"Attention all staff and physicians: UHN is now in Code Orange."
The mock overhead announcement heard in Command Centres set up across UHN sites last Thursday morning, prompted staff to put the hospital's mass casualty incident (MCI) response into action.
The scenario? More than 300 injured and potential casualties flooding Toronto hospitals after a series of catastrophic incidents – a speeding truck collides with two school buses carrying children, causing a large explosion; another explosion strikes shoppers lining up outside a shopping mall; a third explosion and active shooters with high-calibre assault weapons attack people in a different shopping mall.
People needing emergency medical attention are coming to UHN's Toronto General Hospital and Toronto Western Hospital sites, which are already operating at maximum capacity.
The prompts are part of GTA Unified, the largest health-sector focused mass casualty preparedness exercise ever conducted in Canada.
Thirty-four organizations, including 22 hospital sites, participated in the one-day-table-top exercise.
With more than 1,000 unique scenario prompts, GTA Unified was designed to evaluate a complex MCI within the Greater Toronto Area.
"Last year was an unprecedented one for our health system," read the exercise introduction video to all 34 teams. "Lessons learned from multiple mass casualty incident responses in 2018 served to guide the development of the exercise objectives."
Referring to the tragic Danforth Avenue shooting and Yonge Street van incident which shook the city in the summer of 2018, the events highlighted the need for a review of our mass casualty response plan, according to the design team.
Local law enforcement, paramedic services, clinicians, emergency preparedness specialists and other subject matter experts designed the day in-detail so teams could practice collaborating to manage an unexpected flood of wounded patients, causing family and friends, staff and the public extreme distress.
At UHN, the Executive Leadership team and site-based teams gathered to strategize decision-making plans in crises. The Public Affairs and Communications team distilled best-practices for handling media inquiries and public misinformation on social media while protecting patient privacy.
"The amount of teamwork has been absolutely incredible, and just seeing it come together through the exercise makes me feel more confident that if this were to happen we would have a response that would save lives and be something TeamUHN could be proud of," says Paul Beverley, Manager of UHN's Emergency Preparedness team and a veteran of more than 40 years in emergency management.
A journey of preparation
Since October 2018, Emergency Preparedness and the Code Orange Improvement Steering Committee at UHN have worked with teams across UHN to improve the hospital's existing Code Orange response.
Led by Janet Newton and Dr. Sam Sabbah, the committee has seen an overwhelming show of support to work through the planning of our updated Code Orange response leading up to GTA Unified.
"We could not have made such progress without TeamUHN's support and expertise," says Janet.
Dr. Anil Chopra, Vice President, Medical Affairs, UHN, says preparing for the worst-case scenarios seen in GTA Unified "will be incredibly impactful" to patients, staff members and the entire system in the event of a future mass casualty.
"The bottom line is that this is the largest multi-site disaster exercise that's ever been done in Canada and we're going to learn a lot from it," Dr. Chopra says. "The ongoing benefit is that we're going to be meeting on subsequent occasions to figure out what each of our sites learned, what went well, and what didn't.
"This will lead to incremental system improvement and readiness."
Click here to read more about the preparation by TeamUHN leading up to GTA Unified.
Thank you to everyone involved in helping make the day a success, with special thanks to the UHN Emergency Preparedness team for the countless hours they put into design and logistics to make it possible: Natasha Bloomberg, Senior Emergency Preparedness Specialist, Fraser Pennie,
Senior Emergency Preparedness Specialist,
Lisa Colangelo, Emergency Preparedness Analyst, Michael Wrobel, Emergency Preparedness Analyst, Vanessa Somoza, Administrative Assistant, Paul Beverley, Manager, UHN Emergency Preparedness, Frank Tourner, Senior Director, UHN, Risk, Radiation Safety.
