Health-care evacuations are the 'new normal.' Here are lessons from Alberta's last wildfire season

White Coat Black Art26:30Health-care lessons from an unprecedented fire season

The mealshadn't even been served at the 2023 Physicians Appreciation Dinner in Grande Prairie, Alta., when Candice Edeystepped forwardto deliver the bad news.

"I had to go up to the microphone and, at this event that was supposed to be really appreciative of the folks in the room, and just let them know that we were going to basically be staging a mass casualty kind of incident response," said Edey, senior operating officer for the Grande Prairie area of Alberta Health Services (AHS).

Shortly after her announcement on May 6,Edey headedto the hospital to prepare for the arrival of 43 patients forced by wildfire to flee the town of High Prairie, about 150 kilometres away.

"In health care, there's lots of times when we just have to figure out things as we go," she told Dr. Brian Goldman, host of CBC Radio'sWhite Coat, Black Art.

During last year's history-making wildfire season, the hospital became an ad hocstaging centre threetimes, helping about 100 relocated patients and continuing care residents from threatened communities. Officials and first responderssay they've taken lessons away from 2023 about how to prepare for, and respond to, patient evacuationsas they become the "new normal."

Cale Holmstrom's wildfire season last year began with an off-duty phone call. "Learned my lesson," he said. "Never look at your work phone when you're outside of work."

Holmstromis a clinical operations manager with AHS, looking after EMSstations in the Slave Lake district, about 225 kilometres northwest of Edmonton.That phone call kicked off hisefforts to move patients and long-term care residents around the huge (about two-thirds of the province) and sparsely populated north zonelast year.

With awildfire threateningthe hospital in High Prairie, Holmstromprepared even before there was any order to move patients to Grande Prairie, which is about a two-hour drive on a normal day.

"Anybody that's going to take more than a few minutes to get them up and get them out the door, we really wanted to pre-plan," said Holmstrom, who also has experience responding to the fires at Slave Lake in 2011 and Fort McMurray in 2016.

Doing a patient inventory

During last year's crisis, he and twoother health-care officials sat down and took an inventory of everypatient who would need to be moved: "Are they able to take a few steps to get up into an aircraft, if we need to fly them?" he said. "Can they step up into an ambulance? Do we really need to treat them as wheelchair or stretcher-bound-typepatients?"

In the end, the decision was made not to use any aircraft because of the wildfire smoke.

Holmstrom said the convoy of school buses, ambulances and recreational buses that headed for Grande Prairie opted for a safer, but slower, route to keep thepatients at ease bypassing a more direct road because there were unpredictable nearby fires.

Many of those high-needs patients and long-term care residents were taken to the designated staging area, Grande Prairie Regional Hospital,and eventually to other destinations.

'Creativity and collaboration'

Edey's experience creating a staging area for patients at thehospital was brand-new.

She and other members of the hospital teambegan gathering what they neededat the hospital's auditorium, which is near the main entranceand can hold more than 100 people. Stretchers, vital signs machines, IV poles and workstations on wheels were all movedin. Workers put numbers on each bedto make triage simpler.

The patients eventually ended up dispersed throughout the hospital, including in the ambulatory carearea and the day surgery area.

The staff's attitude was upbeat, Edey said.

"I would say almost excitement, right?" shesaid. "People wereexcited to be able to help. There was really great creativity and collaboration....It wasn't perfect, but it was really a sense of:'We can do this.'"

That attitude was needed in the all-hands-on-deck situation.

"You always think of the nursing staff and the doctors, which were really key people," she said. "But we had to have pharmacy there. We had to have porters come and help. We had to have patient registration. We had managers. It was everybody in the building came to assist."

Lessons learned

Edey and Holmstrommentioned several lessons they tookfrom 2023, especially becausethey expect to have similarcrises year after year.

"Unfortunately it is definitely part of our new normal," Holmstrom said.

Edey said thatin preparation for this year's fire season, theIT teamcreated a live patient evacuation tracker, which updates for everybody using the system all at once so information doesn't fall through the cracks.

"So if they're staging Grande Prairie, we'd be able to log in and update information, EMS can access that information as well.... So it really creates a quite a bit more integrated, cohesive system for us to be able to track exactly how those patients are moving."

Holmstrom and Edeyboth talked about the importance of co-ordination throughout the community.

"Pre-plan with your municipalities, pre-plan with your allied agencies, your fire partners, your wildfire partners," Holmstrom said. As an example, he points to the relationships hospitals have with school divisions in hisarea.

"One phone call and we had probably half a dozen school busesbe on standby for us in the parking lot," he said.

Holmstrom said keeping an even keel and taking a moment to talk to displaced patients is key.

"Nothing worse than having 100-and-somefolks who are panicked and, 'Oh my goodness where are we going?'Definitely having a calm, cool, collected approach was advantageous for everybody involved."

Other takeaways were very specific but useful. Holmstrom said helearned it's important that certain dementia patients in close quarters get along with each other.Edey learned the importance of labelling, after some members of the health team were tasked with discovering which walkers or wheelchairs belonged to which people.

After that first evacuation last year, Edey said, the team was quick to make sure that problemdidn't happen again, using spreadsheets and labels to track the equipment.

"That's one thing I'd say we do a good job of is learning and trying to do better," she said.