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Norm Ferrier, M.Sc., CHEM, MICPEM

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The Event On December 20, 2013, southern Ontario was struck by a major ice storm The weather front originated in the U.S. southwest, and stalled over Ontario, bringing freezing precipitation for two full days

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The Event The storm had been forecast Unfortunately, few truly took the forecast seriously Only minimal preparations were completed In healthcare, almost NO real preparations occurred

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The Event Most assumed that this storm would miss southern Ontario, as a similar storm had in 1998 Most were blissfully unaware that the 1998 storm had missed the GTA by only 12 kilometers, passing to the south over Lake Ontario before devastating Eastern Ontario

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The Preparations Hydro One made specific arrangements for dealing with power outages Local electrical utilities also made their own arrangements None of these were anywhere NEAR adequate to deal with the storm which occurred

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The Preparations Local municipalities put their snow removal vehicles on stand-by Snow plows and dump trucks are not much use against fallen trees and power lines

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The Preparations Healthcare facilities made no specific provisions for the coming storm They assumed that their generators and Emergency Plans would simply work, and made no additional contingency arrangements

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The Impacts 600,000 households were left without electrical service Lighting, heating, preparation of food were the major issues in private residences A large number would not have service restored until December 31.

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The Impacts Desperate people take foolish chances in this type of situation Toronto Fire Service estimated that they were responding to TWELVE TIMES the normal incidence of calls for carbon monoxide!!! 111 Carbon Monoxide calls in a single night! These numbers are solely for the City of Toronto.

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The Impacts Toronto EMS also reported substantial increases in the numbers of other predictable call types: Chest pain/Cardiac Falls Motor Vehicle Accidents

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The Impacts Across the GTA, people tried to cook with barbecues or warm homes with fireplaces which had not been used in years! In Newcastle, Ont., two died and a third was hospitalized because the homeowners attempted to run a generator inside their attached garage, assuming that the open garage door would provide adequate ventilation.

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The Impacts Transportation was difficult at best Downed trees, branches and power lines made road travel impossible in some neighborhoods It would be January 3 before all debris was removed and all roads were re-opened

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The Impacts All of Torontos subway and light rail networks were completely affected Local service stations rarely have emergency power to pump fuel The use of private cars was sharply limited as a result

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The Impacts The GTA has literally THOUSANDS of multi-storey apartment buildings! Some keep one elevator on emergency power, but MOST do not! All hi-rises require electricity to pump water for drinking and heating to the upper levels!

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The Impacts When you live in the upper levels of a hi-rise, even a journey to purchase food or medication can be dauntingassuming local stores and pharmacies are even OPEN!!! Individuals arent much better at advance planning than facilities! Community housing often provides housing for vulnerable individuals At peak, 62 community housing complexes, mostly hi- rise, were without power!

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The Impacts Every urban center conceals a resident population of vulnerable people who are largely INVISIBLE!!! No one in the municipal or healthcare systems knows where these people are located! Not even building management in most cases!

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The Impacts Consider the 65 year old dialysis patient who requires treatment three times per week, but lives on the 17 th floor! Consider the cancer patient who travels daily for either chemo or radiation therapy, and lives on the 20 th floor! Where do such individuals end up? Patients who relied on home oxygen also needed special support, provided by the 5 local CCACs.

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The Impacts Response times to medical emergencies became so prolonged, particularly in high-rise buildings, that just getting to the patient was an accomplishment! The other challenge was getting them out of the building! On one night at the peak of the storm, Toronto Paramedics responded to 3,100 emergency callstheir normal call volume for 24 hours is about 800 calls!

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The Impacts While there were fewer patients in the ERs, those who did arrive were sicker Once they arrived, it was almost impossible to discharge them

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The Impacts The anticipated discharge of in-patients halted for a period of time, because road travel was so treacherous! The internal population of hospitals grew far beyond planned levels

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The Impacts Not all of the most vulnerable patients were in the community When Sunnybrook Health Sciences Center lost power, 6 of its tiniest, most fragile patients, located in the Neonatal Intensive Care Unit, required emergency transfer by land ambulance to three unaffected nearby hospitalscontingency plans for such events had been established well in advance.

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The Impacts Supply chains were completely disruptedjust in time delivery came to haunt hospitals, particularly as high use items, food, and bed linen delivery were problematic One Toronto-based hospital corporation operates a single commercial kitchen, trucking hot food to the other two sites!

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The Impacts Most clinical staff have no idea how emergency systems work! Emergency power generators worked, but few understood how little they provided

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The Impacts HVAC systems, for example, are not on emergency power! Elevator service was limited Digital telephones did not work without a red plugneither did wi-fi!

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The Impacts Two large Toronto hospitals, Sunnybrook Health Sciences Center and Toronto East General Hospital were on emergency power for extended periods, and indicated that they were fine Toronto media reported the birth of one child, conducted by flashlight, inside a GTA hospital! Apparently emergency power didnt reach the patients location in the Birthing Center

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The Impacts The media has often repeated that only TWO Toronto hospitals were without powerthat is only part of the story! Hospitals from Niagara to Bowmanville also lost power at various times. The impacts continued to Kingston and beyond. Those hospitals which had power still had supply chain, transportation, and staff availability issues, and a rebound of discharged patients who would have been well enough for care in the community, if the power had stayed on

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Lessons Learned Not all emergencies in healthcare are about surge capacity! Hospitals and other healthcare facilities MUST perform risk-based planning for emergencies!

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Lessons Learned We cannot assume that everything in our facility will just continue to work, regardless of the circumstances! Most healthcare providers have minimal, if any, knowledge about the operating systems in their facilities! Understanding the limitations of the working environment in which we function is every bit as essential as our patient care skills!

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Lessons Learned External events disrupt supply chains Most hospitals steadfastly stick to the principles of just-in-time despite all evidence to the contrary!

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Lessons Learned Supply chains can also be challenged by a combination of convergence and those staff and visitors who may find themselves stranded in our facilities Such factors can double normal occupancy These people will require feeding and other supports which we rarely consider

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Lessons Learned Our staff have personal and family lives These include children and elders, who may also be adversely affected by the emergency This may affect staff availability to us and will serve as a distraction for those who DO come in when we ask them to!

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Lessons Learned Most hospitals ASSUME availability of staff during any crisis It is not uncommon to hear pronouncements such as we are a hospitalwe should take priority during a crisis! What happens to this assumption when staff spouses are Police Officers, Firefighters, Paramedics? Is it still valid?

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Lessons Learned We assume in our planning that staff will have no problem coming to work in an emergency What about closed roads, no public transit, unsafe travel conditions? They may be unavailable due to secondary factors (Toronto-2003, London-2005)

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