ICU doctors in Ottawa, across the province prepare for potential rationing of COVID-19 care

An emergency triage protocol that determines which patients get potentially life-saving care will help minimize preventable deaths in the event intensive care units are filled to capacity with COVID-19 patients, according to one of its authors.

“We haven't implemented it yet, and we're hoping that we won't have to,” said Dr. James Downar, division head of palliative care and ICU physician at The Ottawa Hospital and University of Ottawa.

The protocol instructs doctors to assess patients by using one standardized tool, considering their chances of survival and the total amount of ICU care available at a given time, to determining which critically ill patients receive treatment in a filled-to-capacity ICU.

Dr. Downar said one of the key factors would be a patient's risk of mortality, allowing doctors to rank patients by their chances of surviving 12 months, if there isn't enough care to go around. While the prospect is grim, he added that having a protocol like this in place is crucial to ensure that the decisions about which patients are treated first are made consistently, and in as fair a way as possible.

“The true harms of an overwhelming surge in demand are that a lot of people who could be saved might not be able to get at critical care, and not be able to get home to their loved ones,” Dr. Downar told The Rob Snow Show on CityNews Ottawa. “Our job, as with everything else in healthcare, is to try to use our resources as best we can, to get as many people back home to their loved ones as possible.”

Disability advocates have raised concerns about triage protocols, but Dr. Downar said disability alone would not disqualify a critically ill patient form receiving critical care.

“You give guidance that is not prioritizing people for anything other than mortality risk, and you apply the same standards to literally everyone coming in, regardless of ability or disability,” said the doctor.

“You can't simply stamp out implicit biases and subjectivity, the best antidote to that is with an explicit alternative plan that pushes people to focus on other things that you consider to be relevant and fair; that's what a triage protocol is aimed at.”

Dr. Downar said the triage plan is necessary to ensure these sorts of life-or-death decisions are being made in a consistent way, as fairly as possible, avoiding the chaos and spur of the moment decisions made by doctors in places like Italy, when hospitals were overwhelmed by the numbers of critically ill COVID-19 patients during the spring of 2020.

“Nobody wants to get there, and we're doing everything we can not to get there,” said Dr. Downar.