Calgary hospitals told to conserve oxygen, but doctors fear request is a red flag

Alberta Health Services says a memo urging Calgary hospital staff to reduce use of oxygen is a proactive response to an anticipated increase in demand as COVID-19 hospitalizations climb.

But some doctors say the request is concerning and not something they've seen before.

"Due to the limitations of the bulk oxygen systems at some adult acute care sites in Calgary and the expected increase in demand due to the COVID-19 pandemic, we need to reduce the demand on the bulk oxygen system," wrote Calgary zone respiratory program leads Carmella Steinke and Dr. Jonathan Gaudet on Friday.

Bulk oxygen refers to how oxygen is stored in a large volume in hospitals in liquid form. It is delivered to each patient's room by pipes — almost like tap water.

"Clinical measures require everyone to engage in oxygen conservation measures immediately."

The memo advises doctors and nurses to assess patients to see if their oxygen use can be reduced and to "target the lowest tolerable" levels of oxygen saturation in a patient's blood.

It said the sites most affected are Foothills Medical Centre, Rockyview General Hospital, and Peter Lougheed Centre, all of which currently have COVID-19 outbreaks.

Dr. David Zygun, Edmonton zone medical director for Alberta Health Services, said during Monday's provincial COVID-19 update that the memo was part of an "anticipatory" plan to make sure there are ample resources.

An AHS spokesperson told CBC that Calgary has an adequate supply of oxygen to meet patient's needs, and that any limitation is not in the oxygen supply itself but instead in the capacity of the pipes that deliver oxygen from a centralized source.

"The O2 monitoring and conservation memo circulated was to remind clinicians to provide oxygen therapy in an evidence-informed, responsible manner and to be proactive in safeguarding the resource recognizing that we anticipate a potential increase in patients in need of oxygen therapy," AHS said.

Infrastructure upgrades on the system are underway to be completed by June next year, and AHS said in the meantime it's working with health-care providers to appropriately conserve oxygen resources.

'Restrictions are alarming'

However, Dr. Kerri Johannson said the memo was a first in her 15 years working as a pulmonary medicine specialist in Calgary.

"These restrictions are alarming in that we've never been asked to ration or limit oxygen in an acute care setting before," said Johannson, who is also a clinical assistant professor in the departments of medicine and community health sciences at the University of Calgary.

Johannson said the measures the memo calls for likely don't pose any harm to patients, but they do show strain on the health-care system.

"Oxygen is fundamental supportive care for many hospitalized patients and certainly in patients with COVID-19. So I think while these current measures seem reasonable and I don't think they're compromising patient safety, they raise a major red flag in that we don't know what's going to be rationed next. We've heard of doubling up of ICU beds happening in Edmonton," she said.

"I think what this signifies to me is just the fact that we plan for a certain volume of health-care delivery and in usual times, this would not be a problem."

NDP Opposition health critic David Shepherd told the house on Monday that the memo indicates a reason for concern.

"Even as our hospitals are packed full of the critically sick, AHS is running short on oxygen," he said.

Health Minister Tyler Shandro responded saying that was not the case, and that the memo represented a contingency plan and something that happens "often throughout any given year."

On Monday there were 453 people in hospital and 96 in intensive care in the province.

Dr. Joe Vipond, an emergency doctor and clinical assistant professor at the University of Calgary, said with the number of patients in hospital doubling every few weeks, the system will hit pinch points.

"I am concerned because I don't know what the future holds," he said.