HOSPITAL TEST RUN
The marathon has the potential to send scores to hospital, an ideal time to test its emergency system, the Citizen’s Andrew Duffy writes.
In those first frantic moments last fall when the front end of OC Transpo Bus No. 76 was obliterated in a collision with a Via Rail train, The Ottawa Hospital prepared for the worst.
Early indications from paramedics on scene suggested the crash involved mass casualties. The hospital declared Code Orange — it signals an “external” disaster — and scrambled to accommodate the expected influx of critically injured victims. New surgeries were put on hold; beds were canvassed for patients who could be discharged; emergency department and critical care patients were moved to other wards; additional trauma bays were established; extra staff was mobilized.
Within 20 minutes, The Ottawa Hospital, the region’s main trauma centre, was prepped and ready to handle 30 to 40 critically injured patients.
As it happened, however, the crash that killed bus driver Dave Woodard and five passengers did not flood the emergency department with casualties. Fortunately, only a handful of victims needed treatment for serious injuries.
For hospital officials, the Sept. 18 crash offered a live test of their emergency response system, and like all such tests, it came with lessons.
“The response at the hospital was fantastic,” says Dr. Jon Hooper, an intensive care doctor. “There was a huge response, but at the end of the day, we didn’t really need to do it.”
Why did the hospital over react? As events unfolded at the crash scene, the hospital received limited information from busy paramedic dispatchers so it turned instead to social media, which painted the scene in drastic terms and created a false sense of urgency.
Hospital officials decided to prepare for mass casualties rather than wait for a more precise estimate from the scene. By then, they worried, victims could be rolling in the door.
“We were running by the seat of our pants occasionally where we didn’t have sufficient information to make strong strategic decisions,” remembers John Trickett, clinical director of surgery, perioperative services and the trauma unit.
A review of the day’s events revealed that communication gaps inhibited the hospital’s ability to calibrate its response. It meant the hospital was over prepared — something that resulted in modest financial costs and patient inconvenience — but emergency planners recognized that similar confusion could lead to more serious problems in the future.
In response, the hospital’s leadership decided that the hospital had to be better integrated into the city-run emergency response system. “The dots were all there, but the dots weren’t connected,” says Cheryl Symington, a veteran emergency department nurse who was appointed to a newly created position, emergency preparedness co-ordinator, following the OC Transpo crash.
Symington has since built on the work of Michele Légaré, the hospital’s director of radiation safety and emergency preparedness. Légaré had been working on developing more defined relationships with the city’s emergency services when the OC Transpo accident occurred. She had meetings sched- uled for October.
“September 18th just put a fire under it to get it done faster,” Légaré says.
During the past eight months, Symington and Légaré have forged important new links to police, fire, ambulance, city services and the Red Cross, while putting in place a new emergency management system based on a provincial blueprint.
The Incident Management System (IMS) was introduced in 2008
(At the 2007 Chicago Marathon) their emergency medical system was overwhelmed.
in an attempt to standardize emergency management in Ontario.
Developed in the aftermath of the 1998 Ice Storm that left 700,000 people in Ontario and Quebec without power for more than three weeks, the IMS has been adopted by emergency services across the province. The system, which takes a broad approach to emergency preparedness, is now being extended to hospitals. The Ottawa Hospital is one of the first to use it.
The system will be tested during Ottawa Race Weekend when 48,000 runners pound across 60 kilometres of city streets. The race will offer emergency planners what they hope is a controlled experiment.
“Whenever you introduce a new process,” says Symington, “you want to test it and evaluate it to find out what’s working well and how we improve upon it.”
Race weekend medical director Dr. Jon Hooper says the marathon has the potential to send a flood of people to hospital, which makes it an ideal exercise to answer questions about the emergency system: Are the right communications links in place? Are the key players receiving the same information at the same time? Can the system respond appropriately to a surge in demand?
The demand for medical services can spike on race weekend alongside temperatures. In 2007, the Chicago Marathon was cancelled when temperatures soared beyond 30C. One 35-year-old runner died and more than 300 fell ill and had to be picked up by ambulances along the course. Most were suffering from heat exhaustion.
“Their emergency medical system was overwhelmed,” says Hooper, who holds the authority to stop Ottawa’s race if temperatures rise into the danger zone. “It took them hours to get to each individual call, whether it was race-related or not. The emergency departments were a disaster.”
The 2013 terrorist bombing at the Boston Marathon, which killed three people and injured more than 200, underscored the need for local emergency services to be prepared for any eventuality.
“We don’t expect anything to go wrong, but we’ll use race weekend to enhance our capacity to manage things well when they do go wrong,” says Trickett, leader of a hospital team that co-ordinates the weekend’s 160 medical volunteers.
A number of changes have been introduced for this year’s race based on lessons drawn from the OC Transpo crash and other incidents.
For the first time, the medical station at the Cartier Square Drill Hall will be officially designated as a satellite site of The Ottawa Hospital. It means that paramedics, legally bound to deliver patients to a hospital, will be able to bring runners to the drill hall for treatment. There, they can be assessed, treated and, if necessary, referred to hospital.
The system is designed to ensure the city’s emergency departments are not overwhelmed.
This year, too, a hospital volunteer will act as liaison between the drill hall and The Ottawa Hospital to ensure officials there receive accurate information in real-time.
If the city opens its emergency operations centre in response to a crisis that involves casualties, the hospital will be able to take a place at the table.
The Ottawa Hospital will also be able to call upon the Red Cross to help with family reunifications since frantic family members looking for loved ones often deluge the hospital’s switchboard with calls.