EMS Managing Victims
Jul 15, 2006

The scene: Just before 11:30 a.m. on Feb. 17, 2006, Mother Nature wreaks havoc with snow, rain, wind, and a flash freeze just east of Ottawa, near the town of Embrun. Driving conditions are terrible, but Highway 417 is busy, as usual. Suddenly, fierce winds create whiteout conditions and vehicles start crashing into each other, with some cars getting stuck under tractor-trailers. Half an hour later, after driving through the storm and the traffic jam caused by the accident, Jean Hamel arrives on-site with his paramedical crew. All he can see through the blizzard is wreckage: 38 vehicles are piled up along 500 meters of highway. Working conditions are difficult, because winds are still storming, creating frequent whiteouts.

The greatest challenge, recalls Hamel, a paramedic in Ottawa for 19 years, and one of the supervisors at the tragic Highway 417 pileup, was management of all the different people on-site.

Because the accident occurred just outside Ottawa’s territory, the victims were under the jurisdiction of Prescott and Russell Counties ambulance services. Overwhelmed, they called Ottawa and Leeds Grenville emergency medical services (EMS) for assistance. Because of the scale of the emergency, the three different teams were sent in response to the requests.

Coordinating between the different teams and other responders, such as firefighters and police, the paramedics monitored victims that were getting colder by the minute (temperatures had dropped to –15˚C at noon) while providing care to the most critically-injured.

They also had to make sure nobody was still caught in a car, or had been expulsed and was lying in the ditch. Making sure that all victims were found was challenging in the severe weather conditions, but paramedics know how to work well  under pressure. “It comes down to basics and training,”  says Hamel.

The Highway 417 car crash was not the only accident in the Ottawa area that day, and EMS dispatchers had to make sure that area hospitals could accept every patient. Ambulance sirens wailed around the city, and emergency and trauma centres were filling up. Police reported about 40 traffic accidents between 11:30 a.m. and 1:45 p.m. that day.

From the Embrun pileup, 34 accident victims with minor or (miraculously) no injuries were transported by bus to the nearby Limoges Fire Hall, while the 10 critically-injured were transported to different Ottawa hospitals. “Considering the conditions, it all went very smoothly,” says Hamel.

Although Ottawa’s weather can be exceptionally harsh during the winter, pileups are not a routine call for the city’s 326 frontline paramedics.

Like any other paramedic across the country, day-to-day duties include responding to 9-1-1 calls, providing first aid care to patients, and transporting them to hospitals. They will also give, for example, insulin to a diabetic in crisis, and provide support to mentally-ill patients.

“Canada is right up there with the best-trained paramedics,” says Ian Turner, a Palliser Health Region EMS supervisor in Medicine Hat, Alberta. In March, proving their the Palliser EMS finished in the top five at the 2005 JEMS Games in Baltimore, Maryland, an international competition sponsored by the Journal of Emergency Medical Services. The New York City fire department took first place, ­followed by Sussex County EMS of Georgetown, Delaware; the Regional EMS Authority of Reno, Nevada; and London Ambulance Service (England).

Photo: J.P. Trottier, Ottawa Paramedic Service © City of Ottawa

Health and paramedic services in Canada fall under provincial jurisdiction, so the training and practices may differ from province to province. However variations between the different systems is not as great as one may think, according to Turner. At the moment, each province has its own accreditation protocols, but there exists a voluntary national paramedic accreditation from the Canadian Medical Association. “The move is towards more and more people getting national accreditation,” says Turner, explaining that national accreditation brings more consistency in the techniques students learn, and makes it easier for paramedics to work in other provinces.

The main difference between the provinces remains in who provides the service on a day-to-day basis. In Alberta and Ontario for example, municipalities determine its level of EMS, while in Quebec and British Columbia, paramedic services are under the jurisdiction of regional health agencies. New Brunswick announced last April that its EMS service would be amalgamated and run by the province. However, depending on the scope and scale of any emergency, provinces can decide to take over control of the service, as British Columbia did during the 2003 firestorm.

Fires devastated over 250 square kilometres in the Okanagan Valley, forcing the evacuation of thousands of people in August and September 2003. The geographic size and the terrain were the main challenges to rescuers during that crisis, says Glenn Braithwaite, one of the directors of operations in Penticton, B.C.

During the fires, paramedics from every corner of the province were sent to southern central British Columbia, but their main duty was to provide rehydration and rehabilitation to the firefighters after working long and difficult hours. Few civilian rescues were required, as the region had been successfully evacuated.

In October 2003, B.C. Premier Gordon Campbell appointed an independent team to review the overall response to the firestorm. During the hearings, the team listened to concerns about management of the crisis.

Criticisms ranged from “too many bosses” to “no one running the ship,” and from “lack of coordination” to “jurisdictions and responsibilities were confusing.” These complaints were primarily evident in the early days of the disaster, according to the 2003 Firestorm Provincial Review.

The province should have been ­prepared for such an emergency. British Columbia already had an all-hazard emergency operations system, dubbed the British Columbia Emergency Response Management System, or BCERMS.

BCERMS is a B.C. variation of the Incident Command System (ICS), a tool developed in the United States in the 1970s in response to major wildfires in southern California. It standardized, among other things, communication services and action plans from the different first responder agencies throughout California, and later, the United States.

In Canada, ICS is used during mass emergencies by some provinces, such as Alberta and Ontario. But the 2003 B.C. firestorm review team found that, despite British Columbia’s adoption of BCERMS, the system was not taught and applied equally across the province.

The review team recommended ICS and BCERMS training for every B.C. emergency responder, including paramedics, with the expectation that this would result in better communication and effort coordination.

A number of paramedic teams had already received the training prior to the firestorm, says Braithwaite, “but it’s been reinforced within our organization” since the review.

Natural hazards creating mass emergencies happen every so often, and preparation to those incidents is, most of the time, a combination of learning from past experiences and performing one or two simulation exercises a year.

But getting ready to face an infectious viral threat, such as the avian flu, is a real challenge, according to Lauréanne Collin, media relations officer at the Agence de la santé et des services sociaux de Montréal, Montreal’s regional health agency.

“It’s difficult to create a pandemic simulation,” she says, explaining that Montreal and Quebec City medical teams participated in a mass anti-flu vaccination exercise last year, and evaluations were made during the campaign.

With a metropolitan area of more than 3.5 million people living in about 4,000 square kilometres, Montreal could be one of the hardest-hit Canadian cities in the event of an outbreak.

To mitigate the effects of such a crisis, Montreal is planning to open first aid ­centres that will act as a complementary space to the local community service ­centres and trauma centres. One of the responsibilities of these first aid centres will be to sort patients, determining the level of seriousness of each case, thus helping to reduce overload problems by having only the most severe cases transported to the trauma centres.

In the event of a pandemic, however, the role and responsibilities of paramedics in the Quebec system could be enlarged. In its Pandemic Influenza Plan – Health Mission, published last March, the Quebec Ministry of Health and Social Services concluded that the EMS would “play a crucial role during a pandemic,” but acknowledged that they would be put “under pressure due to personnel shortages.” This new Plan will be implemented in partnership with the 18 health agencies in Quebec.

In addition to responding to distress calls, the Plan will require EMS responders to play a greater role in transporting patients to and from hospitals and first aid centres. When answering a call, paramedics will also be responsible for identifying where patients should be transported, whether it is to a hospital, a first aid centre, or if they should stay at home. Local and regional dispatch centres will continue to handle 9-1-1 calls, but “special procedures, such as the setting up of a provincial centre to regulate inter-establishment transfers” will help manage large-scale crises.

The vital requirement to keep lines of communication open – both between themselves and with the public has been taken into consideration in Quebec’s Plan. Accordingly, government, regional, and local authorities and partners will continually exchange information through a coordination unit, which, in turn, will “prepare a communications action plan designed to ensure the greatest consistency possible and to mobilize all authorities and partners toward a common goal.”

In a pandemic crisis or any other case of mass emergencies, communications between the different services and the responders themselves is the key, emphasizes Ottawa paramedic Hamel. “You have to be able to work together.”

As the Highway 417 pileup, with its rescue mission under freezing whiteout conditions so graphically highlights, every paramedic, firefighter, and police officer has a mission-critical need to be ­connected and stay connected to every responder from every agency involved in any given crisis, big or small.

André Fecteau is a freelance writer based in Ottawa.
© FrontLine Security 2006