A doctor in eastern Ontario has improvised a way to double his small hospital's ventilator capacity in preparation for a possible COVID-19 outbreak.

Anesthetist Alain Gauthier, who has a PhD in respiratory mechanics and works in Perth, west of Ottawa, spotted the idea in a YouTube video.

In basic terms, the rig involves running two hoses from one ventilator and doubling the power.

In just 10 minutes and with the help of some extra tubing, Gauthier made it possible to double the number of patients ventilated in the hospital at once, if needed.

But there's a catch: the two patients attached to the same ventilator need to be of similar size and lung capacity. And if one patient declines, things will need to be adjusted.

It's not perfect, but as Gauthier put it, "if it comes to last resort, I'm prepared to use it."

Gauthier said the population the Perth and Smiths Falls District Hospital serves may be at greater risk if hit with the COVID-19 outbreak. Many of the 60,000 people in the region are older, with underlying health conditions such as diabetes and chronic pulmonary disease.

His hospital recently received four new ventilators, and keeps four old ones that are still functioning in reserve. Those older machines can't be repaired if they break down, however.

In a rural health-care setting, the hospital's ability to increase its surge capacity may be limited in the event of a widespread outbreak.

Learning from YouTube

The idea to double up patients on a single ventilator was studied in theory by American doctors Greg Neyman and Charlene Babcock in 2006. It was tried once, successfully, in the aftermath of the 2017 mass shooting of the Route 91 Harvest music festival in Las Vegas.

Babcock, an emergency physician in Michigan, created a how-to video on YouTube to help doctors around the world respond to COVID-19. That's where Gauthier got the idea.

The goal, Gauthier said, is to avoid the kinds of difficult ethical decisions facing Italian physicians who have had to choose which critical patients should get a ventilator, because there aren't enough to go around.

His efforts speak to the lengths doctors across the country are going to prepare their hospitals and staff for the worst-case scenario, a sudden onslaught of COVID-19 cases, he said.

"We are concerned, we're trying to get ready as much as possible," he said.

His colleagues were incredibly enthusiastic about his ability to potentially double the ventilator capacity of the hospital, he said.

Dr. Alan Drummond, an emergency physician at the hospital, said he even broke social distancing protocol to give Gauthier a hug.

But Gauthier said he wants no credit. He said he's only doing what every Canadian health-care worker is doing right now: trying to brace for what's to come.

"A lot of work is being done by pretty much everyone," he said.

The federal government is also ordering additional ventilators, which will be distributed to provincial and territorial health authorities.