// DR. HOMER TIEN WAS ALMOST AT THE END OF A LONG SHIFT WHEN HIS PAGER WENT OFF. IT WAS JULY 16 – THE NIGHT OF WHAT IS NOW INFAMOUSLY KNOWN AS THE "DANZIG STREET SHOOTING" – AND DR. TIEN WAS SUNNYBROOK'S SURGEON ON-CALL.
Two people were killed that night in 2012, and 24 others wounded in the worst mass shooting in Toronto's history. Gangs were blamed for the outbreak of violence that erupted at a street barbeque in the Scarborough neighbourhood.
The hospital was put on step 2 of Code Orange – high alert status that meant casualties were coming in. Initial reports said 20 patients with gunshot wounds were headed to Sunnybrook – and it was Dr. Tien's job to get everyone into action.
When he arrived in the emergency room around 11 p.m., the head emergency nurse was on the red phone with EMS dispatch on the scene of the shooting, trying to get a handle on the number of casualties coming to the hospital.
"The numbers kept changing and we had no idea how many patients were coming to the hospital, or what condition they were in," recalls Dr. Tien, medical director of the Tory Regional Trauma Centre. "We were preparing for the worst and just hoping we would have the resources to meet the needs that night."
Six of the most critical patients – five with gunshot wounds and one person who was trampled – were immediately transferred to Sunnybrook.
As a major trauma centre, Sunnybrook staff regularly deal with multiple traumas. The trauma centre sees three to four patients per day, or approximately 1,250 trauma patients every year. But six patients in a short time span was a unique circumstance and the first time Dr. Tien activated the full Code Orange, a special alert for mass casualties at Sunnybrook.
(Sunnybrook had put itself on step 1 of Code Orange before as a precaution, when an Air France flight skidded off a runway at Toronto's Pearson Airport in 2005, for example. Sunnybrook staff practised mock Code Orange scenarios for mass incidents in preparation for the G20 summit in Toronto, but this is the first time the Code Orange actually coincided with casualties coming to Sunnybrook.)
During the Danzig Shooting aftermath, Dr. Tien estimates close to 100 staff – including physicians, CT scan specialists, nurses, residents and security staff – were involved in the response.
The first ambulance arrived just after 11 p.m. and five more ambulances pulled up in the next 30 minutes. As the lead trauma surgeon, Dr. Tien likens his role to a traffic cop directing staff to treat patients. He also organized triage, prioritizing patients according to the severity of their injuries.
Dr. Tien assigned three teams of ER physicians, nurses, residents and medical students to the trauma room where they operated on patients needing resuscitation in addition to gunshot wound care. Two other physicians cared for the three patients in the emergency bays, just near the ambulance bay entrance at the hospital.
That night, Sunnybrook hospital's trauma room was in full use with staff wearing blue-grey gowns. Patients were wheeled on beds into the large and spacious trauma room, which at 1,600 square feet, is the largest trauma room in the country.
"It can get chaotic and noisy in there, so it can get tricky because you really need to be focused on the task," he said. "Sometimes it's my job to tell people to quiet down." Meanwhile, police questioned family members and recovering patients in the waiting area about the shooting.
Six patients arrived from the Danzig crime scene that night. And if the team wasn't already busy, a seventh trauma patient from a car crash in Oshawa, Ont. also came in. The Code Orange remained in effect for more than five hours.
While the trauma team worked feverishly, Critical Care Chief Dr. Brian Cuthbertson organized beds in the Intensive Care Unit and identified patients who could be moved out to accommodate the incoming gunshot patients.
"I also got on the phone with St. Michael's hospital to see how many casualties they had and what capacity they had to receive them," he said.
"There is definitely the possibility of being overwhelmed when it's a mass casualty, but everyone is trained on exactly what to do and what their roles are," Dr. Cuthbertson said.
Despite the long hours and stressful circumstances, Dr. Tien remained cool under pressure. "I never felt it was unmanageable," said Dr. Tien, who has worked as a trauma surgeon in Kandahar with the Canadian military. As a lieutenant-colonel, he has pulled shrapnel from soldiers and treated civilians who had stepped on landmines.
Both doctors credit the staff's collective efforts in the seamless treatment of patients the night of the Danzig shooting. "We have really good people, and everyone was working late and working hard to make sure it all went well," Dr. Tien said. "It was definitely a group effort that made it happen."
"It went smoother than anyone expected that night," recalls Kevin Lee, an emergency nurse who worked triage that night. He worked at the bedside of the non-critical patients who were brought into Sunnybrook.
"Not knowing how bad the situation was – that was probably the most stressful thing initially," Lee said. "But nothing went wrong and no one was overlooked."
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