Since Aug. 16, Alberta Health Services has had to postpone a number of elective surgeries across the province in an effort to respond to COVID-19 activity.
Postponing these procedures means recovery beds can be converted to ICU beds and health-care workers can be redeployed from surgeries to the ICU, but what happens when there aren’t any elective surgeries left to postpone?
Both Dr. James Talbot and Dr. Lorian Hardcastle believe triage protocol would likely have to be implemented, which means doctors, nurses and health administrators will have to prioritize patients, essentially having to decide who gets a chance to live and who may not.
In April, AHS publicly released its critical care triage document that is designed to help health-care workers make these decisions.
Health-care workers would be directed to prioritize patients who have the greatest likelihood of overall survival and patients who are “most likely to have a positive outcome with the least use of critical-care resources, either by intensity or duration.”
“Incremental survival differences are based on medical assessments of the patient only and not personal or group characteristics of the patient (i.e. age, sex, race, disability, national or ethnic origin, colour, religion),” the document reads.
For example, if someone comes to the hospital who has been in a serious car crash, this person needs a ventilator to survive, Dr. Lorian Hardcastle with the University of Calgary said. But someone with COVID-19 or another medical reason also needs one and there’s only one left. That’s when this document comes into play.
“Looking at the relative prognosis of those people and how likely they are to survive, that could be looking at their physical condition, their comorbidities, their age, and who’s the most likely to survive if we give them this ventilator or we give them this bed.”
If someone is young, healthy and is more likely to survive, they would likely get priority over someone with a grim prognosis, the AHS document explains.
“But those are painful decisions for health-care workers to make, they’re painful decisions for society to watch being made, so we really don’t want to get into that territory if at all possible,” Hardcastle said.
If things are bad enough, there is a point in the triage protocol that suggests no medical intervention at all.
“You could end up in a situation where instead of trying to do everything possible to save someone, you end up give them palliative care instead because the resources that would be needed to try and save them are used elsewhere.”
While Alberta has not had to use this document yet during the pandemic, Dr. James Talbot feels the health-care system in the province is already in a state of collapse.
“If you end having to invoke a triage protocol or canceling all surgeries except those required to save people’s lives, you’re already in system breakdown,” the former chief medical officer of health said.
Talbot says it’s likely no health-care workers, outside of those who have worked in the military, will have ever used triage protocol like this before.
“I can guarantee that months after this is over, the physicians, the administrators, the nurses, the anesthetists who had to be part of these decisions are going to be traumatized.
“Outside of wartime, you don’t see triage protocols.”
Talbot was one of the signees of an open letter from the Edmonton Zone Medical Staff Association saying Alberta’s hospitals and ICUs could likely be overwhelmed by the beginning of October.
The eight doctors who signed their names to the letter say immunization rates are too low to stop the fourth wave and ask business owners to implement proof-of-vaccine policies and ask those who have been fully immunized to stop going to businesses without such a policy.
The other danger of postponing surgeries is it makes it harder to catch up, Hardcastle added. The province is still attempting to catch up from postponed surgeries in the first wave.
“This just puts us back even further in terms of catching up.
“There are a finite number of surgeons and other physicians, there are a finite number of nurses, so it becomes really difficult within our existing resources to quickly catch up on the procedures we’re delaying,” Hardcastle said.
“It’s very sad that we’ve gotten ourselves to this point because it is preventable.”
As of Monday’s update, there were 803 people in hospital with COVID-19, 198 of whom were receiving care in ICU.
According to a statement from AHS on Monday afternoon, there were 256 total patients in ICUs. Alberta has 286 ICU beds available as of Monday. Before surge beds were added, Alberta’s ICU capacity was 173 beds.