July 2024Spotlight feature

Simulation exercise offers vital training in coping with effects of toxic chemical spill

Section of JGH’s ambulance bay is transformed into decontamination centre

Into the Jewish General Hospital they straggle, appearing every few minutes in the parking bay adjacent to the Emergency Department. By ones and twos they arrive, some moaning, others crying softly, still others numbed into silence by shock.

Here a father, his eyes pressed shut, staggers forward as he clutches his baby to his chest. There in a wheelchair sits a bedraggled woman, limp and exhausted, her head rocking slowly back and forth. Nearby, a woman suddenly faints, crumpling to the concrete floor, as hazmat-suited healthcare workers rush to lift her onto a gurney.

In the simulation exercise, one of the mock victims (in a red plastic smock) is a father who clutches his baby (a doll) while waiting to enter the inflatable shower tent. Here he will wash away the toxic chemicals to which he and his child have been exposed. (Click on this or any photo to enlarge it.)

In the simulation exercise, one of the mock victims (in a red plastic smock) is a father who clutches his baby (a doll) while waiting to enter the inflatable shower tent. Here he will wash away the toxic chemicals to which he and his child have been exposed. (Click on this or any photo to enlarge it.)

All are victims of a major industrial accident somewhere in Montreal. Or it might even have been an act of terrorism. No one is really sure.

All that’s known is that large amounts of toxic chemicals have spilled onto the ground and been released into the air, sending dozens of people streaming for help to the JGH and other city hospitals.

Also of vital importance is one other key fact: none of this is true.

That deadly spill? Never happened. All those victims? They’re perfectly healthy stand‑ins. No injuries, no distress, no danger.

It’s all an elaborate exercise—a simulation of the aftermath of a disaster—to improve the ability of doctors to effectively respond to the real thing.

On this sweltering afternoon in June, the commotion and the acute sense of urgency in the JGH ambulance bay on Légaré Street are being generated by about three dozen residents in emergency medicine who have taken the role of medical staff. Joining them are about a dozen medical students who are playing the victims.

In their bright yellow hazmat suits, the treating emergency medicine personnel are scrambling to help those who have supposedly been affected by the sudden discharge of hazardous materials.

Simulations help prepare for real-world emergencies

Generally, the Emergency Department’s simulation exercises at the JGH are conducted in the Emergency Medicine Simulation Centre, whose newly upgraded premises opened in Pavilion H in mid-2023. That’s where participants hone their abilities by working on a life-like manikin whose complex, life-threatening medical conditions mimic real-world emergency situations.

During the simulation exercise, medical staff (in hazmat suits) rush to assist a mock victim of a toxic chemical spill who has unexpectedly collapsed to the floor after arriving in the ambulance bay of the Emergency Department.

During the simulation exercise, medical staff (in hazmat suits) rush to assist a mock victim of a toxic chemical spill who has unexpectedly collapsed to the floor after arriving in the ambulance bay of the Emergency Department.

However, Dr. Errol Stern, Director of the JGH Emergency Medicine Simulation Centre and co-organizer of the exercise on June 5, says emergency medicine residents also need training in mock disaster scenarios like the one he has helped supervise. It is here that participants experience the stress, turmoil and split-second decision-making that come into play after a potentially deadly, large-scale incident.

“Montreal is exactly where an accident of this kind could conceivably happen,” notes Dr. Valerie Homier, co-organizer of the exercise and an Emergency Physician at the Royal Victoria and Montreal General Hospitals at the McGill University Health Centre.

“We have a commercial port where a lot of chemicals are brought in and then transferred elsewhere,” she explains. “We also have a train that goes through the downtown area, which you don’t see in many cities.

“Plus there’s the Décarie Expressway, where trucks haul chemicals of all kinds. Major collisions and spills, not to mention terrorist acts, are possible in any of these locations and we need to be ready for them.”

Preparing for the simulation exercise

Before the simulation exercise, Neil Michaels, Emergency Measures Coordinator (left, holding plastic sheet), explains how the shower tent is inflated and connected to a water source. Assisting is Margaret Hoodspith, an Emergency Clinical Activities Specialist (right, arms raised). The shower decontaminates patients who have been exposed to a toxic chemical spill.

Before the simulation exercise, Neil Michaels, Emergency Measures Coordinator (left, holding plastic sheet), explains how the shower tent is inflated and connected to a water source. Assisting is Margaret Hoodspith, an Emergency Clinical Activities Specialist (right, arms raised). The shower decontaminates patients who have been exposed to a toxic chemical spill.

In the morning, before the simulation gets under way, the residents gather for about 90 minutes to familiarize themselves with the equipment they will have to use.

Neil Michaels, Emergency Measures Coordinator for CIUSSS West-Central Montreal, starts by explaining that the day’s activities are being staged in a specially delineated portion of the spacious ambulance bay, because a clear space must remain available for Urgences Santé to continue bringing patients into the hospital.

Dr. Anne Sophie Drouin and Dr. Antoine Perron, both emergency medicine residents, practice putting on and removing a hazmat suit.

Dr. Anne Sophie Drouin and Dr. Antoine Perron, both emergency medicine residents, practice putting on and removing a hazmat suit.

According to Dr. Stern, this particular simulation needs to take place in the ambulance bay, because if there really were a mass-casualty incident involving hazardous chemicals, the victims would be directed to this bay in Pavilion K to be decontaminated in a special inflatable plastic shower tent.

In fact, Dr. Stern says, the ambulance bay was specifically designed for decontamination, with the inclusion of plumbing for hot and cold water, a holding tank to capture the contaminated run‑off from the shower, and a separate ventilation system.

After pointing out the highlights of the 10-foot-tall shower tent, Mr. Michaels goes on to explain the proper way to put on and remove (don and doff) a hazmat suit, which most of the residents will be wearing later—ostensibly, to protect themselves from the chemicals on the victims’ bodies.

As the residents practice donning and doffing, Mr. Michaels cautions them to drink plenty of water and to take care not to become overheated in the air-tight suits (equipped with breathing apparatus), especially since the temperature on this summer-like day is expected to climb to at least 28 degrees Celsius.

The morning session concludes with a triage exercise on the lawn behind Pavilion H, where about a dozen medical students play victims who have been sickened near the scene of a chemical spill. Medical personnel hurry from one patient to another to determine the severity of their injuries and the order in which they should be treated.

Simulation exercise gets under way

After lunch, it’s finally time for the hour-long “main event,” as medical staff in their yellow hazmat suits examine the mock victims and prepare them for decontamination in the shower. The barefoot victims take off whatever clothing they feel comfortable removing (usually retaining at least a T-shirt and underwear) and put on a red plastic raincoat-like smock.

During the simulation exercise, a mock victim of a toxic chemical spill (in a red plastic smock) prepares to wash herself in the inflatable shower tent, assisted by emergency medicine residents wearing hazmat suits.

During the simulation exercise, a mock victim of a toxic chemical spill (in a red plastic smock) prepares to wash herself in the inflatable shower tent, assisted by emergency medicine residents wearing hazmat suits.

Victims who are able to walk are led to the shower tent where they wash themselves thoroughly for several minutes. Meanwhile, those in wheelchairs or on gurneys are washed by hazmat-suited residents using hand-held shower nozzles.

Afterward, the decontaminated patients towel themselves off and are guided, one by one, toward the Emergency Department for further examination and treatment.

In the concluding half-hour, the residents—some still with damp, drooping hair—gather for a debriefing to share their observations about what went well and what aspects of the scenario could be improved.

“This was a fantastic opportunity,” Dr. Kaelan Gobeil Odai, an emergency medicine resident, says later. “Having a chance to train and practice with the actual equipment has given me—and all of us—a much better sense of how to work efficiently to reduce risks in these kinds of situations.”

Dr. Badr Ali, another emergency medicine resident, agrees there is “no substitute for a real-life experience when you need to practice communication skills and teamwork. It also helps us identify weaknesses in our skills that we might have overlooked.”

While expressing satisfaction with the residents’ performance, Dr. Stern notes, “You can’t just do this once and think you’re good for the rest of your life. Ideally, I’d like to see emergency medicine personnel involved in a continuous education cycle that includes mandatory training and certification in decontamination, with recertification every two year.”

“What we really need,” continues Dr. Homier, “is for leaders at the provincial level to put a structure in place that enables a wide range of healthcare professionals in all Quebec hospitals—not just doctors, but nurses, orderlies, ICU staff, surgeons, unit coordinators and others—to receive training in preparing for a disaster.”

What Dr. Stern finds particularly gratifying about the day’s exercise is that this essential training—dealing with a mass casualty incident and decontamination—was provided to residents “who are now going to go far and wide.

Your support is vital for training in disaster preparedness

Simulation exercises are an essential means of providing medical and healthcare professionals with the training to cope with a wide range of challenges, including large-scale disasters.

You can help to ensure that adequate funding is available for this vital form of training by contacting the JGH Foundation at 514-340-8251 to support the Emergency Medicine Simulation Education Fund.

“We can confidently say that our McGill-JGH connection is responsible for providing invaluable experience to those who will become leaders in multiple hospitals in Canada and in other countries. No matter where they end up working, they’ll be taking those skills with them.”

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Video and photo gallery

The video contains highlights from the triage simulation exercise on the lawn behind Pavilion H. About a dozen medical students play victims at the scene of a toxic chemical spill. Hurrying to triage them are emergency medicine residents.

CLICK ON ANY PHOTO TO ENLARGE IT

To prepare for the simulation exercise, Neil Michaels, Emergency Measures Coordinator, explains to participants how to put on and remove a hazmat suit. Demonstrating the correct technique are Nursing Educator Joy Estrada (left) and Margaret Hoodspith, Emergency Clinical Activities Specialist.

To prepare for the simulation exercise, Neil Michaels, Emergency Measures Coordinator, explains to participants how to put on and remove a hazmat suit. Demonstrating the correct technique are Nursing Educator Joy Estrada (left) and Margaret Hoodspith, Emergency Clinical Activities Specialist.

Dr. Kaelan Gobeil Odai practices putting on a hazmat suit, with help from Dr. Harmine Leo. Both are emergency medicine residents.

Dr. Kaelan Gobeil Odai practices putting on a hazmat suit, with help from Dr. Harmine Leo. Both are emergency medicine residents.

Participants in the simulation exercise practice putting on and removing hazmat suits in a section of the ambulance bay adjoining the JGH Emergency Department.

Participants in the simulation exercise practice putting on and removing hazmat suits in a section of the ambulance bay adjoining the JGH Emergency Department.

On the lawn behind Pavilion H, participants carry out a triage simulation exercise. About a dozen medical residents (centre and right) play victims at the scene of a toxic chemical spill—some running in panic, some wandering in a daze, some sick or unconscious on the ground. Hurrying to help them are emergency medicine residents (left), who triage the victims to determine the order in which they will be treated.

On the lawn behind Pavilion H, participants carry out a triage simulation exercise. About a dozen medical residents (centre and right) play victims at the scene of a toxic chemical spill—some running in panic, some wandering in a daze, some sick or unconscious on the ground. Hurrying to help them are emergency medicine residents (left), who triage the victims to determine the order in which they will be treated.

During the triage simulation exercise, Sarah Bensemana, a medical student, plays an unconscious pregnant victim of a toxic chemical spill. She is examined by Dr. Patrick Fok—an emergency physician visiting from Halifax—whose observations and orders are recorded by a colleague with a clipboard (left).

During the triage simulation exercise, Sarah Bensemana, a medical student, plays an unconscious pregnant victim of a toxic chemical spill. She is examined by Dr. Patrick Fok—an emergency physician visiting from Halifax—whose observations and orders are recorded by a colleague with a clipboard (left).

During the simulation exercise, a mock victim of a toxic chemical spill is placed on a gurney before being washed by medical staff using hand-held shower nozzles.

During the simulation exercise, a mock victim of a toxic chemical spill is placed on a gurney before being washed by medical staff using hand-held shower nozzles.

During the simulation exercise, medical staff with hand-held shower nozzles (rear) wash a mock victim of a toxic chemical spill who is lying on a gurney. Meanwhile, another mock patient who has already been washed waits in her wheelchair to be taken into the Emergency Department for further examination and treatment.

During the simulation exercise, medical staff with hand-held shower nozzles (rear) wash a mock victim of a toxic chemical spill who is lying on a gurney. Meanwhile, another mock patient who has already been washed waits in her wheelchair to be taken into the Emergency Department for further examination and treatment.

Emergency medicine residents and staff organizers and supervisors of the disaster simulation gather at the conclusion of their day-long exercise.

Emergency medicine residents and staff organizers and supervisors of the disaster simulation gather at the conclusion of their day-long exercise.

 

The organizing committee of the disaster simulation exercise (from left): Neil Michaels, Dr. Errol Stern, Dr. Valerie Homier, Margaret Hoodspith, Kayla Feola and Joy Estrada.

The organizing committee of the disaster simulation exercise (from left): Neil Michaels, Dr. Errol Stern, Dr. Valerie Homier, Margaret Hoodspith, Kayla Feola and Joy Estrada.

 

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