The term “triage” may be a scary one to hear, but Alberta’s health authorities are preparing its staff and the public for the possibility of that extreme measure.
When triage is declared health officials must decide which critically ill patients are eligible to receive care and which are not.
A 52-page document outlining how life and death decisions will be made if the province’s health-care system is overwhelmed past its breaking point has been posted publicly by Alberta Health Services.
The framework for the critical care triage protocol in Alberta describes the procedure that will be put into place when all available resources and mitigating steps for critical care have been exhausted.
“We’ve started the educational process,” AHS CEO Dr. Verna Yiu told reporters on Thursday.
According to the AHS triage framework, the decision to activate the protocol would be up to Dr. Yiu, “in consultation with the AHS Executive Leadership Team.”
“Basically this week was really sharing with our staff about what it is,” said Dr. Yiu, “and really setting up the infrastructure in place so that we – if we had to use it, again this would be an absolute, absolute last resort – that the staff are ready and trained and prepared.”
According to the AHS document, the critical care triage protocols are designed to “create an objective process to guide health-care professionals in making difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical care resources for everyone.”
WHEN TRIAGE MEASURES CAN BE TRIGGERED IN ALBERTA
The framework divides the province-wide triage measures into two possible phases, based on the severity of surging volumes of critical care patients.
When the usual number of critically ill patients is exceeded, and all available critical care surge beds is at 90 per cent or greater, the AHS triage guidelines state that should be considered a “Major Surge” and “Phase 1 Triage may be required.”
According to the AHS framework, Phase 1 triage would mean “eligibility assessment for entry into critical care are based on one year expected mortality of approximately greater than 80 per cent.”
In other words, the greater your likelihood of survival, the better chances you have of receiving care.
Phase 1 triage would not affect pediatric patients, however Phase 2 would.
The triage guidelines state that Phase 2 may be required in the event of a “Large Scale Surge.”
According to the framework, a large scale surge is when “critically ill patient demand exceeds available capacity and human resources,”
“All feasible strategies to maximize staffing resources, staffing functions, supplies and equipment and access to invasive mechanical ventilation will have been used prior to initiation of this triage phase,” the document reads. “Provincial occupancy of available critical care surge beds is 95 per cent or greater.”
In a Phase 2 triage scenario patients would receive eligibility assessments, and current critical care patients would receive a “discontinuation assessment.”
When the triage protocol is active, consent from patients or their families would not be required to withhold or withdraw care.
Vaccination status will not be a consideration on whether a patient is treated.
HOW CLOSE IS ALBERTA TO ACTIVATING TRIAGE?
Dr. Neeja Bakshi, a general internist with primary inpatient practice at Edmonton’s Royal Alexandra Hospital, told CTV News Edmonton on Friday she believes the province’s ICUs could “potentially” be overrun within the next 12 to 14 days.
“Whether or not that’s to be the time we have that means that’s going to be the time we have to enact the protocol is a bit of a moving target,” said Dr. Bakshi. “It depends on resources and how much we can try to do within the current system.”
“This is also why we are starting to educate the folks that might be involved in the triage protocols right now.”
As the fourth wave of COVID-19 surges across Alberta, the province has begun to implement extraordinary measures to make room for the daily average of 20 new patients being admitted into the province’s ICUs.
While Ontario has agreed to accept patients from Alberta, Dr. Yiu said on Thursday that AHS is also in conversation with other provinces about sending patients if needed as well.
According to AHS, field hospitals in Edmonton and Calgary have also been prepared.
When asked about triage protocols and ICU care rationing, Dr. Yiu stopped short of making any predictions.
“From our perspective the numbers are changing daily and almost hourly… Things that were projected from last week already (are not) accurate this week,” she said. “It’s related to the fact that we are continuing to find additional capacity.
“But it comes at a cost. And that cost is that when we start reducing the procedures and postponing procedures. That’s how we’re finding a lot of the capacity.”
The AHS CEO stressed the importance of getting every eligible Albertan vaccinated in order to avoid extreme measures like triage.
“I just can’t say enough how important it is for Albertans to go out and get vaccinated,” she said.
On Friday, the province announced 80 per cent, or more than 3.1 million of eligible Albertans, have received at least one dose of a COVID-19 vaccine.
Alberta has 310 ICU beds including 137 surge beds, Dr. Yiu said. Eighty-six per cent of those beds are occupied – largely by COVID-19 patients.
Dr. Yiu said the province currently has over 600 ventilators and an additional 200 “less than optimal ventilators,” which “could be used.”
According to the province, there are 911 hospitalizations due to COVID-19 with 215 of those in ICUs, as of Friday.
Alberta has 19,201 active cases of COVID-19.
The province has seen 2,523 deaths related to COVID-19.