Handling out-of-province transfers and critical care triage protocols

October 20, 2021

Dear CMPA members in Saskatchewan,

We know that the fourth wave has been exceptionally difficult in your province and that you are facing numerous challenges, including the transfer of critically ill patients, difficult resource allocation decisions, and concerns over deferred care.

Please know that we are here for you, to guide and support you through difficult medico-legal situations as you manage the stress and uncertainty of providing care during a pandemic.

This message provides advice on how to handle out-of-province patient transfers and the possibility that a critical care triage protocol could be activated in Saskatchewan.

Out-of-province patient transfers

On October 18th, 2021, the Saskatchewan Health Authority (SHA) advised that out-of-province patient transfers to Ontario were being initiated to help address capacity challenges resulting from the surge of COVID-19 patients admitted to ICU.

In order to effect the transfer, a clinical team (including physicians) will perform assessments of patients to determine whether the patient is medically stable and safe to transfer. Efforts are also undertaken to coordinate with partners in the receiving province (e.g. the Ontario Critical Care Command Team) to ensure the receiving hospital is prepared to admit the patient.

Physician Obligations

Physicians involved in transfer of patients out of province should act reasonably to:

  • Determine whether a patient is adequately stable for transfer
  • Follow health authority policies and procedures established for this process, including with respect to coordination with the transfer team and the receiving hospital
  • Document all decisions in the patient’s chart

If a patient or their substitute decision maker refuses to be transferred, the member should follow established policies and procedures to communicate that transfers are required by the health authority in the current state of emergency. Members should reach out to health authority administration to assist, as required. If you have any additional questions, please contact the CMPA for further advice and assistance.

Possibility of critical care triage protocol

It is also possible the “Saskatchewan Critical Care Resource Allocation Framework: COVID-19 Pandemic” (“Critical Care Triage Protocol”) could be activated if critical care resource shortages are not sufficiently addressed through patient transfers and other public health measures. As of writing, the Critical Care Triage Protocol has not yet been activated.

Critical care triage protocols can provide objectivity, consistency, and efficiency for decisions regarding the management of critical care resources, if there are insufficient critical care resources and ICU beds to manage the surge of patients with COVID-19. Critical care triage protocols provide guidance for determining which patients receive treatment, the level of care, and under what circumstances. These protocols are used as a last resort and do not extend beyond the COVID-19 public health emergency.

If you require context-specific advice regarding your medico-legal risks associated with implementing a critical care triage protocol, please contact the CMPA.

We are here for you

If you have questions or need support with medico-legal issues, please do not hesitate to:

  • Contact us anytime via CMPA’s secure member portal.
  • Call us at 1-800-267-6522 Monday to Friday: 7:30 a.m. to 3:30 p.m. CT or 6:30 a.m. to 2:30 p.m. MT. Conversations are confidential, empathetic, and non-judgmental.

Our priority is to assist you as you navigate the medico-legal challenges of this crisis and the unprecedented strain placed on you, our members. Rest assured, as a CMPA member, you are eligible for assistance and liability protection for medico-legal difficulties arising as a result of care provided in Canada in the context of the COVID-19 efforts.

We appreciate your ongoing commitment and dedication to the patients in your communities. We are here for you.


Lisa Calder, MD, MSc, FRCPC
Chief Executive Officer