Eastern Ontario braces for poststorm stress
Christopher Guly
CMAJ 1998;158:524-5
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Christopher Guly is a freelance writer living in Hull, Que.
© 1998 Christopher Guly
At the height of the ice storm that ravaged Eastern Ontario in early January, Joseline Sikorski remembers her town of Winchester looking as if it had been hit by a bomb. The town of 3000 residents, which is about 50 km southeast of Ottawa, had no electricity and many homes had neither phone nor water. No one ventured out to negotiate the ice-covered sidewalks. The only people seen were in their vehicles, queued up waiting for fuel. They needed cash or a credit card because the automated banking machines were also down. "It was like something out of a science fiction movie," she says.
Sikorski is CEO of the community's medical lifeline, the 80-bed Winchester District Memorial Hospital, which felt the full impact of the storm. The hospital, which serves a catchment area with about 24 000 residents, lost power for 3 consecutive days and was forced to function with the help of a generator. Because it was one of the few buildings in the community to have heat and electricity, the hospital opened about 16 additional beds to provide shelter for elderly residents of nearby long-term-care facilities. Care was provided by the hospital's 38 physicians, some of whom lived in homes that had lost their power.
Sikorski, a nurse by training, and her staff camped out at the hospital to ensure they were available for any emergency. She says the worst part was enduring the feeling that they were on their own. "There really needs to be a regional perspective in looking at dealing with an emergency like this," she reflects. "Everyone plans in isolation."
At one point the hospital's phones no longer worked. A patient had a heart attack and needed to be transferred to the Ottawa Heart Institute. Fortunately, the Ontario Provincial Police were able to notify the institute that the man was on his way.
But the crisis could have been worse, says Dr. Robert Bourdeau, medical officer of health for the Eastern Ontario District Health Unit, which includes Winchester. "Our biggest concern was not to turn an emergency into a real disaster," explains Bourdeau, who saw staff members deployed to the 50 shelters operating in the region. Among other things, they helped ensure that food served to the shelters' temporarily homeless residents was safe. "When the shelters opened everybody wanted to chip in and bring food, but that raised questions as to whether the food was cooked or not and how it was handled," says Bourdeau.
In one shelter, which was serving hundreds of meals daily, health inspectors discovered that ventilation in the kitchen had been shut off to conserve energy, causing a buildup of gas from the stove. Fortunately no one who sought refuge in the shelter experienced carbon monoxide poisoning, but several cases were reported in the area in the storm's wake. "I must say that there was no medical crisis," says Bourdeau. "If there will be any crisis, it will come with post-traumatic stress syndrome."
That hunch is shared by Bourdeau's colleagues. "What we're dealing with now and are going to continue dealing with is the whole stress and mental health issue," says Dr. Robert Cushman, chief medical officer of health in the Ottawa-Carleton region. "We're seeing a lot of people stressed, with some at the edge about to flip."
Cushman says most cases reported so far involved people with a history of psychiatric illness. "The stress caused by the storm has driven them over the edge and manifests in the worst aspects of their illness through elements of agitation and anxiety."
To deal with an anticipated increase in the number of cases of post-traumatic stress, the Royal Ottawa Hospital sent letters to family physicians advising them how to treat patients experiencing anxiety and depressive-like conditions. "What the storm has done is uncover some problems," says Dr. Marv Lang, director of clinical services at the psychiatric facility. "People who went door-to-door to check on folks found some people living in squalid conditions, who had a poor ability to care for themselves and were probably psychiatrically ill."
These people were admitted to the hospital. But even though the ice storm's after-effects may produce some patients with stress-related illnesses, Lang says the Royal Ottawa didn't see as many cases of anxiety, stress and depression as it expected during the region's state of emergency. "We were in contact with shelters to monitor how people were coping," says Lang, "and on the whole they handled things remarkably well."
Nevertheless, there were emergencies and casualties. In Eastern Ontario alone there were as many as 20 storm-related deaths. On Jan. 8, when the city of Ottawa was virtually shut down, the Ottawa Civic Hospital treated an elderly man who was rescued from his blacked-out home. It took a team of 20 in the hospital's emergency ward 6 hours to revive him.
The hospital sent its nonessential staff home Jan. 9 and the 549-bed facility began operating in emergency mode. Elective surgery was cancelled. Two wards were reopened to provide up to 75 more beds if they were required, and 2 dedicated telephone lines — one for the public, the other for staff — were established to provide breaking news. Employees who could not get home or, if they could, weren't sure if they could return to work the next morning, were given beds; 30 employees used them the first night. The hospital cafeteria was kept open late into the night to feed hungry and exhausted physicians and nurses.
"At 9 am Thursday, when we started getting calls from staff that they couldn't come in and we were at 100% occupancy, we called an emergency meeting of key directors from 15 departments," says chief operating officer Wendy Nicklin. "Within an hour and 10 minutes we had made 25 decisions to ensure that our beds were well-managed and utilized, and that we had adequate staffing."
In addition to the senior with severe hypothermia, the hospital's emergency ward dealt with storm-related injuries such as fractures and a few cases of carbon monoxide poisoning. "It was a very traumatic event," says Nicklin, "because the medical staff was dealing with a stressful situation at the hospital while dealing with their own stresses at home."
They coped, she says, because staff rallied and helped one another, as did staff at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa. "One of the things that impressed me was how everybody pitched in and mobilized to help — even those who didn't have power at home," says Susan Richardson, CHEO's vice-president of patient services. "The territoriality that you might find was gone — people rose to the occasion."
Like the Civic, CHEO had a strategy in place to deal with any emergency, including supplies of linen and sterile medical equipment. Even though it ended up providing a boarding house for visiting parents, for some residents and staff members from a group home in the area, and for some children who needed technical support because of a medical condition but were without power in their homes, CHEO didn't experience an emergency. Most of its storm-related activity centred on handling the 100 calls its child-health information line received from people concerned about issues like carbon monoxide poisoning.
Although most hospitals and health units in Eastern Ontario coped well with the storm and its aftermath, Mother Nature did manage to create at least some tension between hospital staff and management. At the Riverside Hospital, 1 of 2 Ottawa facilities scheduled to close because of Ontario's restructuring plan, administrators have a potential fight on their hands with some nonmedical employees who want full pay for work missed because of the storm. Since they weren't told to stay home, the workers are out of luck. "We're going to have to put together a policy that deals with the payment of employees unable to get to work because of natural disasters," says hospital spokesperson Eleanor Dunn.
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