Recent events in Ontario have focused public attention on emergency response capacity.
Making the case to continue to invest in services and programs available to respond in an emergency is a challenge in the current fiscal climate.
Elliot Lake is a picturesque mining town of 11,000 residents on the north shores of Lake Huron, located midway between Sudbury and Sault St. Marie. On June 27 at 2 pm a portion of the roof of Algoma Mall in Elliot Lake collapsed, raining heavy concrete and debris into the malls’ food court. During the frenzied few hours after the roof collapse, there were reports of people trapped under debris. The mayor declared a state of emergency, deploying provincial resources to assist in the search and rescue efforts. Some have suggested that the response was inadequate, and poorly coordinated. Tragically, two people lost their lives in the collapse.
The work is just beginning for those who will attempt to piece together how this collapse occurred, and whether the response was adequate. Ontario Premier Dalton McGuinty has stated that an independent public inquiry will be held around the response to the collapse. A likely focus of the inquiry is whether there is appropriate provincial capacity and coordination of disaster and emergency response services.
“All Emergencies are Local”
Disasters can strike at anytime, anywhere. The unpredictable nature of such disasters makes planning a challenge. Natural disasters like tornados, forest fires, landslides, transportation accidents, and terrorism can all lead to “mass casualty incidents” which can result in injury and damage which overwhelms locally available resources.
However, Rob Burgess, Senior Director of the Sunnybrook Centre for Prehospital Medicine, which operates Ontario’s Emergency Medical Assistance Team, notes that “all emergencies are local” and that the immediate response to emergencies relies upon local resources such as Emergency Medical Services (EMS), fire, hydro and public health as a first response.
In Ontario, the Emergency Act allows municipalities to declare a ‘state of emergency’ in order to “promote public good by protecting the health, safety and welfare of the people of Ontario” and can include implementing emergency plans, evacuating people from certain areas and institutions and establishing facilities to provide care and services. In addition, declaring a ‘state of emergency’ allows municipalities to draw on resources from beyond their area. The Emergency Act also specifies that municipalities are responsible for drawing up disaster management plans, which Burgess notes should include “deciding when and if to call the province and request support.”
David Gomez, a general surgery resident and research fellow in trauma systems at St. Michael’s Hospital explains that “you never respond to a mass casualty incident in isolation” as “whenever one of these events happens, you have to move patients, share resources, and in a coordinated way take care of people who would overwhelm local resources.”
Provincial Support, Services & Coordination
In Ontario, the Emergency Management Branch of the Ministry of Health and Long-Term Care was established in 2003 after the outbreak of Severe Acute Respiratory Syndrome (SARS). The Emergency Management Branch has in its’ mandate to “plan, organize, manage and coordinate provincial responses to emergencies that affect and impact health.”
While most resources to respond to emergencies are municipal, there are some provincial resources that can be deployed when disasters or emergencies require a response that is beyond the capabilities of local service providers. One such resource is the Emergency Medical Assistance Team (EMAT), which was put together in 2004. EMAT is a mobile medical field unit that can be deployed within 24 hours to anywhere in Ontario that has road access. Based at Sunnybrook Health Sciences in Toronto, EMAT is a mobile hospital which can treat up to 56 patients, and can provide patient isolation in the case of an infectious disease outbreak, medical support in the case of chemical or radiological contamination, or case management and triage of patients in a mass casualty situation.
EMAT is mostly staffed by volunteer, on-call health care professionals and support personnel. Nevertheless, the administration, training, support and logistics of maintaining this 160 person team costs about $1.5 million per year. EMAT has deployed four times since it was founded. Mostly recently, EMAT deployed in July, 2011 to set up mobile health services for forest fires evacuees in Northwestern Ontario.
While the amount of resources and staff needed depends on the scenario, ensuring that the necessary equipment and people are available to respond in the event of an emergency requires ongoing planning, logistics and coordination.
Other provincial and regional resources include regional Heavy Urban Search and Rescue (HUSAR) Teams. There are five regional HUSAR teams across Canada, and the Ontario team was recently called upon to respond to the Elliot Lake disaster. The Canadian military can also be deployed, if called upon by municipalities or a province, for emergency response support.
Making the Case: Preparing for the Unknowable
Burgess says “it’s always challenging to maintain the momentum and enthusiasm [to fund emergency response services] for those who are making tough decisions with limited budgets.” He notes that “the farther away you are from a significant event… the more likely it is that support may begin to wane” suggesting that emergency and disaster preparedness receives the most attention immediately after an event, when the public and decision makers are most concerned about avoiding future incidents.
The SARS Commission, established after the SARS outbreak, asked “why was Ontario so unprepared for SARS? Our public health and emergency infrastructures were in a sorry state of decay, starved for resources by governments of all three political parties” . The Commisssiom described SARS as “a crisis that never should have happened.”
Gomez led a study, published last year in the Canadian Journal of Surgery, which surveyed medical directors of trauma programs across Canada and found that 43% of trauma centers had not run any disaster drills in the past two years, and that only one half of medical directors of trauma centers were members of their organization’s disaster preparedness committee. Also, given how important cooperation is during emergencies, it was found that there was poor representation on committees from key partners and stakeholders, and that only 22% of trauma centers had agreements in place with other institutions or agencies regarding cooperation during an emergency.
Gomez says “there is a real need to standardize planning and response” for emergencies, arguing that “when things go wrong, you can see the impact of mistakes.”
Kenneth McBey, a professor of Disaster and Emergency Management at York University notes that the $6.5 million per year Federal Joint Emergency Preparedness Program,which provides funding from the federal government to develop provincial and municipal programs to prevent and respond to natural disasters, pandemics and terrorist attacks, was cancelled in the last budget.
McBey warns that “pushes to reduce taxes and the size of government” across all levels will impact emergency preparedness capacity and programs, noting that with “growing population density and decaying infrastructure … something has got to give” suggesting growing vulnerabilities across Canada when it comes to emergency response capacity.
Researchers are not the only ones who are sounding the alarm about the lack of planning and resources dedicated to emergency response.
A scathing Federal Senate Report from 2008 argues that Canadian federal, provincial and municipal governments are “not moving quickly enough to minimize the damage” that will occur during the next big disaster and that government efforts in emergency preparedness are characterized as a “quagmire of lethargy.”
Ontario implemented a number of new programs and government agencies in the aftermath of SARS; will the same occur in the aftermath of Elliot Lake?