity would be 177 per cent.

Parks said it's not at the point where doctors must make on-the-spot, life-and-death decisions. But he said that's not far away and, when it comes, the second stage of triage will follow quickly, including making those same decisions about children.

AHS is doing everything it can, he said, but the government has failed to lead by imposing lax health restrictions and by allowing mass gatherings, including in schools and at sports events.

Alberta is seeing well over 1,000 new COVID-19 cases a day.

Parks said there needs to be an immediate response, including mandatory mask mandates everywhere and shutting down schools and mass gatherings.

Dr. Verna Yiu, head of Alberta Health Services, said Thursday the fact that intensive care wards have not been overwhelmed is partly due to the deaths of COVID-19 patients.

 "Each day we see a new high," Yiu said Thursday, referring to the total number of patients in ICU.  

"It's tragic that we are only able to keep pace with these sort of numbers because in part some of our ICU patients have passed away," she said. "This reality has a deep and lasting impact on our ICU teams."

Alberta normally has 173 ICU beds, but has more than doubled that number to 368 by taking over other hospital spaces, such as operating rooms, and reassigning staff.

A total of 195 additional spaces have been created to accommodate an influx of COVID-19 patients. 

Hospitals have opened 42 additional ICU surge spaces in the past seven days, including 18 in the past 24 hours, AHS said. 

The number of patients in ICU has increased by 18 per cent in the past seven days, AHS said. 

There are currently 304 patients in ICU, the vast majority of whom are seriously ill from COVID-19.