Hospital’s plan pays off on night of Broncos crash
Code Orange ensures staff ready to respond to influx of injured
When Heather Miazga started getting messages about the Humboldt Broncos bus crash, she immediately went into hockey-mom mode.
As the on-call clinical director for Saskatoon’s hospitals, however, she had to push personal feelings aside and rush to the Royal University Hospital to prepare for the incoming wounded.
Like hockey parents across the country, the tragedy hit close to home. Miazga couldn’t help but think of her son David, who was a Humboldt Broncos hockey player for a number of years.
“We do have lots of connections with the team and still lots of connections with the (Saskatchewan Junior Hockey League) ... It is a community and a family. It touched a lot of peoples’ lives, especially the hockey moms and dads,” she said.
But there was no time on April 6 to dwell on personal thoughts.
Within 20 minutes of getting the call, Miazga, director of surgical services in Saskatoon, was at the RUH where a regional command post was set up.
It was her week to be the oncall clinical director — to get the wheels in motion on the clinical side before critically injured patients started arriving in Saskatoon.
When Miazga got to the ER, the charge nurse already had the department’s Code Orange policy in hand.
Code Orange is called when there’s an influx of casualties. It wasn’t operational immediately that night, but already staff were anticipating what would be needed. Soon, specific pieces of the plan were put into action across a number of departments.
City Hospital didn’t receive trauma patients, but stayed open to accommodate regular ER patients. Sixteen people from the crash were triaged to either the RUH or St. Paul’s Hospital.
Extra staff was brought in, including housekeeping because patients were quickly moved out of the ER and beds were cleaned.
Lab employees were brought in to make sure there was enough donor blood products at the ready (extra blood can’t always be kept on hand because it can expire).
Additional equipment for operating rooms was brought from other sites.
“I’m still just in awe and inspired by our team by how everybody stepped up to the plate and activated their plans,” Miazga said.
Earlier in her career, Miazga had worked in the ER and intensive care unit. Over 30 years of nursing, she’d never seen a disaster of this magnitude. “Thank goodness we do emergency preparedness planning,” she said.
Plans on paper provided a good base, but each event is unique.
“It’s not just the care providers that have plans. It’s right down to our support services — housekeeping, lab and operating rooms,” Miazga said.
She’d worked earlier that day and knew there had been more discharges than usual at Saskatoon’s three hospitals, which allowed some flexibility.
Typically the RUH can handle only two or three trauma patients at one time.
As emergency teams responded to the crash site that evening, back in Saskatoon, teams knew they had about two hours to prepare for the arrival of patients.
The response of first responders and medical personnel in Nipawin and Tisdale was stellar — particularly given the level of injuries they were dealing with, Miazga said.
Consultations were underway with the emergency triage transport physician and the ER physician on-site.
While patients were stabilized, the emergency management system contacted STARS, ground ambulance and fixed wing ambulances.
Miazga didn’t leave the RUH until 3:30 a.m. on April 7 when all of those from the crash were receiving care and the Code Orange was over.
The full scope of the tragedy didn’t hit her until she awoke the next day.
“We’ve had a lot to debrief and work through — not just on the Code Orange, but personally,” Miazga said.
The Code Orange protocol designed by the former Saskatoon Health Region worked well, but with the amalgamation of 12 health regions to a single health authority, she wonders how the new call system will work.
“That’s probably a big piece of work that needs to be done,” Miazga said.
In the former Saskatoon Health Region, Lori Frank was director of risk management and involved in emergency preparedness for 15 years. She’d never experienced a Code Orange in that role.
Now she’s executive director of governance and policy with the Saskatchewan Health Authority (SHA).
Under the single health authority, regional-based Code Orange policies will be reviewed and revamped to create new, provincialscope procedures, she said.
“I can only speak about the former Saskatoon Health Region, but all of our staff are trained in codes and emergency preparedness planning,” Frank said.
Directors trained in emergency preparedness are on call 24/7, every day of the year.
When there’s an influx of incoming casualties, the director on call is the lead to assess if medical services need to be mobilized differently.
The question becomes: “Is it something that we can’t manage outside of the normal circumstances?” Frank said.
Mock drills prepare staff to deal with catastrophic situations.
“We might do a tabletop exercise in a particular facility,” Frank said. “We bring a group of staff, physicians and managers together, and we talk through how we might better our responses in a certain code situation.”
The Code Orange response is protocol driven. “There’s lots of documentation and a job description checklist ... that people follow in the various roles. Many people can play different roles,” Frank said.
As the incident progresses, the commander and leaders change.
“You can’t keep someone in a role for days on end,” Frank said. “There’s not only a commander or a leader but then there’s a set group of support around logistics, around operations, around safety, around risk.”
Following the Broncos crash, some multi-jurisdictional debriefings were held to look for areas of improvement. More will be done, but a recovery period was required for everyone involved in the incident, Frank said.
“Whether it’s the physicians or nurses involved or anyone in the system,” she said, “we ensure that staff, and anybody involved has access to critical incident stress debriefing, immediately, if that’s deemed necessary. But also after the event is over.”
Lessons learned from Code Orange will be critical in setting up a provincial program for emergency preparedness and planning.
Bringing 12 regions under one roof is a major undertaking considering patients, geographical and unique requirements, said Derek Miller, executive director, infrastructure management for the SHA.
“It’s going to take some time for us to get through that, but in the end I think we’ll end up with a better system that’s more flexible and able to respond to whatever type of emergencies might be coming toward us in the future,” he said.
Despite the crash happening in a rural area and massive casualties having to be transported to Saskatoon, all the teams involved in the Code Orange worked “fantastically,” Frank said.