Code Orange: How Sunnybrook handled the mass shooting

Dr. Homer Tien had already put in a full day’s work and was relaxing, watching TV news at home Monday night when his pager went off. A surgeon at Sunnybrook Health Sciences Centre, he was needed at the hospital ASAP. There had been a mass shooting and Sunnybrook was the designated trauma centre where the most seriously injured would be taken.

When a nurse told Tien over the phone what had gone down in Scarborough, he admits, he had an “oh sh-- moment.”

As medical director of the trauma centre, he had to scramble into action. Responsible for overseeing the emergency response, Tien activated a modified Code Orange, essentially the hospital’s disaster plan. In his five years of working at Sunnybrook, there had never been a Code Orange.

Still, Tien was prepared. While he has never seen this magnitude of serious casualties at Sunnybrook before, he has seen worse elsewhere. Tien moonlights as a trauma surgeon with the Canadian Armed Forces and five tours in Kandahar have taught him how to prioritize under incredible pressure.

“You are always a bit nervous because you don’t know what’s going to come in. I don’t actually know how many patients are going to come in yet and I don’t know what injuries they are going to have. It’s always a matter of hoping we have enough resources,” he explains.

When Tien arrived at the hospital shortly after 11 p.m., he marched straight over to the nurse in charge of the emergency department. She was patched through to EMS at the scene of the shooting and was getting an idea of what kind of casualties to expect. But in the chaos of the evening, the numbers kept changing.

Initially they were told there were “multiple” casualties; then they were told 20 had been shot. The next update had the number at 10.

On this night, Tien was essentially acting as a traffic cop, making decisions, then changing them on the spot in response to new information.

“Someone needs to have an overview because what you need to do is prioritize. There are all these resources that we don’t have a lot of and you have to prioritize who gets say an x-ray first, who goes to the operating room and for what operation and who goes for a CT scan and in what order they go and who gets their lab work drawn first.”

In addition to the enormous triaging job, he also had to make decisions on calling in extra staff — an extra team in the OR, an extra emergency physician, an extra intensivist. Fortunately it was shift-change time and a lot of the staff who were scheduled to go home voluntarily stayed.

In all, Tien estimates about 66 staffers were involved in the response — everyone from anesthetists to OR nurses, and from lab technicians to cleaning staff. From having participated in a mock Code Orange in advance of the 2010 G-20 summit, everyone knew their roles.

“I felt the whole thing went smoothly because of the … emergency medicine physicians and nurses who stayed past their shifts and who came in on their off night to help out, ICU staff and residents who came down to help out and OR staff who came in to open another room,” Tien says.

About 15 minutes after Tien arrived at the hospital, the first ambulance from the shooting pulled up. In the next half-hour, five more ambulances arrived.

The hospital was ready. Tien had assigned three ER physicians, along with nurses, residents and medical students, to trauma bays to tend to three most seriously injured shooting victims who required resuscitation. Two other ER physicians led teams in the regular ER who cared for three others. In the midst of it all, a seventh trauma patient arrived, a car-crash victim from Oshawa.

As paramedics wheeled patients in, they gave a rundown of vital signs and injuries. Five of the patients had been shot and the paramedics pointed out where the bullet wounds were. The sixth patient had been trampled in the melee.

Again, in traffic cop mode, Tien directed them where to take the patients — to which trauma or ER bay.

“It’s chaotic in the sense that there are a lot of people, a lot of moving parts, but I guess it’s my job to make sure people understand where each person is going,” he says.

He also tried to bring order to the chaos.

“If the ambient noise is too loud so people can’t think or work, (it’s my job) to quiet it down. If you’ve got 30 people in the trauma room and they are all asking for stuff, you can’t hear yourself think. Loudly I will say, ‘Quiet down.’”

Recounting the night’s events, Tien is weary. He worked until 5 a.m. and was back at the hospital at 9 a.m. for his next shift. He had to check in on his patients from the previous night. The three in the worst shape were now in the ICU.

“It’s one of the busiest nights I have had here, for sure.”

Original Article
Source: the star
Author: Theresa Boyle