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.
“How do we make sure an ambulance can get to a routine event, like a crash on the highway? How can we ensure that the same consistent standard of care would be available to that person? How do you get the ambulance onto the Don Valley Parkway when there are two million extra people in the region?”
Dr. Mazurik was part of the SARS Operation Centre in 2003 and was the Toronto Central LHIN G20 planning lead. She has conducted multiple multiagency exercises in Toronto since 2003 and will draw on her experience during those events to help prepare for the Pan Am Games. As the games approach, she’ll work with external partners, like EMS and police, to plan simulated crises.
“The easiest time to discuss what you should do is not at the time of a crisis,” Dr. Mazurik says. “Having stakeholders review their disaster plans simultaneously in preparation for a planned event or exercise creates readiness. The unexpected byproduct of this process is revealing innovative ways to deliver health care more efficiently now.”
She worked with a team in the lead-up to the G20 to create an electronic dashboard that could provide an at-a-glance look at the capacity of the critical services of 20 hospitals in Toronto. Hospitals uploaded their capacity data. A green icon meant all was well. Red triggered a teleconference. The system proved extremely useful, she says.
“The riots downtown meant that dialysis patients couldn’t get to appointments. There were burning cars; the TTC wasn’t running,” Dr. Mazurik says, adding they worked closely with police and military. “It triggered a response via the dashboard. All the other hospitals that had dialysis that weren’t in that zone of terror were ready and willing to take those patients. It was unprecedented. In the past, we would not have been aware there was a problem, let alone be able solve it.”
Dr. Mazurik is in talks to update the dashboard to be used during the Pan Am Games. And, better yet, all the time.
“There are certain kinds of situations that we hope aren’t going to come again,” Dr. Mazurik says. “But, as they say, there is no such thing as luck; there’s just working hard to be prepared.”
WHEN THE LIGHTS WENT OUT
When ice and wind took out power lines and left much of Toronto in the dark on December 21, 2013, Sunnybrook’s emergency response principles were put to the test.
Emergency generators immediately kicked in, providing critical areas with power and keeping patients safe.
And the emergency operations centre – bringing together staff leads from power plant, risk and patient safety, administration and units across the hospital – was up and running soon after the lights went out.
“I think it’s human behaviour to hear the word ‘emergency’ and think the worst,” says Trevor Hall, Sunnybrook’s patient safety specialist and emergency preparedness leader. “Sunnybrook’s response proved that an emergency can be controlled. People came to work. We had great communications, which is something that often fails. Most patient service wasn’t interrupted. I think all of Sunnybrook and our external partners did a great job working as a team and maintaining the patient experience.”
Because it was unclear how long Sunnybrook would be off the grid, a decision was made to transfer six babies out of the Neonatal Intensive Care Unit (NICU) to neighbouring hospitals. The NICU had undergone mock Code Green (evacuation) exercises to practise these scenarios.
Sunnybrook’s power was restored within two days. But as power outages around the city continued into the third day, a concern arose among Toronto hospitals, the local health integration network and community partners, as well as the Ministry of Health and Long-Term Care, that the emergency departments across the city could see a surge in patients due to the extreme cold.
The province’s Emergency Medical Assistance Team was deployed and set up a field hospital in Sunnybrook’s McLaughlin Auditorium within nine hours. The field hospital saw patients not sick enough for a medical bed, but who had other issues preventing them from being released to a warming centre or home.
“This demonstrated great leadership and enhanced patient safety,” Hall says. “It also proved that Sunnybrook can provide surge capacity for the city and the GTA when it matters most.”
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