Critically-ill coronavirus patient may be transferred from Dublin to other Irish hospitals if intensive care capacity is exceeded in the capital, a senior HSE official in the Republic of Ireland said.
National director of acute operations at the HSE, Liam Woods, was responding to concerns raised by medics in several Dublin hospitals that they were running out of beds in ICU units.
Mr Woods said the issues related to traditional ICU capacity and stressed that there were surge plans in each hospital to increase critical care capacity by utilising high dependency units.
He said baseline ICU capacity across Ireland was 312 beds, but that number was set to rise to 812 under surge planning. He said the plans depended on training up staff and securing more ventilators.
Mr Woods said there was surge capacity still available at Dublin hospitals where baseline capacity had been exceeded.
But he said if that extra capacity was also exceeded as the outbreak progresses, then patients may be moved elsewhere in the country.
Mr Woods said other cities were not experiencing similar pressures on ICU capacity and he noted that 138 intensive care beds were empty nationally as of Tuesday.
He highlighted that critical care patients are already moved between hospitals in normal circumstances, though he acknowledged that movement was usually towards Dublin, not away from it.
“Some of the surge capacity that is available is still available in Dublin,” he said at the National Public Health Emergency team media briefing on Wednesday.
“Is there a point in time at which one will consider potentially moving patients from Dublin? Of course, if the situation became particularly challenged that will be an option.
“It’s not happening at the moment because it’s not necessary at the moment, but should the situation arise, it is something we will look at and individual hospitals would engage with.”
Earlier on Wednesday, a senior medic at the Mater hospital in Dublin said the ICU unit was full and some patients had been moved to the high dependency unit.
The director of critical care medicine at The Mater Misericordiae University Hospital said that most of those in the ICU beds are Covid-19 patients.
Dr Colman O’Loughlin said that furtherCoron plans are in place when the high dependency unit has also become full.
Speaking to RTE’s Morning Ireland, Dr O’Loughlin said: “We were lucky in this Covid (-19) crisis that we had a lead-in time to allow us to kind of shut down the normal activity of the hospital and free up a lot of spare capacity that exists in the hospital.
“That has allowed us to build a plan for surge one, surge two, surge three, and surge four etc, so we can act on those plans as the surge comes in.”
He said that patients are being moved to the high dependency ward where there are another 18 beds and, when that becomes full, staff have set up ventilators on other wards.
Dr O’Loughlin added: “The biggest challenge at that stage will be the staffing problem.
“To run intensive care beds it requires a huge amount of medical staff and in particular nursing staff to run it safely.
“We have a standard of care which is one-to-one nursing so every patient has a dedicated nurse 24 hours a day to run normal standards of care for intensive care in Ireland.
“So that would be threatened, that could be diluted if we stretch beyond the numbers that we’re comfortable, so that’s a bit of an unknown yet.”
Dr O’Loughlin also said that staff can no longer carry out the hospital’s end-of-life care pathway.
He said that one of the “really difficult parts” of the disease was arranging family members to be with their loved ones who will not survive Covid-19.
He added: “Families are aware, and we’re aware, there’s such a huge public obligation to try and minimise the spread of this disease.
“At the same time it’s important to us to offer families the chance to come and be with their loved ones, if they’re going through the process of passing away, or have passed away.
“We offer families, in minimum numbers like one or two people, to come into the intensive care.
“We offer them the PPE and demonstrate how that’s put on, a lot of families have been reluctant to do that which is very, very difficult for them.
“They’re aware there’s a public health issue beyond all this.
“We try to cover them as much as possible and reassure them.
“We have never seen it like this before.
“We have a very well established end-of-life care pathway in the hospital in intensive care, and a lot of us cannot do it now because of this disease so we’re doing our level best to help families.
“It’s extraordinarily difficult.”
