1. Supporting Paramedics in Challenging Environments: Elliot Lake and Other Places Dr. Michael Feldman Sunnybrook Centre for Prehospital Medicine May 16, 2013

2. Algo Centre Mall

3. Algo Centre (Eastwood) Mall Construction began in 1979, opened in 1980 77-room Algo Inn and several large retail outlets, food court, and small retailers 10% of Elliot Lake’s retail space Constructed of structural steel frame with concrete decking, clad in metal Parking garage on rooftop

4. Structural Problems 1990 – reports of leaking roof 2008 – roof leaks causing damage to multiple retail units; Scotiabank closes temporarily due to water damage 2008 – project to install a membrane to seal the roof was cancelled due to costs Summer 2011 – chunk of concrete falls into restaurant Interior damage was noted in 2012 when additional work was undertaken to maintain the roof

6. June 23: Collapse 12 m x 24 m section of the concrete roof deck collapses onto the two floors below Elliot Lake Fire Department able to visualize hand and foot of one victim, hears tapping in the rubble pile Firefighters digging unable to gain access to other victims and slabs of concrete began shifting Up to 22 people unaccounted for in food court area HUSAR Canada Task Force 3 requested Sunnybrook physician Dr. McDonnell mobilizes with team

7. Earthquakes that California in 1989 and 1994, and Kobe, Japan in 1995 demonstrated the need for specially trained Heavy Urban Search and Rescue (HUSAR, US&R in the United States) resources to respond to incidents of structural collapse caused by earth-quakes and other major hazards.

8. HUSAR: The location of trapped persons in collapsed structures using dogs and sophisticated search equipment; the use of heavy equipment such as cranes to remove debris; the work to breach, shore, remove and lift structural components; the treatment and removal of victims; and the securing of partially or completely collapsed structures

9. Toronto HUSAR Canada Task Force 3 Team members: – Toronto EMS, Toronto Fire, Toronto Police and search canines, Toronto Water, and Sunnybrook ED Initial training – Structural Collapse Awareness/Ops course – Hazardous Materials Awareness Specialized training and roles – Search and rescue technician, search specialist, heavy equipment operator, logistics technician, disaster medical specialist

10. Toronto HUSAR Canada Task Force 3 Hazardous material surveys/evaluations Structural/hazard evaluations of government/municipal buildings needed for immediate occupancy to support disaster relief operations Stabilization of damaged structures, including shoring, cribbing operations on damaged buildings Water/ice rescue operations

11. Role of Sunnybrook ED Physicians Provide physician resource Serve as base hospital physicians to delegate medical care by paramedics Develop protocols Develop and maintain medical cache Provide preventative and emergency care to team members, search canines, and disaster victims Critical care capability for up to 10 patients

20. June 24 Search & Rescue

22. Medical Considerations Team health and safety – Nutrition, hydration, personal protective equipment, rest cycles, primary care Preparations for receiving victims – Medical intelligence – Liaison with local EMS, Ornge, local ED – Anticipation of crush injuries: ensured adequate supplies of fluid and bicarbonate

23. Support for Paramedics Need for physicians at scene is rare but has high impact potential Variety of incidents – Severe entrapments – Mass gatherings – Mass evacuations Preparation: ‘jump kit,’ prescription pad, personal protective equipment, and blood supply

29. June 26 Heavy Equipment

32. June 27 BodyRecovery

33. The headlines you didn’t see: – “No Rescuers Suffered Serious Injury” – “A Textbook Operation” – “Good Decision-Making” Commission of inquiry started hearings in January 2013 Base hospitals should consider how else they can support their paramedics Questions?