Ontario doctors being asked to prepare for ICU triage scenario

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Earlier this week, the co-chair of the province's COVID-19 health science table said if things don't change, doctors will be forced to make some tough choices.

Now, it looks like they're already preparing for that.

Michael Garron Hospital's Dr. Michael Warner told CBC News that doctors are being asked to prepare to have to make choices between who gets care, and who doesn't.

Warner says ICU doctors across the province have been told to prepare to use critical care triage, to determine who will be prioritized for care when ICUs become overwhelmed.

He told CBC that the province sent out a memo Wednesday which outlines the triage protocol, but there's been no date set for when that could start, however Warner said he fears it could be in a matter of weeks.

When Dr. Adalsteinn Brown warned of this scenario earlier this week when presenting the latest modelling projections — he said this situation would impact all patients needing care, whether they were in a car accident, are cancer patients, or have had a heart attack.

According to the CBC:

  • In a level one triage scenario, patients who have a greater than 20 per cent chance of surviving 12 months from the onset of critical illness based on an evaluation of their clinical presentation at the point of triage should be prioritized.
  • In a level two triage scenario, patients who have a greater than 50 per cent chance of surviving 12 months from the onset of critical illness should be prioritized. 
  • In a level three triage scenario, patients who have a greater than 70 per cent chance of surviving 12 months from the onset of critical illness should be prioritized.

Warner says doctors will be required to use criteria to determine who is most likely to survive their critical illness in the short-term, along with 12 months from then.

According to the CBC, the memo states this triage protocol should only be considered as a last resort, and only used when "all existing local and regional critical care resources have been used, all reasonable attempts have been made to move patients to, or resources from areas with greater critical care resource availability, and only for as long as the major surge lasts."