Pediatric patients now excluded from Alberta’s critical-care triage protocol

Hospitalized children who need critical care will receive treatment even if Alberta’s intensive care units are stretched beyond capacity, says Alberta Health Services.

The health authority confirmed Wednesday that children and youth will no longer be included in Alberta’s emergency triage protocol, a plan that details how Alberta doctors would ration care if COVID-19 pushes hospitals past their breaking points.  

“AHS has decided not to activate pediatric triage should we ever reach the point of activating the critical-care triage protocol,” AHS spokesperson Kerry Williamson said in a statement to CBC News. 

“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.” 

The change was communicated to physicians and staff last Friday, Williamson said. 

“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.” 

The critical-care triage protocol, a 52-page document developed by AHS, describes how the health-care system would cope if ICUs no longer have the resources to care for every critically ill patient.

Revised most recently in May of this year, the protocol has never been enacted but health-care workers have been briefed on the document so they can be prepared.

“Triage is not about withholding care from patients, it is about providing the best care to the greatest number of people,” the guidelines state.

“The best action when demand for absolutely scarce critical-care resources exceeds supply is to save the greatest number of lives possible.”

The triage framework would only be implemented if all efforts to increase ICU capacity are exhausted. To avoid triggering it, AHS has been finding additional beds, redeploying staff, cancelling thousands of surgeries and turning any suitable spaces it can find into ICU beds. 

Alberta has 376 ICU beds — 173 baseline beds and 203 additional. There are currently 300 patients requiring ICU care, including 242 with COVID-19.

“We currently have adequate ICU capacity, and hope to never have to implement the protocol,” Williamson said Wednesday.

Alberta reported 3,358 new cases of COVID-19 over the holiday long weekend. As of Monday, there were 1,053 people being treated for COVID-19 in hospital. 

Provincially, ICU capacity is at 80 per cent. Without the additional spaces, provincial ICU admissions would be at 173 per cent of capacity, AHS said.

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