Alberta revises triage protocol to exclude children

Children needing Alberta hospitals are no longer at risk of being denied critical care.

Edmonton Journal 3 minute read October 14, 2021

Teams in a crowded Calgary intensive care unit tend to a COVID-19 patient on a ventilator. Supplied by Alberta Health Services

Children needing Alberta hospitals are no longer at risk of being denied critical care if COVID-19 pushes the system to the point where doctors have to decide who gets the last of the ICU beds.

Alberta Health Services confirmed Wednesday that it has decided not to use pediatric triage should the province ever reach the point of having to activate its critical care triage protocol and decide who qualifies for care in the event that patients outnumber available ICU beds.

“This is a shift in our approach, which was communicated to physicians and staff last week. This step is not a change to the protocol, but a change in how we would implement the protocol should we ever need to use it. The protocol now only applies to adult patients,” spokesman Kerry Williamson said in an email.

“This decision was made following ongoing discussions with our pediatric teams, who expressed understandable distress at potentially having to use pediatric triage. Any gain in ICU capacity from pediatric triage would be negligible.”

Under the 50-page critical care triage protocol released earlier this year, triaging may be required in a “major surge,” which would occur when 90 per cent or more of available ICU beds in the province are occupied. The first phase of triaging would only allow patients who are predicted to have more than 20 per cent likelihood of surviving one year to enter the ICU.

Potential pediatric triage was originally to be considered as part of the second phase, which would have kicked in when 95 per cent or more of available ICU beds were occupied. At that point, only those with a 50 per cent chance of surviving one year would be admitted to the ICU.

Alberta ICUs have been overwhelmed particularly during the current fourth wave of the COVID-19 pandemic. Hospitals have been forced to convert non-ICU beds in ICU “surge” beds and other areas into dedicated COVID-19 wards. Patients from smaller hospitals have had to be transferred to hospitals in Edmonton and Calgary to find space and thousands of surgeries across the province have been cancelled.

At a press conference Tuesday, AHS president Dr. Verna Yiu said Alberta’s ICUs were at 78 per cent capacity when you include the more than 200 surge beds that have been created. Without those extra beds, ICU capacity would be at 172 per cent capacity, she said.

Yiu said she is feeling “a little bit more optimistic than I’ve been in quite a while” but that the situation still remains extremely serious.

“The number of Albertans needing ICU care has fallen by a small amount in the past week but it’s still too early to suggest that this is a trend. But it’s a good sign and a faint silver lining to what has been a very difficult period for our health-care system,” she said.

On Wednesday, Williamson said Alberta currently has adequate ICU capacity and AHS hopes to never have to implement the triage protocol.

“Again, triage will only be implemented if all efforts to increase ICU capacity are exhausted — and that has not happened yet,” he said.

– With files from Anna Junker