What follows is the second instalment of a two-part series detailing how staff, physicians and agencies pulled together to respond to the April 6, Humboldt Broncos bus crash.
Heather Miazga’s son used to play hockey for the Humboldt Broncos a couple of years ago.
Miazga, a director for Surgical Services with the Saskatchewan Health Authority, was the clinical director on-call the night of April 6, the night a crash between a semi and a bus took the lives of 16 members of the Humboldt Broncos Junior A hockey team and injured 13 others. At about the same time she received the call from SHA administration alerting her to the accident, her husband received a similar call from another hockey dad.
“It was surreal,” said Miazga. “I mean, we still go to the games. We still have those hockey connections.”
Miazga’s professional experience is in emergency and critical care. So, when she walked into the Emergency Department at Royal University Hospital (RUH) that night, she was preparing herself for an influx of patients with critical and serious injuries. And she was relieved to see that others were preparing, too.
“The first person I saw was our charge nurse in the Emergency Department and she already had the Code Orange policy out and was reviewing it before the Code Orange was even officially called,” said Miazga. “We were calm, and talked through what we knew from the initial reports coming in and began to plan and assess what we needed to do.”
And in the early stages of a Code Orange situation, sometimes that sketchy initial information is all there is to go on.
“You have to get the best information that you can,” said Dr. Jon Witt. “And you have to get it quickly, knowing to some degree that it’s going to be inaccurate and it’s going to change.” Witt is a transport physician and trauma team leader. Although he wasn’t on call that night, Witt was asked to come in and help co-ordinate patient transport.
As the former medical director for Saskatchewan Air Ambulance, Witt understands what emergency services are available, not only across the province but across Western Canada. He said that in mass trauma and casualty situations, the focus is on getting enough basic information to base decisions on; it’s all a delicate balancing act.
“If I don’t pull enough resources, then we have patients sitting and waiting, which could mean death,” he said. “And, if I pull too much, the rest of the province and the other provinces (if called in) don’t have enough services available for other incidents that may take place. Farm accidents, heart attacks, strokes, car accidents – they don’t stop when there’s been a mass trauma. So, if I shove everything towards the trauma and they don’t need it all, I’m guaranteeing that there’s some other people out there who will get quite ill or die if we over respond. So the right information is critical.”
Much of that information came to Witt and Miazga in real time via the STARS Emergency Link Centre. For the Incident Command team at RUH, Link provided a constant connection with the hospitals in Tisdale and Nipawin, as well as other partner agencies such as STARS, ground Emergency Medical Services, Saskatchewan Air Ambulance, Alberta Air Ambulance and Transwest Air.
“Knowing as much as we possibly could at that point, the injuries that were coming in and when, made it that much easier to make those key decisions,” said Miazga. “For example, there was a question around whether or not we should keep the day teams on into the night. At that point, the first patients wouldn’t start arriving until around 8:30 or 9 p.m. (Saskatoon is more than 200 kilometres from the crash site), so we sent the day staff home so that they would be refreshed and ready to help out the next day.” Having that information made it easier to call in additional physicians, surgeons and staff for the night crew, to clear beds in the Intensive Care Unit (ICU) and for operating rooms to get prepped and ready to go.
“In these situations, there’s an urgency to make decisions immediately,” said Witt. “And while I mean no disrespect, our focus that night was on the living. In a trauma situation, we have to gauge who it will benefit most from early transport and prioritize based on that.” Witt believes that, in a Code Orange situation, teams just have to prepare for everything and reassess as patients arrive. “In this case, these were mostly, young, athletic men in their teens to early twenties. Despite the severity of the injuries, knowing that they were hockey players; that they could fight through, gave them all a very good chance of survival.”
Miazga believes that survival was successful because patients were triaged and stabilized on the scene and at the hospitals in Nipawin and Tisdale first.
“I’ve had a few people ask me why we couldn’t get those patients into Saskatoon sooner and my response is that it wasn’t best for them to be immediately transported here,” she said. “Because of the work our teams in Nipawin and Tisdale did to stabilize these patients, it resulted in better outcomes for them. We were able to accommodate 14 critically ill young adults on our doorstep in manageable segments of time with acuity priority and we were able to look after them all. So we are very grateful to our Nipawin, Tisdale and Melfort teams (Melfort sent physicians and staff to Tisdale to assist) and we respect the skills they brought to the table.”
For Miazga, there will always be opportunities to learn and improve on any code situation. However, she’s very proud of the work that was done that night and in the days that followed.
“I’m just so proud of our entire team,” she said. “And I mean everyone. Not only Emergency and ICU but our housekeeping, security, Client Patient Access Services, social work, surgical services, mental health services, communications and neurology departments. Although I don’t mean to, I’m sure I’m leaving someone out, but I’m just so proud of how our system stepped up to the plate and responded.”
Added Miazga, “it was the hardest weekend of my career. But it was also the most humbling and the proudest. This all worked as well as it did because everyone stepped up and made it work and I thank them all for that.”
The staff and students of Kyle Composite School, located in the community of Kyle, sent thank you posters to the medical staff (green poster) and the Royal University Hospital team (yellow poster) for the care and attention they provided to patients and families.