AHS issues triage protocol for critical care as ICU admissions reach all-time high

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Patients with greater chances of surviving beyond the next year should be prioritized if Alberta’s health-care system is overwhelmed by the COVID-19 pandemic, new documents released by Alberta Health Services Friday reveal.

The triage protocol will be used to determine which patients will receive critical care if demand on the health-care system exceeds resources.

The 50-page Critical Care Triage Framework comes as an all-time high number of COVID-19 patients are receiving treatment in intensive-care units. As of Thursday, there are 151 patients in Alberta ICUs with COVID-19, matching the peak seen during the pandemic’s second wave.

In the event of a “major surge,” where 90 per cent or more of the province’s critical care surge beds are in use, AHS could invoke the protocol. In that instance, only patients with a greater than 20 per cent chance of surviving the next 12 months would be admitted to ICUs.

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And if 95 per cent or more of surge beds are in use, during a “large scale surge,” the triage protocol could enter its second phase, where only patients with greater than 50 per cent of surviving the next year would be admitted. Care could also be discontinued for patients whose expected mortality exceeds that threshold.

In that scenario, triage for pediatric patients could also be considered.

“The triage protocols create 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,” the document reads.

“These protocols ensure that such decisions are made in an ethical, fair, and structured way and not ad hoc.”

When multiple patients have incremental differences in their likelihood of survival, the document says, care priority should be based only on medical assessments, not on personal characteristics like age, race, sex or disability.

If distinctions can’t be made for which patient would benefit more from critical care, priority should be given to whoever arrives first to a hospital. If patients arrive at the same time, random selection would be used.

The document also contains a list of eligibility and exclusion criteria, helping doctors calculate expected mortality based on conditions like cardiac arrest, stroke or severe traumatic brain injury.

AHS briefed some health-care workers on the protocol in a Friday afternoon meeting.

Alberta chief medical officer of health Dr. Deena Hinshaw said Thursday the protocol is a last resort but that it is important to plan for these scenarios.

“We are not at the point now of needing to use this protocol, and I hope that we never reach it,” Hinshaw said.

“This planning has been underway all year. AHS has capacity for current needs and can still increase it if demand increases.”

The province is reducing surgeries by up to 30 per cent in response to the third wave of COVID-19 and its potential impact on the health-care system.

“These measures will help free up spaces in our hospitals for patients who need a higher level of care and give AHS the flexibility to redeploy frontline staff and resources to where they are needed most,” Hinshaw said.

Alberta can expand its capacity for ICU patients to 425 beds, if needed. Currently, there are 151 Albertans in ICU with the novel coronavirus, patients who are among the 632 in hospitals.

The protocol was initially drafted during the H1N1 pandemic in 2009, and was further developed in response to COVID-19.

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