Ventilator shortage is warning of potential crisis

Last week, so many ventilators were in use in Minnesota hospital intensive care units that many hospitals rented extras and several hospitals shifted patients with respiratory problems elsewhere for care.

"Was it a crisis? No, but it got a little too close for comfort," said Dr. John Hick of Hennepin County Medical Center and medical director for an emergency-preparedness compact among the 29 metro hospitals.

"The thing is, availability of ventilators is kind of a bellwether for our capacity to deal with a crisis," Hick said.

No unusual events brought the hospital ICUs to the brink of running out of ventilators. Hospital officials said they were caring for a typical mix of patients with traumas such auto accidents, major surgery, acute illnesses and a surge in older patients with chronic diseases and flu or pneumonia.

"Even if we hit a temporary local crisis, we can deal with that," Hick said Tuesday. "What worries me -- what keeps me awake sometimes -- is what will we do when we get a regional or national pandemic? That's going to happen. It's just a question of when and how bad.

"The truth is, in a major crisis like a pandemic we may be forced to triage patients because we just won't have the hardware, and some will die," Hick said.

Pressure on hospital ICUs, where ventilators are used, has eased slightly this week, the hospitals say.

State officials do not track ventilator use but probably will begin to do that, said Minnesota Health Department spokesman John Stieger. But a department survey on Tuesday found that 83 percent of the 950 beds in hospital ICUs were in use, compared with 85 percent last week. Hospital officials say ICUs usually are about 80 percent full.

Some health planners such as Hick have warned for several years that with ICUs running near capacity, a major disaster or flu outbreak could "tip us over the balance and people would die for lack of ventilators."

Hick has urged state officials to stockpile ventilators, "but in a year when we're cutting health care spending, buying ventilators at $50,000 each in case of emergency is kind of a hard sell. (The state has 37 portable ventilators placed around the state for training, but available for emergencies.)

Turning away patients

At Abbott Northwestern Hospital, "our two ICUs -- 55 beds -- were totally full last week, and for a couple days we couldn't take any more critically ill patients," said Dr. Kevin Graham, a cardiologist and president of the hospital's Minneapolis Heart Institute. "We had at least one patient headed our way who we diverted to another hospital."

"I was wearing a pager night and day because we were right at the edge," he said. "I've been doing this for 20 years, and last week the situation was extraordinary."

At the Mayo Clinic in Rochester, "we were close enough to capacity that we rented four ventilators ... to make sure we had enough capacity in case we had a rush of admissions," said Curt Buck, director of respiratory care services. "We were told by the rental companies that we took the last four they had."

It was the first time in more than a year that Mayo's more than 100 ventilators were not adequate, Buck said. "And this is not usually our busy season. Not as many people from outside the region come here for surgery in the winter."

Additional ventilators also were rented for University of Minnesota Medical Center, Fairview and for Fairview Ridges Hospital in Burnsville. But at Fairview Southdale hospital in Edina, only five to eight of its 15 rented ventilators were in use last week, said spokesman Ryan Davenport.

There was heavy use of North Memorial Medical Center's 44 ventilators last week, "enough so that we checked out availability of renting more, but we didn't need to do that," said spokeswoman Wendy Jerde.

The supply of rental ventilators "got very tight last week. It's still pretty tight," said Gary Blackford, CEO of Edina-based Universal Hospital Services, the dominant supplier in Minnesota and nationally.

"It's the flu season everywhere and demand is high. But we moved in some extra ventilators to Minnesota last week" to supplement the 100 or so in stock, he said.

"This is a scary situation and it ought to make people nervous," said Hick at HCMC. "We got through last week and we can do it again -- we probably will. But when we get hit hard with a bad outbreak, people are going to be saying, 'Why didn't you prepare for this?' And there won't be any good answers."

Warren Wolfe • 612-673-7253