Trevor Hall is always planning for the worst. Floods, global infectious disease outbreaks, chemical spills. You name it, he’s considered it.
But Hall is no pessimist. He is Sunnybrook’s patient safety specialist and emergency preparedness leader, and he knows that good planning could make the world of difference to Ontario’s health system should one of these disasters occur.
Hall is in the midst of planning a mock chemical decontamination exercise for Sunnybrook’s emergency department. First, the participants will learn what is involved in a chemical response and how to properly put their protective suits on. Then they’ll practise.
“It’s giving staff the experience in a safe environment and making it as realistic as possible for them,” he says. “We also look at it from the patient side: What does it feel like to be brought into a room where people are in these suits? Imagine being that patient. You are contaminated, you are not feeling well, you have to take your clothes off and get water all over you. It’s scary. How can we improve this experience for you?”
Simulated emergencies like decontaminations allow the emergency preparedness team and staff to have a better understanding of the steps they will undertake during a crisis, and to see where things might go wrong and how it may impact the health system.
Emergency preparedness planning often begins with more questions than answers, according to Hall.
“Based on the feedback we receive through actual incidents and response, or preventive analysis, we find out where the gaps are and try to address those,” he explains. “It may be as simple as bringing people together in the room to ask, ‘How would we deal with this?’ or it could involve building a simulation – like the decontamination exercise or an evacuation – to see the response.”
A former firefighter and business school graduate, Hall says he fell in love with emergency response and hospital management. He became a nurse with a focus on quality improvement before taking on his current role.
“It’s fascinating to see how, by designing health-care systems, you can really impact the response,” he says. “It all comes down to the system. We use prospective analysis: How can things fail? And then we really tailor exercises, plans and protocols for those responses.”
“At Sunnybrook, we take a leadership position by saying, ‘This is the question, this is our hypothesis and let’s test it out.’ It’s a scientific approach.”
THE SUNNYBROOK EFFECT
Dr. Laurie Mazurik, a Sunnybrook emergency physician and emergency preparedness strategic lead, says as Canada’s largest trauma hospital, Sunnybrook’s processes and expertise can be used to inform plans across the health system.
“If there’s a mass casualty event tomorrow, how can we ensure that all of our pre-hospital services and hospital services are working together to ensure the best care?” Dr. Mazurik asks. “It used to be a crisis management strategy to have 20 per cent of your beds open. But that’s just not possible in Toronto these days.”
The only way to add capacity is to work as a system of hospitals and community partners, says Dr. Mazurik.
“Crises tend to be a very good catalyst for communications and collaboration,” she adds. “Toronto has been lucky and unlucky. Major event planning for events like the G20, exercises – over 30 in the past 10 years – and actual crises like SARS, the blackout of 2003 and ice storms have galvanized the community, but decreasing health-care capacity continues to increase our vulnerability.”
Both Hall and Dr. Mazurik routinely take Sunnybrook’s expertise in this area beyond its walls. Hall works with the province’s Emergency Management Assistance Team, and Dr. Mazurik is leading an international team to develop an emergency preparedness curriculum on behalf of the Public Health Agency of Canada.
Along with a team of Sunnybrook trauma surgeons, and health and safety leaders, they are also involved in emergency preparedness planning for the 2015 Pan Am Games to be held in Toronto and the GTA. Medical leaders will look at the health system as a whole, and how surges of patients will be managed in the event of an infectious disease outbreak or a CBRNE event (chemical, biological, radiological-nuclear, nuclear or explosive/extreme weather) resulting in mass casualties during the games, which is expected to bring about two million extra people to the city.
“We have to think about our health services as a system, and we need to ensure that our health system is there for each Ontarian and our welcomed guests,” Hall says. “The influx of people alone will increase the amount of care that could be needed. And we need to make sure that we can effectively respond to that demand.” They will look at a wide range of potential issues, from a chemical attack to heat-related incidents to transportation.