MONTREAL -- Some Quebec nurses are speaking out about a protocol they say could cost some patients their lives. 

According to Quebec health ministry protocol last updated in August, an intensive care patient with COVID-19 who goes into cardiac arrest must be intubated before receiving chest compressions, losing precious time. 

“It's almost like a death sentence,” said an ER nurse who asked to remain anonymous.

The protocol was designed to protect health-care workers from COVID-19, since chest compressions are thought to risk aerosolizing the virus and spreading it. It applies to patients diagnosed or just suspected of having the virus.

But some nurses aren’t comfortable with it, pointing out that intubating someone takes a few minutes. Though the delay may seem minor, any holdup in a moment of cardiac arrest could lead to severe brain damage or even death. 

“The whole point of chest compressions is to push blood around the body, especially to the brain, if the heart has stopped," said Montreal cardiologist Dr. Christopher Labos.

"So if you’re not doing chest compressions, every minute that passes, that’s more brain damage. At a certain point, let’s say after five minutes, brain damage can become irreversible."

“It’s really tough,” said another nurse who wanted to remain anonymous. The nurse himself spent two weeks in hospital after contracting COVID-19. 

“It’s a catch-22,” he said. “During the first wave, my floor became a COVID floor, no surgeries were going on and we were just dealing with COVID patients. The protocol at the time was pretty much, 'If they’re coding, don’t do anything,' and they pretty much die there.” 

For non-COVID patients in cardiac arrest who arrive in the ER and in COVID-free cold units, the health ministry says compressions don’t have to wait until the patient is intubated -- they can start after a mask is put on. 

But some regional health authorities have implemented their own resuscitation protocol -- which they are allowed to do, according to the ministry -- and require all patients to be intubated when they enter the ER. 

“It’s an issue because we don’t know who is [COVID-19 positive] or who isn’t as they come in to the ER,” said another nurse. “With the numbers as they are, anyone could be positive.” 

For example, one October update from the Lakeshore General Hospital, obtained by CTV News, shows that patients who arrive in emergency must be intubated before starting chest compressions. 

"It must be assumed that most patients requiring resuscitation are at risk of having COVID-19." the document reads.

"As a result, for the vast majority of patients requiring code blue, resuscitation must be performed with all COVID precautions This means… external cardiac massage after intubation only."

The nurse who called it a "death sentence" said it's especially jarring for nurses to abandon the work already done by paramedics enroute to hospital.

“Imagine what it’s like for nurses in the ER to receive a patient who was getting compressions from the paramedics, and as soon as they enter the hospital, we have to get them to stop the compressions until we could intubate first," he said.

"This happened many times and goes against everything we are taught. How many lives is it costing? How many patients are alive but brain-dead because we did not do compressions immediately?” 

According to another document obtained by CTV News, the original protocol implemented in March at the Lakeshore was even stricter. It required all patients to be intubated before starting chest compressions. 

Now, some are hoping the protocol is loosened and that the message is received by health districts province-wide, and implemented consistently. 

"Why is the protocol different depending where the patient is in the hospital?" said the nurse. "Are some people’s lives worth saving more than others?”

Health Minister Christian Dube was not available for an interview Tuesday to discuss the issue.

In British Columbia, patients who are COVID-19 positive or suspected of it do not have to be intubated before receiving chest compressions. Health care workers are advised to put a mask on the patient and start compressions, then the code team will intubate.

Labos said he believes B.C.'s protocol makes sense.

“If you’re in a situation where you’re in full PPE, where you have an N95 mask a face visor and everyone is fully gowned up, I think the risk of aerosols being generated by simple CPR is probably pretty low, and I think there is a very real concern that if you delayed CPR it would lead to adverse patient outcomes,” said Labos. 

Patients’ rights advocates say they hope the measures in place give patients the best chance at surviving, whether the patient has COVID or not. 

“As an advocate, I would ask that all the appropriate and best practice measures be put in place so that wherever we are in Canada, in Quebec, in any given CIUSSS of CISSS, that we do administer urgent care to the patient, make sure we are safe and the patient is safe,” said patients’ rights advocate Paul Brunet.