Canada’s provinces are starting to tap the federal stockpile of reserve ventilators as they struggle to cope with the strain being placed on intensive care units by pandemic (H1N1) 2009 influenza.
Alberta received 45 ventilators from the Public Health Agency of Canada (PHAC) stockpile on Nov. 9 and planned to deploy them across the province if needed to increase critical care capacity to treat patients.
Alberta Health Services’ Senior Medical Officer of Health Dr. Gerald Predy confirmed that the province asked for the ventilators on Oct. 30. “We recognize that, based upon the experience in countries like Australia and in the southern hemisphere, having some surge capacity in our critical care units is important,” he says. “We’ve already purchased some ventilators to help us with the surge capacity, but we just wanted to know what was available from the federal stockpile.”
Unbeknownst to Predy, as he was talking to CMAJ, the ventilators arrived, said Wendy Beauchesne, a spokesperson for the province’s emergency operations room. “They will be distributed across the province as needed,” she added.
Alberta had already purchased enough ventilators to increase its capacity by about 65%, Predy says. He emphasized that intensive care units in Alberta’s hospitals, while stressed by the number of people ill with pandemic influenza, are currently managing. As of Nov. 9, there were about 100 people with confirmed or suspected cases of the virus in critical care beds, about one-third of the available intensive care unit beds within the province.
Twenty-five Albertans have died of pandemic (H1N1) 2009 as of Nov. 9, Dr. André Corriveau, Alberta’s chief medical officer of health, told a press conference.
Predy later said that “we anticipate from what we are seeing (now) that we are going to see more critically ill people with H1N1 over the next couple of weeks, for sure, so we just want to be as prepared as we can.”
Pandemic (H1N1) 2009 flu patients in intensive care units have typically required aggressive means of oxygenation, often staying on ventilators for weeks at a time.
Alberta is reviewing public health and other programs across the province to see what it can suspend in order to redeploy staff to critical care areas and has developed a short refresher program for nurses who may have once worked in intensive care units but have not done so recently, Predy says.
“Part of our plan as well is to put critically ill patients in other parts of our facilities that aren’t generally run as critical care units,” he says, referring to post-operative recovery areas and other spaces that could be reassigned. Thus far, the infections have been spread evenly across the province.
Ontario also bought additional ventilators — 216 of them — in anticipation of a surge in pandemic patients. The province expects to distribute the additional ventilators to teaching hospitals this month.
Several Ontario hospitals also report that their critical care capacity is being stressed. Sudbury Regional Hospital “reached and exceeded our capacity” on October 26–27 and was forced to transfer three patients to other hospitals, said spokesman Sean Barrette. As of Nov. 10, Sudbury Regional had eight patients on ventilators with confirmed or probable cases of swine flu and had cancelled 47 elective surgeries, at least in part because an anesthetist was sick with the virus, he said.
Timmins and District Hospital triggered a “code orange” alert, cancelling elective surgeries, restricting visitors, and at one point closing its critical care unit to new admissions.
All Northern Ontario hospitals “have been very stressed,” Barrette says.
In Toronto, Ontario, the University Health Network has had to delay some surgeries because of a lack of capacity in their critical care units, although that pressure eased by Nov. 10, says Dr. Rob Fowler, a member of the Canadian Critical Care Trials Group and a physician at Sunnybrook Hospital. “All the ICUs [intensive care units] in the city have cases, from 1–2 to 5–6 on ventilators,” he adds.
In Winnipeg, Manitoba, there are three children on ventilators with confirmed cases of the pandemic virus, and several other children on ventilators where doctors suspect pandemic (H1N1) 2009, says Dr. Anand Kumar, a critical care physician and associate professor of medicine at the University of Manitoba.
Canadian Critical Care Society President Dr. John Granton says Newfoundland and Labrador has been another pandemic hot spot.
But Granton adds that critical care doctors across the country are finding it difficult to get a clear picture of what’s happening nationally. “We’re still really lacking in communication at a national level to see what trends are and how this is being addressed, and how people are coping.”