"It was one the hardest shifts ever for many of our staff"

DEBRIEF: HOW UNITY HEALTH TORONTO's ST. MICHAEL'S HOSPITAL HELPED SCORES OF PATIENTS NEEDING TREATMENT ON THE DAY OF THE TORONTO RAPTORS’ VICTORY PARADE

 Toronto’s first major sports championship in 26 years. A joyous parade to celebrate the Raptors’ first-ever title win. As many Raptors fans at the time suspected, a last chance to salute superstar Kawhi Leonard before he would leave the team as a free agent. 

June 17, 2019, was supposed to be a beautiful day for Toronto’s sports fans to savour — and for many it still was, despite the chaos that broke out in part of Nathan Phillips Square when gunfire erupted in the packed crowd. As Toronto’s downtown trauma centre, St. Michael’s was tasked with treating those who were shot, stabbed and trampled. A Code Orange was ultimately called — alerting staff that an external emergency had occurred that would result in an influx of patients. Overall, including people presenting with more minor injuries and others who needed treatment unrelated to the parade, nearly 270 patients were seen in St. Michael’s Emergency Department (ED) on the 17th. 

This is the story of that day.

As told by

DR. NAJMA AHMED, INTERIM SURGEON-IN-CHIEF

Dr. najma ahmed

INTERIM surgeon-in-chief

JASMINE ERRETT, EMERGENCY TRIAGE NURSE

JASMINE ERRETT

Emergency TRIAGE NURSE

KRYSTAL FOX, REGISTERED NURSE, EMERGENCY TRIAGE

KRYSTAL fox

registered nurse, emergency TRIAGE

DR. SARA GRAY, EMERGENCY MEDICINE AND INTENSIVE CARE UNIT PHYSICIAN

dr. sara gray

Emergency Medicine and Intensive Care Unit Physician

DR. DAVID MACKINNON,​ EMERGENCY PHYSICIAN AND TRAUMA TEAM LEADER

DR. DAVID MACKINNON​

Emergency Physician and Trauma Team Leader

SARAH MARSHALL, NURSE PRACTITIONER, TRAUMA AND ACUTE CARE SURGERY

Sarah Marshall

Nurse Practitioner, Trauma and Acute Care Surgery

mcclung

spencer mcclung

Registered Nurse, Neurosurgery and Trauma

DR. DAVE PASKAR, GENERAL SURGEON AND TRAUMA SURGEON

dr. Dave Paskar

General Surgeon and TRAUMA SURGEON

AMELIA PENDLETON, SOCIAL WORKER

Amelia Pendleton

Social Worker

DR. ANDREW PETROSONIAK, EMERGENCY PHYSICIAN AND TRAUMA TEAM LEADER

Dr. Andrew Petrosoniak

Emergency Physician and Trauma Team Leader

snider

dr. carolyn snider

Emergency Department Chief

DR. SAMUEL VAILLANCOURT, EMERGENCY PHYSICIAN AND TRAUMA TEAM LEADER

dr. Samuel Vaillancourt

Emergency Physician and Trauma Team Leader

FARAH WARSI, EMERGENCY TRIAGE NURSE

Farah Warsi

EMERGENCY TRIAGE NURSE

PART I

The whole city was ecstatic — including staff

“We felt jealous of those who had the day off and could enjoy the celebrations … but (we were) a little nervous”

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

I was so excited! I had been a hardcore fan of the Raptors since Day 1. As a long-suffering Toronto sports fan, I was so pumped to actually attend a championship parade. I was planning on taking my daughter because she had become a fan of the Raptors – mostly for the mascot – and she likes parades. I thought it would be one of those cool things where we could say, ‘We were there’ when she was older.

Spencer McClung

Registered Nurse, Neurosurgery and Trauma

I had been downtown celebrating on the night the Raptors won the championship. It was so much fun being around such a large number of people united by the celebration. I was therefore quite excited for the parade and was anticipating a similar atmosphere, but with 10 times as many people. If a big group of excited people is an absurd amount of fun, a bigger group should be even better, right?

Krystal Fox

Registered Nurse, Emergency Triage

We talked a little about how we felt jealous of those who had the day off and could enjoy the celebrations. We were excited that the Raptors won but a little nervous at the number of people that were expected to show up downtown. 

Amelia Pendleton

Social Worker

I was certainly expecting a busy night. Every time the Raptors got closer to winning the championship, it would be a busy time. I was expecting more patients than usual for a Monday night, likely all decked out in their Raptors gear.​

Dr. Samuel Vaillancourt

Emergency Physician
and Trauma Team Leader

I couldn’t help but think about the Boston Marathon – I did my master’s of public health there a year before the marathon tragedy, and with such a high concentration of people here in Toronto I was worried about the risk. I knew the downtown core would be busy and dense – which always brings a risk of us being activated and a heightened need for trauma services.

Sarah Marshall

Nurse Practitioner,
Trauma and Acute Care Surgery

I attended a conference the Friday before the Raptors parade and the theme was Code Orange and mass casualty. I immediately began to reflect on our practices at St. Michael’s and how we measure-up to other hospitals’ practices. I thought to myself, “I am going to find that Code Orange book on Monday and really familiarize myself with the protocol.”

PART II

Calm before the storm

Everyone knew it would be busy. Extra staff were called in and others volunteered to be available just in case. There was a palpable buzz inside the hospital and it turned out St. Michael’s was well-represented at the parade, with off-duty staff joining the celebrations and providing intel from the scene about possible impacts on the ED.​

Spencer McClung

Registered Nurse, Neurosurgery and Trauma

I biked into work on the morning of the parade and passed by Nathan Phillips Square at about 7 a.m. — the streets were already buzzing with excitement. For me what really stood out was the incredible diversity of people. It was truly heart-warming — and goosebump producing — to see people of all ages and ethnicities uniting under one banner. It was going to be an amazing day.​

Dr. Samuel Vaillancourt

Emergency Physician
and Trauma Team Leader

That morning I was actually in my research office on Yonge Street, I wasn’t scheduled to work in the hospital. The office, unsurprisingly, was pretty empty, and you could just hear the crowd outside cheering. It was so joyful! 

farah warsi

EMERGENCY TRIAGE NURSE

As I was heading into work in the early hours of the morning, the crowds and celebrations seemed well underway!

dr. najma ahmed

INTERIM SURGEON-IN-CHIEF

The mood was celebratory, happy and light-hearted. As a trauma surgeon, knowing that there were estimates of as many as two million people participating, I was also nervous about a mass casualty event, about the crowds and hoping that all the fans were going to be safe and secure. I was worried also about less dramatic things like heat stroke, heart attacks, trips and falls, drunkenness — things that can happen when any large crowd assembles. 

Dr. David MacKinnon

Emergency Physician
and Trauma Team Leader

I was off-duty and my wife and I planned to watch the parade at Queens Quay and York near our old condo. We thought it would be wise to be away from the large crowd that would be at Nathan Phillips Square. Afterwards, my friend invited us to his uncle’s hotel room in the Sheraton overlooking Nathan Phillips Square from the 27th floor.

PART III

“I HOPE YOU’RE READY… SOMETHING’S HAPPENING”

As the massive crowd gets increasingly restless and exhausted under the hot sun, a doctor’s text message alerts the Emergency Department to possible trouble.

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

The parade experience was super frustrating. They were three hours late and it was so hot out and we were close to leaving as my daughter’s nap time had come and gone. 

Krystal Fox

Registered Nurse, Emergency Triage

There was a point in the day when we felt the mood in the air change. For me, it was when I walked over to Nathan Phillips Square on my lunch break and realized you couldn’t get past the Eaton Centre. I had an overwhelming feeling that the crowd was getting anxious, after having waited hours now for the players to arrive. It felt like a pot just about to boil over.

Spencer McClung

Registered Nurse, Neurosurgery and Trauma

I was keeping a close eye on the progression of the parade, also trying to time my lunch break with the team’s arrival at Nathan Phillips Square. With all the delays along the parade route I finally scooted outside to see how close I could get to the action. I didn’t get very far. The streets were bursting with people. 

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

The players finally passed us and it was amazing to be there. My daughter was so excited to see “the Raptor” in real life. As soon as the team came and went, we scurried back to daycare for a quick lunch and nap and I headed into St. Mike’s to do some paperwork before rounds and call that evening.

Amelia Pendleton

Social Worker

I arrived at the hospital at 2 p.m. for my shift and was so blissfully unaware of how hectic the night would turn out. But we heard about the unbelievable number of people who were at the parade and began hearing about potential issues that were causing injuries. 

Dr. Carolyn Snider

Emergency Department Chief

Our absolute first inkling that things were going to get bad quickly was via texts sent by Dave MacKinnon at the hotel.

Dr. David MacKinnon

Emergency Physician
and Trauma Team Leader

A short while into the ceremony, we could see a large area in the back right of the crowd clearing out quickly with people running. We talked about what could be happening — was it actually a serious incident, or false alarm and panic? Simple fireworks set off or something else? The North York van incident brought other possibilities to mind. My next thought was to give a heads-up to the team at work. In large-scale incidents preparation is critical, so I texted photos of what was happening in the crowd to our chief and deputy chief so they could react quickly if needed.

Dr. Carolyn Snider

Emergency Department Chief

David first sent me pictures of the crowd and said, “I hope you’re ready,” and I said, “We are.” 

Dr. Sara Gray

Emergency Medicine and Intensive Care Unit Physician

I was supposed to work until 4 p.m. and the parade was supposed to finish by early afternoon. But we could see how late it was running and the crowd was getting restless. Near the end of my shift, my chief dropped by and asked me to stay late in case we needed extra help. 

Dr. Carolyn Snider

Emergency Department Chief

Just a few minutes later, Dave texted again with pictures of the crowd dispersing and said, “Something’s happening.” And that’s how we knew. 

Dr. Samuel Vaillancourt

Emergency Physician
and Trauma Team Leader

I was walking out of my office and I heard two loud sounds. I thought it sounded like gunfire, but I wasn’t sure. Then as I was moving up the street on Yonge towards Dundas Square I could see a whole lot of panicked people moving around and making their way north. I could get a sense that it was dense enough for someone to get trampled. I thought that it could be really bad so I made my way towards the hospital.

Spencer McClung

Registered Nurse, Neurosurgery and Trauma

I managed to thread my way through to a viewing screen near Queen and Bay Streets. It was midway through the fourth speech when I heard a few screams in front of me and the entire crowd seemed to simultaneously turn away and start running.  As I rode the wave of people fleeing some unknown danger, I distinctly remember thinking that no matter what the cause of this panic was, we were going to have a busy afternoon at work. 

JASMINE ERRETT

Emergency TRIAGE NURSE

The EMS hotline rang and the first thing I heard was, “Hey St. Mike’s, how many traumas can you take?” The trauma team was called and we all jumped into action. My adrenaline started pumping and everything began to move at double time. I remember Dr. Snider coming to triage and saying, “We got this.”

Dr. Sara Gray

Emergency Medicine and Intensive Care Unit Physician

Trauma patients started arriving from the parade and I started organizing the emergency department response.

Dr. Carolyn Snider

Emergency Department Chief

I joke that Sara Gray has a black cloud over her because it never fails, things happen when she’s on. But it’s a good thing because she has a master’s degree in emergency planning and has been instrumental in helping us plan.

PART IV

“It was supposed to be such a happy day”

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

I was working in the ICU office and was catching wind of some of the trauma activity through various avenues: Twitter, text messages, etc. First were the multiple stabbings at the Eaton Centre. I checked in with my colleagues and they said everything was under control. 

Krystal Fox

Registered Nurse, Emergency Triage

These patients were managed in our usual fashion. Shortly after though, every police officer in sight started running out of the department at once. I yelled out to them and asked where they were going and one officer yelled back, “active shooter.” The entire staff started mobilizing, preparing for the worst.

Dr. Carolyn Snider

Emergency Department Chief

The hardest part of that day was the lack of knowledge about what was coming, the anticipation of more coming through. You get communication from so many different channels — social media, colleagues, paramedics and cops, through texting — you hear rumours like a stage collapsing and have to get ready for that. You prepare not knowing what’s coming.

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

Then we confirmed the shootings happened.

Dr. Carolyn Snider

Emergency Department Chief

We had four traumas within approximately five minutes come through.

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

At first, with just the shooting victims having arrived, again things seemed under control. But there was soon a second wave: people who were trampled as part of the crowd response to the gunshots. We were expecting a lot more patients, and there were rumours flying around — mostly false — of more injured to come. A Code Orange was called overhead and I changed out of the Raptors gear that I was still wearing from the parade and headed down to the ED. 

Dr. Carolyn Snider

Emergency Department Chief

I remember looking a person in the eyes, it was one of our first traumas, an innocent bystander, and seeing how scared they were and thinking, ‘God, this could be bad.’ That was the moment. It was supposed to be such a happy day. That was the moment I thought this could get really, really bad.

farah warsi

EMERGENCY TRIAGE NURSE

As the traumas began flashing and calls started coming in from dispatch, all hands were on deck. The trauma bays were organized and assembled with teams ready to treat, stabilize and move patients to the appropriate areas. There always remained a sense of calmness throughout the entire shift.

Sarah Marshall

Nurse Practitioner,
Trauma and Acute Care Surgery

In emerg there was a ton of extra bodies to help in what must’ve seemed like organized ​chaos. Each extra body was immediately assigned to a team and put to task in a very efficient manner to await the next patient to arrive. The anticipation of what would come in was extremely high.​

Dr. Sara Gray

Emergency Medicine and Intensive Care Unit Physician

We were lucky to have so many people around who could work, doctors and nurses came from other floors to help out, and other emerg docs came in from home to assist. We divided into teams and cleared a zone of beds so we could rapidly accommodate the extra patients.

Spencer McClung

Registered Nurse, Neurosurgery and Trauma

As charge nurse on the inpatient trauma unit, my main role would be to make space for newly admitted patients, and to make it quickly to avoid as much backlog as possible in the ED.

Amelia Pendleton

Social Worker

Initially, I didn’t know the best place to be with so many patients arriving at once — I wanted to make clones of myself so I could be everywhere. When I was joined by two other social workers as the trauma patients kept rolling in, the situation felt more manageable and we were able to cover more ground to support patients and families. 

dr. najma ahmed

INTERIM SURGEON-IN-CHIEF

Yes, it was a frenzy, but watching over this with experienced eyes, I knew that this was controlled chaos, that every person had a job to do and that every one of them was answering their responsibilities with unwavering dedication and mastery. Everyone from the locating operators to the chiefs of department. Each minute and each detail was accounted for with precision and compassion.

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

Basically we started doing what we always do: get down to work and just take really good care of people at their times of most need. I buzzed around to the people already in the department to see if anyone needed another set of hands or a surgical opinion. Next, I went to the triage area with Dr. Carolyn Snider and we started to sort out the second wave of the trampled, some having limped and been carried from Nathan Phillips Square.

Amelia Pendleton

Social Worker

There was one distraught family member that particularly stuck with me. His distress was a reminder that while the volume of trauma patients arriving and their medical needs was a priority, the family members were also experiencing life-changing events and were in emotional crises. It was a rush not only of patients, but of families, friends and other parade-goers that were frightened enough to seek shelter in the hospital.

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

It was busy and a little chaotic but I clearly remember the feeling that I had: “We got this.” We often have busy trauma nights, with patients coming from multiple events, so them coming from one place really did not make it that much tougher. We had this.

Dr. Sara Gray

Emergency Medicine and Intensive Care Unit Physician

We’ve had many Code Orange situations at St Mike’s, and I’ve worked several of them, and I always walk away grateful. I work with such an amazing team of people. Not everyone can make a disaster run so seamlessly. Not everyone can provide that level of care and compassion and expertise. I feel privileged to work with them.

Krystal Fox

Registered Nurse, Emergency Triage

The end of the night still felt unsettled. I had worked 15 hours at this point, as did many of my fellow nurses, and there was this lingering feeling that it wasn’t over. There were so many people still downtown and rumours flying around about after-parties. The night staff had come in and there were fresh faces but the evening staff who were working until 11 p.m., and those of us who stayed late, were exhausted. Everyone was on edge still and wondering if we had seen the worst of it.

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

Things eventually settled down nicely after a couple hours and I was carrying around a list of all the patients. We had met as a team a few times to “run the list” and make sure that each patient had their results and plan. Our goal was to ensure each patient got the same care that they would have received had they been the only trauma patient that night — and I can say that we achieved that goal. The rest of the overnight was actually really quiet and I actually got some sleep for a change! 

PART V

THE DEBRIEF

“That’s what good teams do — they never rest on their past wins and they work towards getting better and being ready for the next test.”

Dr. Carolyn Snider

Emergency Department Chief

It was one the hardest shifts ever for many of our staff. As emergency physicians, nurses and staff, we’re prepared for anything that can happen and when those things happen you just hope things go as planned. In this case, it did – on reflection I’m not at all surprised. I’m so proud to work with such an amazing team.

Amelia Pendleton

Social Worker

I think it was hard to initially process the magnitude of what had happened that night. On one hand it felt like another day at work in an extremely busy Emergency Department. But on the other, and after discussing with staff, it was clear this was an extraordinary night for everyone. It was hard to wind down after going home. I couldn’t stop thinking about the number of patients and what their medical outcomes would be.

dr. najma ahmed

INTERIM SURGEON-IN-CHIEF

I felt sorrow for the victims and sadness for the families. This is preventable harm. We must do better. We have to ask ourselves, do we really want to live in a city where parents have to think twice about allowing their children to attend a celebration in the heart of the city in the middle of the day?

Dr. Samuel Vaillancourt

Emergency Physician
and Trauma Team Leader

I really feel that this event made every emergency service stronger. It forced us to examine the systems we had in place and our response to the events. Of course, we always wish these events wouldn’t happen – much like the Danforth shootings or the van attack – but it forces us to be better. I walked away with a sinking feeling, the day stuck with me. But although it was bad, it could have been worse. 

JASMINE ERRETT

Emergency TRIAGE NURSE

After the parade finished, there was still excitement but I remember saying to my colleague how tired I was. I was emotionally and physically spent. I went home, fell into bed and then got up in the morning to do it all over again. There are parts of that day I can’t remember. I feel like I blacked out. Medically, our team took care of business like a perfectly efficient machine. The teamwork that day was unmatched. Patients got the care they needed and we kept the ED moving. I’d never been so proud to be a part of the team.  

Amelia Pendleton

Social Worker

Debriefing was so important for us to discuss as a team what worked, what didn’t and what we could do differently in the future. It’s easy to get caught up in the work we do and we forget to take time to reflect on the experience of going through something at work that most people never have to. The ED team has been great at setting aside time to debrief both emotionally and clinically from huge events like the Raptors parade, but also the daily tragedies — and wins! — that can occur while working in an ED. 

Krystal Fox

Registered Nurse, Emergency Triage

One of my favourite parts of the night was when a police officer asked if we needed anything. He offered to get me a coffee or a snack. It was a kind acknowledgement that we were all in it together. I felt overwhelmed with gratitude to the Toronto Police for working far past their shifts’ end to keep us and the public safe. I wanted to hug every paramedic who had to push through crowds to get to patients in order to bring them to us. Lastly, I felt immensely proud to work with such an incredible group of people. 

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

I was very proud about what we had accomplished as a team at St. Mike’s and tempering the damage of the violence. Many things had worked well as part of our mass casualty response, some others less well and there were lessons learned and things to fix. But that’s what good teams do — they never rest on their past wins and they work towards getting better and being ready for the next test.

 

PART VI

The Raptors’ championship trophy makes a surprise visit to the ED

Dr. Andrew Petrosoniak

Emergency Physician and Trauma Team Leader

When I heard the trophy was coming to the ED, I think I probably had a smile on my face the rest of the day. It was such a great gesture and people were so grateful.

Sarah Marshall

Nurse Practitioner,
Trauma and Acute Care Surgery

Having the trophy come to St. Mike’s and seeing the patients’ excitement was very satisfying. 

Krystal Fox

Registered Nurse, Emergency Triage

The trophy was a sweet treat. It was nice to have our own little moment of celebration even if it was only for a few minutes.

Dr. Andrew Petrosoniak

Emergency Physician and Trauma Team Leader

All of us who were there got a picture with the trophy. It was definitely a highlight for me as I’ve been a Raptors fan since Day 1! I sent the picture to my wife who replied that she didn’t think I even smiled that much on our wedding day. I reassured her, this was a distant second in terms of excitement compared to our wedding day! 

Dr. Dave Paskar

GENERAL AND TRAUMA SURGEON

I actually missed this, however it was great to see all my friends with the trophy. A loot bag with a Raptors championship T-shirt was put aside for me as the missing super fan. I had a patient who had been wearing that same shirt the day of the parade and we had to cut it off of him to treat his injuries. I am planning on giving him my shirt soon.

THANK YOU

To all our staff and members of the emergency services community 
for helping our patients in their greatest moments of need.

REPORTING AND TEAM PHOTOS BY JENNIFER STRANGES.
OTHER PHOTOS CONTRIBUTED BY DR. DAVID MACKINNON, DR. ANDREW PETROSONIAK, AND YURI MARKAROV.
PRODUCED BY MICHAEL OLIVEIRA.

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