Practice makes perfect, even for doctors

A passenger train collides with an 18-wheeler in downtown London, causing the train to jump the tracks and flip on its side. Passengers are bleeding out; a young child has a severe head injury; there are possible amputations. Now what?

As part of a Canadian Surgery Forum this past week in London, a day-long mass-casualty training exercise led by University of Western Ontario professor Vivian McAlister took surgeons through a number of ‘now what?’ situations as a way to improve communications between hospitals and its surgeons during large emergencies.



Dr. Tarek Razek, Chief of Trauma at McGill University Health Centre and Montreal General Hospital, knows full well how overwhelming a mass-casualty situation can be. Five years ago, he led the medical response following the shooting at Dawson College in Montreal, where two were killed and 19 injured following the campus shooting.

He admits his hospital “got lucky” that day, but says at times “it’s better to be lucky than good, but you have to be good to take advantage of luck.”

Perhaps more than luck, Razek credits timing. The Dawson incident occurred in the daytime on a weekday. It was near the end of the day where regular activities were winding down but all the staff were still present in the building.

“This horrible event happened at a fortuitous moment in time,” Razek says. “Logistically, that was easier for us to respond to – more access, easier communication. If that happens at 4 a.m. at a night club on a long weekend, it becomes more challenging to make the same response happen.

“But it still needs to happen. So you always need to be much more organized to make it happen.”

And training sessions, such as the one in London, are key. “If you think you’re done and as good as you need to be, then you’re a fool,” he says. “You’re never as prepared as you need to be; you’re never as prepared as you think you are. So it’s extremely important you work on your preparation for these things. As well, preparation for these kinds of big events is extremely useful in the emergency system to respond to the regular everyday mini-emergency situations.”

Razek adds Canadian hospitals are not as good as many think when it comes to a mass-casualty response.

“There’s a large turnover in the health-care system. So it’s not something you’re good at and you’re done; it’s a continuous aspect. Most hospitals do have something they are doing, but more can always been done,” he says.

There’s also a “civic responsibility” when it comes to large-scale emergencies. With Japan’s recent earthquake, for example, Razek notes the citizens played roles in knowing what their responsibilities were when it came to the evacuation route.

“You need to be ready and engaged in your own environment to prepare for ‘what if,’” he says. “You don’t want to think these things will happen, but if you look around, these things happen.”

Locally, London Health Sciences Centre emergency physician Michael Peddle says he’s done similar training in the United States, but would like to see more north of the border.

“The adage of your level of preparedness is inversely proportional to your last disaster holds true for most of these things,” he says. “We’re prepared in that we thought about it; we started the process of planning. But until you actually go and train, drill and practice those things, you don’t see where the problems or errors will occur. That’s why we have days like this where we can actually try and figure things out.”

While he feels Canada undersells its preparedness, Peddle adds we certainly don’t have the same level of training opportunities in Canada, likely because we haven’t had the same number of events.

“The best thing that comes out of this day is not just to get people talking and have some training, but is to make the links between people. You start to make those connections,” he says. “The idea is to take what we learned today and implement it and get regular events into our own community hospitals to see how it works. What works in Windsor doesn’t necessarily work in London or Vancouver due to intricacies in their particular communities.”

Elgin Austen, Campus Community Police Service director, says the university has undergone a number of annual emergency training exercises over the last few of years, but nothing to-date in conjuntion with the hospitals.

“We have communicated with the hospitals in the past …. they’re doing their own thing,” Austen says. “We do have them registered in our emergency procedures, so we know who all the key people are. They would be alerted in advance in case of an actual emergency.”

Western has had a high-calibre emergency response system in place for many years, including an Emergency Response Team, an Emergency Operational and Control Group, SERT (Student Emergency Response Team), HazMat Team, in addition to a well-trained Campus Community Police Service and Fire Safety and Emergency Management.

While Razek says things have significantly changed at his hospital from where they were five years ago, there’s still an awful lot to do.

“Not by any stretch of the imagination would I stand here and say ‘Ya, we’re good to go.’ There’s an awful lot we can do to make us more prepared as we probably ought to be,” he says. “You’re going to regret that attitude and eventually something will happen. The only way you get good at something is doing a lot of hours of practice.

“There’s no magic pill, you just have to practice.”