Important lessons learned: One doctor, two Canadian mass tragedies

Two of the deadliest mass tragedies in Canada over the last decade took place within about 140 kms of the Melfort, Sask., community where Dr. Michael Stoll has lived and practised clinical and emergency medicine since 2009. When these catastrophic events happened—the 2018 Humboldt bus crash that killed 16 people and injured 13, and the James Smith Cree Nation stabbings in 2022 in which 12 people died and 18 were wounded—Dr. Stoll was among the physicians who triaged and treated the injured and guided the handling of the dead. “I had the unfortunate luck of being involved in both mass tragedies,” he recounted during a session at the annual conference for the Society of Rural Physicians of Canada, which took place in Niagara Falls from April 20 to 22. “They were both very difficult times, but a number of important lessons came out of these events. The medical response to the Humboldt bus crash—where casualties were mostly members of a junior hockey team—was “more haphazard,” with poor communication between the health teams in three locations. Read: Beyond 'bikini medicine': Women's heart health conference aims to raise awareness By comparison, the medical response to the James Smith Cree Nation stabbings was better coordinated, with a STARS physician named Dr. Schaana Van De Kamp on the scene working with a local doctor—Dr. Stoll—to triage and decide where patients should be sent. Dr. Stoll shares some of the lessons he learned from both events. Sometimes ground is faster than air Yes, travel by air is faster than ground transportation. But when there’s a long wait time for an air ambulance, it may be better to transport patients by ground ambulance, said Dr. Stoll. This was one of the challenging situations faced by some of the boys who got hurt from the Humboldt bus crash. Code Orange? Consider calling it sooner Dr. Stoll took on the coordinator role in Melfort after the first two patients arrived. The assaults happened on a long weekend, but Dr. Stoll managed to round up about half a dozen physicians and asked the night nurses to stay so that the hospital had two groups of nurses on site. Nonetheless in subsequent debriefs, the conclusion was that the Code Orange should have been called earlier. Read: Is there a doctor in the forest? Doc performs his first cricothyrotomy after bike accident Effective onsite triaging can lives While the Melfort hospital started to prepare its rooms with trauma equipment as soon as it was alerted to the James Smith Cree Nation stabbings, staff didn’t quite know what to expect. Having a physician on the ground with strong triaging and decision-making skills made all the difference, said Dr. Stoll. In addition to assessing the condition of the stabbing victims, the STARS doctor on site for this mass tragedy also took stock of what resources were available in nearby hospitals. She found out from Dr. Stoll, for example, that the Melfort hospital’s CT scanner was available only on weekdays—an exception was subsequently made for this critical situation—and that there was no operating room team available. In the end, the STARS physician made the call to fly three patients to Saskatoon, send seven to Prince Albert—where three were intubated in the emergency department and sent directly to OR—three to Nipawin and three to Melfort. Two more patients, who had a male family member fatally stabbed in the incident, came to the Melfort hospital in their own car. Local docs are there to help—so use them In the Humboldt bus tragedy, physicians in the communities near the crash site were not involved directly in triaging patients. With the James Smith Cree Nation stabbings, the local teams were in constant communication on the needs and status of each patient and this information was shared with the team in Saskatoon to decide which patients needed to go where. Having local physicians and health teams involved is “paramount,” said Dr. Stoll. “We have the advantage of proximity, we know the community and many of us are trained across a number of areas, so why not utilize us?” Read: What do sole overnight ER docs do all night? R-E-S-P-E-C-T for everyone please In crisis situations where different teams pitch in, it’s important to recognize everyone’s contributions and avoid diminishing certain groups’ efforts, said Dr. Stoll. He recounted the week after the James Smith Cree Nation stabbings, when he learned that someone in Saskatoon who had discussed the tragedy with media had made some backhanded comments—”the typical thing about rural medicine”—about how doctors in Prince Albert had handled the tragedy. “The narrative was that Saskatoon was the knight in shining armour and all the talk was about how STARS had saved the day,” recalled Dr. Stoll. “I remember feeling defeated. In rural medicine, we do what we can do with limited resources, and we do a good job of it.” Read: 'Can't even get a tetanus shot:' Saskatchewan's rural towns lack healthcare workers

Important lessons learned: One doctor, two Canadian mass tragedies

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