As ICU beds fill due to COVID-19, Canada’s largest air ambulance fleet sees more transfers

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TORONTO — At Humber River Hospital in Toronto, Ont., the intensive care unit is as stretched as the staff managing the COVID-19 patients filling their beds.

“Unfortunately, those patients are deteriorating quickly, in many cases needing ICU resources. So our ICU is in surge capacity almost every day,” said Dr. Tasleem Nimjee, the director of Medical Innovation at Humber River and an emergency physician.

As COVID-19 hospitalizations in Ontario continue to rise in tandem with record numbers of daily new cases, hospitals in the hardest hit regions are facing increasingly full ICUs, with Ornge, Canada’s largest air ambulance fleet, transferring more patients than ever from one busy ICU to a less busy one to ease the strain on overburdened facilities.

“We all remember the scenes from Northern Italy and from New York City and wave one, where there was an overwhelmed healthcare system,” said Dr. Chris Simpson, executive vice president of medical for Ontario Health.

“I think doing this is to prevent exactly that -- we don't want to be in a position where we have to deny care to people who are critically ill.”

This week, Ontario launched an unprecedented effort to mitigate the issue by asking Ontario hospitals to reserve a third of its intensive care hospital beds for patients transferred from busier hospitals in other regions.

“People just have to understand that it's stretching our healthcare system pretty tight. And then on top of that, people still have accidents, people still have emergencies, they still have heart attacks and strokes, those things all have to be dealt with as well,” Michael McCallion, the operations control manager for Ornge, told CTV News.

INFLUX OF ICU PATIENTS

Ornge air ambulances are specialized and equipped to safely transfer the very sick. Each year, they make some 20,000 patient-related transports and are the only ones able to move patients on ventilators -- by land or by air.

These once-rare ICU transports are increasingly becoming the norm, with COVID-19 patients transferred to hospitals as far away as Barrie, Ont., some 80 km to 110 km away from Toronto hospitals.

“We have six ambulances currently assigned to us in this area right now,” said McCallion, who estimates they’ve become 30 to 40 percent busier.

“Two of those are currently working in moving and COVID patients. So essentially, 33 per cent of what we have on the screen is actually doing COVID patients at this time.”

Health officials had already predicted the coming influx back in December when the number of ICU patients were already hitting levels never seen before during the pandemic: January was almost certain to be worse.

Public health officials predicted more than 500 critically ill COVID-19 patients by late January -- nearly doubling the number of patients in ICU three weeks earlier. As it stands, there are now nearly 1450 COVID-19 patients in Ontario hospitals, with more than 369 of them in intensive care units.

And all signs indicate this kind of triaging will last for a while.

“I would think at least a month -- more likely two months. It’s difficult to predict,” Dr. Bruce Sawadsky, the chief medical officer of Ornge, said in an interview.

“I think we’re just at the beginning. We’re planning on an increase in critical care … that’s going to increase in the next couple of weeks, if not month.”

Between Nov. 1, 2020 and Jan. 3, 2021, a conservative estimate of about 240 patients were moved between intensive care units in Ontario, according to a manual review of data provided by Ornge. A year earlier, between Nov 1, 2019 to the end of January 2020, a conservative estimate of about 150 patients were transported from one ICU to another. That’s a 60-per-cent increase over a shorter window of time.

These figures also do not include patients who may have been transported from an emergency room to an ICU due to a surge, something Ornge says it has seen over the last month as well.

“‘Decanting’ of patients from one ICU to another ICU to create capacity is not usual business for Ornge,” spokesperson Joshua McNamara said in an email. As a result, the organization only began tracking the data in December.

That data showed that 49 patients were moved specifically to create more capacity. Of those, 32 were confirmed to have COVID-19, while 14 others did not necessarily have a COVID-19 diagnosis yet, but showed symptoms or may have travelled in the previous 14 days. Just three did not have the virus, or raise any red flags in their screenings.

The patients being transferred to ease capacity are usually more stable and relatively new to the ICU, but are still nonetheless quite sick, with most ventilated and sedated, according to Sawadsky.

FACING CHALLENGES

Like many other places, staffing has also been a challenge for Ornge, with staff encountering child-care issues, needing to stay home due to minor illnesses or concerns with community exposure under COVID-19 protocols, he added.

“We’re trying to find innovative ways, while managing the staffing issues.”

To make it all work requires proactive teamwork between Ornge and all its partners, including hospitals, critical command, and the Ministry of Health, Sawadsky added.

With all the effort front-line teams are putting in to ensure a seamless operation, some express frustration at some of the dismissiveness over the pandemic.

“I think everybody’s starting to see the stress. I mean a lot of people are seeing it in the hospital system, the nurses, the doctors, the medics are seeing it every day,” said McCallion.

“And then we hear the stories about people who sort of believe this is a fallacy. You see people protesting, saying COVID is a hoax … you can’t make people believe what they should but it’s real it is happening."