Pediatricians in Alberta are up for the prospect of deciding which critically ill children will be eligible for care, should a surge in COVID-19 cases push the province to its highest level of triage protocol.
The uncomfortable reality comes as the presidents of Alberta’s largest health care unions and the largest activist advocacy group urged Premier Jason Kenney to immediately request federal aid to deal with the province’s overwhelmed hospitals.
As of Sunday morning, provincial critical-care capacity stood at 84 percent, according to Alberta Health Services (AHS). Without the additional surge space, the capacity would be 160 percent. About 75 percent of surgeries have been canceled in all hospitals, including children’s hospitals, so that staff can be redeployed to respond to COVID-19 patients at other sites.
“It is our assessment that Alberta’s health care system is not merely ‘on the verge of disintegration’ – we believe it is indeed collapsing before our very eyes,” reads a September 18 letter from union presidents to Mr. Kenny .
The AHS began sharing its framework for critical care triage during a pandemic or disaster with staff last week – a road map to follow as a “complete, complete last resort”, said President and CEO Varna. Yiu said.
The introduction to the 52-page document says that the protocols “create an objective process to guide health care professionals in the difficult determination of how to allocate resources to critically ill adult and pediatric patients when there is sufficient critical care for all.” There are no resources.”
The protocol, which is yet to be activated, will begin with a number of measures including patient transfers, redeployment of medical staff and extended working hours. Phase 1 triage will begin when provincial occupancy of all available critical-care surge beds exceeds 90 percent. Under this phase, only patients with more than 20 percent chance of survival next year will be eligible for critical care.
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At 95 percent occupancy, the province will move into Phase 2, in which only adults with more than a 50 percent chance of survival next year will be eligible for critical care. Pediatric testing will also be considered at this stage; Children with complex chronic diseases, for example, may not be able to receive critical care under normal circumstances. Care of patients already in the ICU can also be stopped.
Samina Ali, a pediatric emergency physician at Stollery Children’s Hospital in Edmonton, said she hopes such a scenario can be avoided, but the need to consider triage children for care in Canada is also shocking. Is.
“Never in my life’s training I thought I’d read something like this,” she said of the triage document. “Never in my career I thought I’d have to consider those factors in decision making. And I hope sky high that I never have to talk to a family about it.”
Dr. Ali said that the framework can be traced to the most capable prejudices in society.
“I know these are not exactly the intentions of the people who I’m sure worked with a heavy heart to create these policies, but when you say that chronic conditions and chances of survival affect your decision-making. That includes a lot of kids who aren’t neurotic or have life-limiting conditions,” she said. “And that hurts me a lot.”
Dr Ali said the primary concern is for patients and their families, but he is equally disturbed by the impact on health care workers, who may be asked to make these decisions.
“There will be so much moral crisis and conflict,” she said. “I’m very concerned about post-traumatic stress disorder and burnout and quitting.”
Edmonton-based pediatrician Tehseen Ladha, who holds a master’s in public health, also believes that Phase 2 can be avoided, but added, “It’s certainly a shock to be in a position where this document table But it is too.”
Dr. Ladha is among the doctors who are calling for a complete lockdown in the province to stop the rapid spread of the virus. It’s a move that would go far beyond the measures announced by the Alberta government last Wednesday, which have been called confusing and come with a number of exemptions and exceptions.
“It is important to clarify that we have not called for a lockdown until this point, and the reason we have not done so is because there were still opportunities to be proactive and put in sensible public-health measures that could have prevented this,” Dr Ladha said. he said.
“But it’s too late now. Because we’re in a reactive phase, we really need to shut down all non-essential services and businesses to substantially reduce that exponential growth.”
In their letter, heads of groups including the United Nurses of Alberta, the Alberta Union of Provincial Employees, the Health Sciences Association of Alberta, the Canadian Public Employees Union and the Alberta Federation of Labor urged Mr. Kenny “in the strongest possible terms”. . To call on Ottawa to immediately deploy the military, Red Cross and all available medical staffing resources to other provinces.
“The tank is empty. The well is dry,” the letter said. “Our members have been going in and out for 19 months, but they are worried that this wave of the pandemic will crush them.”
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