Ontario’s always-ready medical crisis team has been deployed to communities staggered by tornados and stalked by mental health crises. The healthcare providers who choose to do this work are trained to respond to chemical spills and catastrophic explosions.
When Ontario’s Emergency Medical Assistance Team got the call to deploy to CFB Trenton, the quarantine zone for planeloads of Canadian citizens and permanent residents evacuated from the epicentre of the novel coronavirus epidemic in China, they were confident, team leaders say.
“Everyone who is part of the team knows that the situations they could be part of are high-profile. They represent a crisis or a challenge to the province’s healthcare system,” says Steve Urszenyi, EMAT’s commander and program manager.
“These are all highly trained medical professionals, in their own full time day jobs, who recognize that they have a hunger to help other people … and the confidence to go out and provide that help, because they know they have the training, the skills and the abilities.”
Flying into circumstances from which others are fleeing, in order to help those who can’t leave, is the whole point, team members say.
The evacuees in Trenton are quarantined in a country suffering from a larger epidemic of misinformation, fear, and discrimination than of actual coronavirus cases. They are stuck in a particularly unique version of this plight.
In addition to tending to the bodily health concerns of the evacuees, EMAT has provided round-the-clock mental health support.
“A lot of people are very, very worried about their family … back in Wuhan,” says Nathan Kelly, an EMAT member and registered nurse with specialized mental health training who finished a nine-day deployment to Trenton on Thursday night.
“You’re seeing a lot of anxiety related to that.”
EMAT was created in 2004 in the wake of the SARS outbreak, which overwhelmed Ontario’s healthcare system. The terrorist attacks of 9/11 were still fresh, too.
Ontario’s Ministry of Health recognized the need for a crisis response team that could absorb some of the surge during a future outbreak, and respond to other disasters and emergencies.
The Emergency Medical Assistance Team, the first of its kind in Canada, is a provincially-funded group, operated by Sunnybrook Health Science Centre, one the country’s foremost trauma and emergency hospitals.
The nurses, paramedics, social workers, and doctors who are part of EMAT live and work in different parts of the province, so that if all of about 160 of them were needed at one time, no single community would be depleted. (EMAT members, who typically have full-time jobs as well, apply to join and voluntarily put their names forward for deployments, but are paid for their work.)
The team has responded to a huge variety of emergencies and events.
They deployed to the Ottawa area after tornados tore through it in September 2018, causing serious injuries, power blackouts, and widespread damage.
A mental health team travelled to Attawapiskat First Nation in 2016 as a youth suicide crisis devastated the community.
They were positioned in Ottawa during the Canada 150 celebrations as a precaution for any mass casualty event.
They have trained for any number of disasters, natural and manmade.
But the Trenton operation, a rapid response to an infectious disease, is why this program was invented in the first place.
“We’ve learned a lot from SARS. The province is much, much better prepared today than we were 17 years ago,” says Patrick Auger, EMAT incident commander.
“Really, what we’re doing is protecting the healthcare system,” says Auger.
(Both Auger and Urszenyi worked as paramedics during the SARS crisis.)
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Ontario’s Ministry of Health had been monitoring the growing epidemic in Wuhan, China, since December. As the case counts and deaths mounted in January, there were rumblings that the federal government might charter an evacuation flight from the beleagured region. EMAT was drawn into the discussions, and began modelling different operational circumstances.
On February 1, the team got confirmation that the evacuees would be housed at CFB Trenton for two weeks. That weekend, members of the team visited the site for a reconnaissance, to plan how to manage the operation.
Every step was planned out in advance: how the passengers would safely disembark; what personal protective equipment EMAT staff needed; how to assemble a heated, powered, phone-equipped, fully functioning field hospital, equipped with a biocontainment unit, in a military parking lot in the middle of Canadian winter.
When the first evacuees disembarked from the plane and walked into the hangar, everyone waiting there spontaneously erupted in an ovation. “Everyone was clapping and cheering them on as they came in,” Urszenyi says.
“They’re very relieved to be home in Canada,” he says, adding that many federal departments and agencies helped welcome and care for the group. “Everyone has been very positive, very much willing to help and do whatever they could to make this process as nice as it could be given what it is.”
EMAT’s isolation unit, equipped with negative pressure systems, air filtration, and other engineering controls that brick-and-mortar hospitals rely on, is used for higher-risk procedures, such as swabbing people with respiratory symptoms to test for the presence of virus.
So far, there is no cause for concern: all of those tests have been confirmed as negative by Canada’s National Microbiology Lab.
Most of the medical care provided on site has been managing pre-existing conditions and filling prescriptions, team members say.
Mental health resources are being used, Urszenyi confirms.
Kelly, the mental health nurse, says that concern about loved ones back in China and other anxieties are causing “disruptions in sleep, low mood, things like this. They come and speak to us, and we reach out to them as well.”
Kelly, who works for Niagara Region Public Health and is a board member of the Registered Nurses Association of Ontario, joined EMAT in 2017. His first deployment was to the Ottawa tornado zone, where he provided on-the-spot counselling and connection to mental health resources.
Last week, Kelly indicated he was available for EMAT deployment and got a call to confirm that night. Within 24 hours he was in Trenton.
Kelly explains his motivation to do the work as “trying to make sense of chaos, and helping people when they are in absolute need — in absolute need,” he says, adding emphasis.
“When most people are flying out and getting out of there, we’re flying in, to make sure people are looked after.”