Ventilators alone are not the solution

Dr. Christopher Tufton is challenging critics who say there are still not enough ventilators being distributed to health care facilities, after it was revealed Thursday that there are 118 ventilators in operation within the health care system.

Minister for Health and Wellness, Dr Tufton, reiterated that this figure was the maximum number of ventilators that Public Health had, and insisted there was clinical justification for where they were located and how they were used within the system.

“Some people do the math and say 118 divided by 24 means each hospital needs x number of ventilators, but for a population of 3 million, there are not enough ventilators. There is a clinical justification for ventilators — where they are located, how they are utilized, the support systems that are required, why we have a referral system between hospitals. And this is an opportunity to get that understanding so that the public is not misinformed or given an impression that leads (someone) to the wrong conclusion,” he said at a press conference on Thursday.

Dr Tufton noted that ventilators alone are not the solution, as ventilators need to be supported by infrastructure, “so we need to be able to move patients from one location to the next as needed so that the complete system is supported.”

In this regard, the Chief Medical Officer (CMO) of the Ministry of Health, Dr Jacqueline Bisasor McKenzie, explained that the ventilators are being used based on a referral process between 24 hospitals at different levels across the country.

“The lowest tier hospitals provide basic care and then patients are moved to the next level depending on the type of support they need. And that support isn’t necessarily in terms of infrastructure and equipment, but also in terms of the type of staff and the multidisciplinary care that’s needed to support some patients,” she said.

She pointed out that the HDUs and ICUs have been set up in hospitals that have proper infrastructure and equipment and are also adequately staffed to treat patients who require intensive care.

However, Dr Bisasol McKenzie pointed out that not all patients who require intensive care or high dependency care will need a ventilator, as they may be breathing on their own but will need constant observation to monitor their condition.

“We have people who are on or need to be on ventilators and in that case they need to be transferred to a high care unit, an intensive care unit or somewhere where they can be monitored and observed,” she said.

The CMO said the health system’s ability to manage intensive care units is hampered by a shortage of staff such as intensivists, doctors of different specialties and especially intensive care nurses who perform various functions within the intensive care units.

“Intensive care nurses are essential and if we have space for 60-70 ICUs and HDUs, we need four times as many nurses to support patients across three shifts and give them breaks,” she said, noting that many in these professions tend to move on in search of better opportunities.

She noted that while ventilators are available, intensive care units may not be able to support patients due to a lack of staff.

Meanwhile, with the Opposition pressing the Government on how many operational ventilators there are on the island and where they are located, Dr Tufton insisted they were all accounted for and being used to save lives every day.

“There is no need for the public to fear that they have somehow disappeared, as the opposition has explicitly or insinuated in recent days,” he said.

The campaign for answers has been led by shadow spokesman for health, Dr Alfred Dawes, who renewed his call for a ventilator audit at a press conference on Wednesday.

He first raised the issue of ventilators after a premature baby died at May Pen Hospital in Clarendon last Tuesday because there were no ventilators available.

At the time, he was questioning the operational status and whereabouts of more than 100 ventilators that were donated to government through the efforts of Jamaican private sector organisations, the European Union and individuals during the COVID-19 pandemic.

In response, Dr Tufton said an audit of ventilators on the island was being carried out, the documents of which were made public on Thursday night.

Dr Tufton said at a press conference on Thursday that the audit found there were 210 ventilators registered with the health system, of which 118 were in working order, 40 were under repair and 52 were out of date.

The audit found that Western Regional Health Authority hospitals had 26 working ventilators and eight that were not working. Six of the eight were waiting for parts, undergoing repairs or scheduled for repair, one had been scrapped and one was beyond repair.

An audit by the Southeast Regional Health Board found that 49 ventilators were in working order, while 42 were not. Of the out-of-service units, 15 were waiting for parts or repairs.

The University Hospital of the West Indies (UHWI) also has 25 working ventilators, but 29 are not in operation and 16 are awaiting parts or repairs, according to the audit.

Additionally, the Northeast Regional Health Authority has 10 ventilators in operation, but five are out of service and two of those are waiting for parts/repairs. The Southern Regional Health Authority has 19 ventilators in operation, but six are not working and all are set to be scrapped.

The audit also revealed that several hospitals in the health region did not have ventilators.

“This audit provided us with concrete data on all of the ventilators that we have in the public health system. Based on this audit, there are no shortages of ventilators and therefore there should be no speculation or insinuation that ventilators are not being used for any reason,” Dr. Tufton said.

“We have taken the extreme step of not only identifying ventilators that are in service, that are being repaired or that are going to be repaired, but also identifying ventilators that are outdated and are no longer in use because in the public system, we have to keep those that we are not using. It is a lengthy process to dispose of such products but in the interest of transparency, we have taken all measures to eliminate speculation around ventilators,” he added.