A nugget of Big Medicine every day. #55 Blow out your metaphysical envelope
In December 1997, Dianne and I were staying at the lighthouse keeper’s cabin on Cape Borda on Kangaroo Island, South Australia. It was the first real vacation I had since taking the reigns of the all-volunteer Cote Saint-Luc Emergency Medical Services [EMS] in 1993. Di had business in Melbourne and Adelaide and I was lucky enough to be along for the ride.
Out on Kangaroo Island, we had up close and personal contact with the wallabies who came to stand near the kitchen door while Di was preparing home-made soup. The roadtrips between destinations provided vast vistas of seemingly unbroken gum trees and red clay roads. Wherever we went in our rented aging Toyota Bluebird, we arrived covered in a thin layer of red dust.
We learned the importance of having one person ‘spot’ while the other worked hard at keeping the car from ‘going bush.’ Dianne, the spotter, was on the constant look-out for mobs of kangaroos which would burst from the forest without warning. We had been told that if there was one kangaroo we should pause momentarily as it would likely be followed by more. We were never disappointed.
I remember the sunsets at Cape Borda. When the last light faded away there was nothing but this great big blackness stretching out into the sea.
It was as if the lights had gone out on the whole world.
We returned home to Montreal just in time for Christmakah. And then, at the beginning of January, the Ice Storm began.
The Ice Storm brought an incredible response from the membership of CSL EMS. Seventy-five of our members worked in round-the-clock shifts responding to emergency medical calls, assisting the fire department, establishing mobile medical command centers, serving with the EOC, transporting sick and injured patients to hospitals, conducting door-to-door medical verifications, conducting medical evacuation assessments, and assisting the police with evacuations. We expanded our response fleet from three trucks to five trucks then to eight trucks — including five ambulances.
At one point our entire city was without power and drinkable water, we had evacuated almost five thousand senior citizens, we didn’t have cots for our shelters [the Canadian Armed Forces were never a presence in our area and the Canadian Red Cross simply did not have enough supplies to cope], we were running medical and fire calls at an incredible volume [we completed 1,200 calls in just over 10 days when our normal call volume for a 12-month period was 2,500 calls], one-third of our medics were on antibiotics and/or injured in some fashion [cuts, sprains, etc.], and our station had suffered a major electrical surge that damaged or destroyed all of our electronic gear.
From The Montreal Gazette article ‘Heroes of the storm’ of Sunday, January 18, 1998: “In Cote St. Luc, EMS volunteers received accolades from several readers for their tireless actions under often-dangerous conditions. One team — Blair Johnson, Sonia Lagoutte and Blair Schwartz — was evacuating a Cote St. Luc Rd. apartment building when they received a 911 call from someone having a heart attack in the same building. As the ailing woman’s relatives held candles and flashlights, the volunteers hooked up a heart monitor and other lifesaving equipment. Once they stabilized the woman, the volunteers picked her up and carried her down the stairs and transported her to a local hospital…”
The toll was incredible. Most of our medics experienced some sort of post-traumatic stress reaction. Virtually everyone’s immune system bottomed-out after the adrenalin rush subsided and we all came down with similar versions of the flu. One of our trucks emerged damaged but mainly intact after being struck by a falling tree at the scene of a medical call.
As you know, I am a self-confessed weather freak. My friends ask me to send them weather alerts for lightning, thunder, rain and snowstorms. Their kids call me ‘the weather guy.’
During the summer I would sit out on the front porch of Cote Saint-Luc EMS and watch as the thunderstorms would roll in from the West.
So, it should come to no one’s surprise that in January of 1998 I was watching the beginnings of the ice storm system on my desktop computer’s weather-mapping application and thinking, “That doesn’t look like it’s going to leave anytime soon.”
We decided to act proactively and even before the power began to fail en masse, we had made arrangements to rent a massive self-propelled movie set generator from Panavision in Montreal.
The truck arrived with its own operator. His name was Gerry Lapointe and he became part of the EMS family during the Ice Storm. When he wasn’t tending to the generator, Gerry put coffee on and prepared breakfast for our crews every morning, cleaned the kitchen, the Communications Center, the bedrooms and the bathrooms – and even helped prepare emergency supplies for one of the field hospitals/shelters.
January 5, 1998.
11:32 80 F Shoulder injury, 15:10 87 F Respiratory distress, 17:35 75 M Psychiatric, 21:39 57 F Difficulty breathing, 22:31 91 M Respiratory distress, 23:01 76 F Chest pain and difficulty breathing
Power has started to fail in various areas as we deal with freezing precipitation.
January 6, 1998.
At 05:00 hrs on the morning of January 6th, dispatch begins to become inundated with calls for assistance. There are reports from the Provincial EOC that some 700,000 households are without power. Hydro-Quebec is asking customers to be patient as it might take some time to restore the current.
Bruno Saint-Onge, Emergency Medical Technician-Firefighter. Bruno conducted rapid recognition courses for our members – explaining the critical differences between utility wires, low-, medium-, and high-tension wires. He helped our crews as they responded to assist the fire department by prioritizing multiple calls for assistance. Bruno’s technical guidance was invaluable during the first few days of the storm. He worked with the Montreal Fire Department by day and then volunteered with CSL EMS by night — all the while anxiously awaiting the birth of his first child.
By 11:34 hrs on the morning of January 6th, EMS crews had responded and prioritized more than 25 calls for fire department assistance. Many of those calls were for wires down, branches on wires, trees on houses, etc.
At 11:35 hrs on January 6th, EMS crews received the first of what would be many calls for medical verification. A 75-year-old man was on a home oxygen system and plans were made for his eventual evacuation.
At 13:14 hrs on January 6th, EMS crews were first-in at a working dwelling fire. The safely evacuated and treated the three occupants of the home.
15:03 hrs 88 F Difficulty breathing, 15:15 hrs Medical verification, 16:38 hrs 92 F Chest pain
Scott Hunt, Emergency Medical Technician. Scott coordinated all of the overlapping schedules and worked virtually every evening during the Ice Storm. In a cruel twist of fate, while Scott was volunteering with Cote Saint-Luc EMS his own family’s apartment was severely damaged when a fire ravaged their building in St-Laurent.
17:51 hrs 35 M Firefighter injured, 19:08 hrs 89 M Stroke
Provincial EOC reporting 450,000 households are without power. People are finding it difficult if not impossible to find a hotel room in the city.
My career in EMS has taken me over some peaks and down some valleys – but no valley was so pronounced as the abyss that greeted me the morning I decided to call for help.
I called Urgences Sante [Montreal’s provincially-owned and operated ambulance system] and asked for assistance in setting-up shelters for the thousands of senior citizens we were evacuating from dark, frigid, carbon-monoxide intensive apartment buildings.
You could not measure the depth of my despair when I realized that no help was coming. However, that despair was almost immediately replaced by the realization that we would have to take care of ourselves — that no cavalry was going to come riding over the hill.
The next day brought more difficulties but with them came a renewed sense of purpose and a determination to overcome all obstacles.
During the Ice Storm, we established a 150-bed in-patient acute care unit inside a local high school, organized a staff of seven emergency physicians–twenty nurses–several social workers–and several dozen volunteers, received equipment from sources as diverse as The Rolling Stones’ stage medics [a LifePak 10 and a pulse oximeter] after their show was cancelled due to the unfolding disaster — and Physio-Control Canada [2 LifePak 9s, a LifePak 11, 4 FirstMedic 710s and a LifePak 500 as well as major technical support trucked-in during the height of the insanity], established a 35-bed intensive care unit for chronic care patients who had been evacuated from convalescent or nursing homes, established a 16-bed Alzheimer’s unit in the library of a local synagogue, bought 300 cots from a manufacturer and transported them into town on three commandeered transit buses with a police escort, resuscitated two cardiac arrest cases and another respiratory arrest case, evacuated another couple of hundred residents, and lent a hand to our firefighters as they battled several all-hands blazes.
January 7, 1998.
10:42 hrs Evacuation assessment of a 10-storey apartment building.
10:46 hrs The transport of the first 16 evacuees from the building begins. They are taken to the shelter at City Hall. The fire department is called to scene to ventilate the building after fumes from the generator began circulating throughout the hallways.
23:42 hrs 78 F Difficulty breathing.
Richard Liebmann, then Captain of Operations for Cote Saint-Luc EMS and now Chief of the First Response Division for the Montreal Fire Department. Rick was on vacation when the Ice Storm began but he immediately became involved in our emergency operations. He and his wife left to Toronto on Thursday, January 8th to attend an engagement party. Somehow, Rick and Tammy drove back to Cote Saint-Luc in the middle of the night on Friday the 9th. They missed the family affair in order to help out back home.
January 8, 1998.
Provincial EOC reports that 950,000 households are without power in Quebec. There have been a few problems with the phone lines.
01:31 hrs Medical verification, 01:34 hrs Medical verification, 10:10 hrs 86 F Unconscious, 10:12 hrs 81 F Difficulty breathing, 11:07 hrs Evacuation of a 10-storey apartment building, 11:48 hrs Evacuation of a 15-storey apartment building, 12:01 hrs 80 M Difficulty breathing, 12:30 hrs Evacuation of a geriatric care facility. With assistance of police and fire departments, 120 residents were transferred to shelters, 21:20 hrs 9 F Poisoning
Jonathan Cooperman, Emergency Medical Technician. Jon developed a rapid and very effective method of preparing for and carrying out evacuations in many of our City’s high-rise apartment buildings. His medical census and assessment became the backbone of multiple evacuation operations. Jon was also involved in the rescue of an unconscious resident during an all-hands dwelling fire.
We had many senior-centric highrise or multi-building facilities that had to be evacuated due to reasons ranging from back-up power system failure to elevated carbon monoxide levels. We drafted police officers to assist with mass evacuations of senior citizens using city transit buses. That decision provided a sad reminder of the troubled times people have lived through in their lives.
As police officers, many in tactical or ‘bulked-up’ uniform/gear due to the weather conditions, went door-to-door in the darkened hallways of highrise apartment buildings, hundreds of Holocaust survivors flashed back to a time where they were forced from their homes and into transport to the death camps.
We had, of course, unintentionally made matters worse by providing the police officers with the instructions to residents to gather their essentials into a bag as quickly as possible and then make their way to the lobby where they would be loaded into buses for the ride to the shelters. At the shelters we had the standard line-up check-in procedure. The first round of evacuations [several hundred people] resulted in dozens of cases of severe mental trauma and more than a few syncopal episodes.
We adjusted by having medics accompany the police officers on their evac rounds and in the buses, softened the approach [used as much light as possible in those darkened hallways to ‘de-scary’ the encounter], brought social workers into the mix on the buses, and altered the check-in procedure to include large round tables where a social worker and a medic were assigned to each table to help residents acclimate to their new surroundings. It became more like a last-minute social gathering than the forced evacuation that it was.
We were fortunate to have been able to react quickly enough however those first senior evacs remain as a vivid reminder of the need to get things right [or as right as possible] for the community we serve – and to plan ahead with as many stakeholders as possible at the table.
January 9, 1998.
Provincial EOC reporting 1.3 million households are without power in Quebec.
02:11 hrs 76 M Difficulty breathing, 09:27 hrs 82 F Hip trauma, 09:57 hrs 80 M Chest pain, 10:25 hrs 75 F Respiratory distress, 12:02 hrs 82 F Difficulty breathing, 13:38 hrs 84 M Chest pain and difficulty breathing, 17:40 hrs 70 F Chest pain and difficulty breathing, 18:23 hrs 80 M Difficulty breathing, 23:20 hrs 83 M Difficulty breathing
Dawna Hobbs, Captain of Training. Dawna ran the show from the generator-powered EMS House. She marshaled the crews, organized their assignments, and established a field communications center to loadshare with the emergency dispatchers. Dawna made tremendous personal and professional sacrifices to ensure there was always an evening command presence at the EMS House.
I remember driving home to Pointe Claire on Highway 20 in a borrowed emergency vehicle of one kind or the other. I’d go home to check on Dianne in our blacked-out home and she’d have the woodstove going and there’d be a new example of inventive culinary genius available to sample every evening. The simple pleasure of eating baked potatoes wrapped in foil in front of the flickering light of the flames.
There were never any other vehicles on that stretch of road. It was always very lonely. The darkness would be complete with only the occasional blue/green explosion as yet another transformer exploded somewhere. One night, I thought I saw a light flashing in the distance. As I slowed to get a better look I watched as a long convoy of Detroit Edison utility trucks rolled past under police escort. That was a very sweet feeling and I still get choked-up when I remember that long line of white trucks.
January 10, 1998.
Provincial EOC reporting 1.4 million households are without power in Quebec. Water must be boiled prior to consumption.
00:40 hrs 72 M Weakness, 02:02 hrs Evacuation, 07:00 hrs 80 F Medical verification, 07:31 hrs 78 M Chest pain, 11:05 hrs 77 M Chest pain, 15:41 hrs 10 M Burn trauma, 22:09 hrs 70 F Cardiac arrest. Resuscitated.
Dr. H. Mitchell Shulman, MD, Medical Director. Mitch became the Medical Director of an operation that grew to include a team of eight physicians, twenty nurses, several social workers and psychologists, dozens of volunteers and the seventy-five members of Cote Saint-Luc EMS. His morning rounds involved checking in on the hundreds of evacuees in all of our shelters. Mitch made sure he was readily accessible and fully involved in the clinical side of operations even providing direct advice to EMS crews on certain critical responses.
January 11, 1998.
Provincial EOC reporting 900,000 households without power. An estimated 11,000 soldiers are now on the ground in Quebec. A 1-800 number has been established for those with electricity to register and let the govt know how many people they can provide temporary shelter for in their homes. People have been asked to avoid the downtown core unless absolutely necessary. The boil water alert has been lifted.
01:28 hrs 70 F Chest pain, 01:35 hrs 52 F Severe headache
Roberto Abbruzzesse‘s family has power in their Montreal North home. More importantly, the Abbruzzesse’s kitchen has electricity. With their heart and soul working overtime in that kitchen, huge trays of wonderful Italian dishes make their way into the EMS House. That was quite something — being adopted by the Abbruzzesse family.
04:57 hrs 75 F Respiratory distress. Cote Saint-Luc EMS transports this patient to the Jewish General Hospital ER — but not before an Urgences Sante coordinator attempts to stop the EMS crew from transporting the patient.
I have always wondered about this episode. In a major metropolitan area in the midst of a disaster how did it seem sane for that coordinator to attempt to block the transport of a critically ill patient to hospital when there was no other ambulance available with a reasonable response time?
More than a decade later and I really don’t believe we have progressed much beyond that surreal moment. Our emergency services are still locked in sandbox political battles over perceived turf. The patient’s needs are continuously overshadowed by those of the organizations that are supposed to be there to serve.
“There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives. The clock begins ticking when someone calls for help. The primary consideration should be who can get there quickest to render aid – not which response organization has a ‘claim’ to the territory. It’s not about what uniform the responder is wearing. Every EMS organization should take an enormous leap of faith forward, work with all of the stakeholders and establish a model that ensures everyone in the community gets the EMS they deserve.”
05:01 hrs 84 F Respiratory distress, 05:33 hrs 90 F Respiratory distress, 09:42 hrs Medical verification, 11:43 hrs 84 F Chest pain, 17:25 hrs 83 F Chest pain
18:54 hrs All-hands dwelling fire. With firefighters fully committed to battling the blaze and shorthanded, EMS crews assist with pump operations and ventilation. An injured Cote Saint-Luc firefighter was transported by Cote Saint-Luc EMS to St Mary’s Hospital’s ER.
20:12 hrs 27 F Head trauma, 20:14 hrs 63 M Unconscious, 23:10 hrs 90 F Unconscious
January 12, 1998
Provincial EOC reporting 655,000 households without power.
03:02 hrs 75 M Difficulty breathing, 03:18 hrs 75 F Difficulty breathing, 06:19 hrs 82 F Medical verification, 14:07 hrs Evacuation of a five-storey apartment building, 15:08 hrs 79 F Cardiac arrest. Resuscitated, 20:09 hrs 65 F Head and back trauma. Car crash in the underground garage of an apartment building.
22:42 hrs All-hands working dwelling fire. An EMS crew is first-in and pulls an unconscious 27 M from the entry of the duplex.
23:01 hrs 75 F Medical verification. Cote Saint-Luc EMS was called by neighbours after they were unable to contact the resident. After forcibly entering the home, the EMS crew found the resident conscious but hypothermic. He was transported to the Bialik shelter.
January 13, 1998
00:35 hrs 75 M Chest pain, 04:01 hrs 79 F Difficulty breathing, 06:51 hrs 91 F Chest pain, 11:18 hrs 39 F Labour, 16:39 hrs 79 F Chest pain and difficulty breathing
18:53 hrs 76 M Severe hypothermia. Police officers discovered this patient and his wife in their frigid blacked-out home. They would have likely died within hours had they not been found by police.
19:15 hrs All-hands fire in a multi-storey apartment building. From The Montreal Gazette article ‘Heroes of the storm’ of Sunday, January 18, 1998: “Larry Rinzler saw the ceiling-high flames in the ground-floor apartment as soon as he arrived at the building on Kingsley Rd. in Cote St-Luc. He immediately pulled the alarm and started banging on doors, yelling “Fire!” Rinzler, a 24-year-old Cote St-Luc Emergency Medical Services volunteer, can’t recall what day this happened — after going full out for an entire week with no more than four of sleep a night, his mind is a bit foggy. But he does remember using what strength he had left to hoist a woman in her 80s on to his back and carry her through thick smoke down at least 10 flights of stairs in a blackened building…”
Larry Rinzler, Emergency Medical Technician. As documented in The Gazette, Larry helped evacuate an apartment building while firefighters battled a fire on the first and second floors. He also made arrangements with Via Route so that transport could be arranged to and from Brockville, Ontario [thank you SANDS] to pick-up another rented ambulance. Larry was by my side when we knocked on Paul Shaviv’s front door at 06:00 hrs on a Saturday morning — the first step in making the Bialik Shelter a critical reality.
And I remember sweating the details of having to awaken this very orthodox Jewish man and his family from their sabbath sleep because we needed his permission to establish a large shelter in the private school where he was the principal. Larry assured me it would be fine. And, of course, it was.
January 14, 1998
08:11 hrs All-hands dwelling fire, 10:53 hrs 89 M Chest pain and difficulty breathing, 15:34 hrs 35 F Head trauma. Car crash, 16:49 hrs 68 M Severe head trauma, 18:05 hrs 76 M Respiratory distress, 21:01 hrs 87 F Chest pain and difficulty breathing, 23:11 hrs 79 M Difficulty breathing
Richard Edelstein, Businessman. Richard walked into the EMS House and volunteered his services. He knew CPR and First Aid and he was willing to do anything to help make a difference. Richard was part of a team that conducted hundreds [if not thousands] of door-to-door checks on residents throughout the City. He carried supplies, washed dishes, and delivered equipment. We invited him to be a part of the crew whose photograph appeared in The Gazette but Richard had already moved onto Drummondville — where he was delivering firewood to families in need.
January 15, 1998
11:54 hrs Evacuation assessment.
I remember a long-distance mobile telephone conversation with someone at another agency considering lending us a hand during the crisis. We were evacuating another hundred or so senior citizens from a nursing home at the time. This gentleman from that other agency [they declined to help out due to bureaucratic considerations] said they would be willing to send someone to better assess the gravity of the situation. Right at that moment a large piece of ice dropped off a fifteen-storey building and hit a parked car on the street behind me. There was a big crash.
He exclaimed, “What was that!”
And I distinctly remember my reply, “Hell just froze over, sir.”
I came out of the Ice Storm experience with a renewed faith in the good of humanity — and in the ability of a group of committed individuals from diverse backgrounds who come together to successfully tackle a seemingly insurmountable task.
We blew out the metaphysical envelope that had always defined our service’s capabilities. Normal would never be the same as it was before the Ice Storm.
Be well. Practice big medicine.