Code orange: 'Human tragedy' of fatal bus crash tests staff at Ottawa Hospital

It didn't take long for staff at the Ottawa Hospital to learn something terrible had happened at Westboro station late Friday afternoon.

After initial reports started trickling in through social media about a double-decker OC Transpo bus crashing into a bus shelter, officials called paramedics to find out what, exactly, was going on.

Emergency responders confirmed there had already been fatalities and asked hospital staff to prepare for the incoming wounded.

"When they were able to confirm that we had at least five critical patients that would be coming, and possibly over 12, that's when we made the decision to call the code orange," said Dr. Guy Hébert, the head of the Ottawa Hospital's emergency medicine department, who was on duty that day.

In the end, the hospital treated 18 patients — 12 at the Civic campus and six at the General campus.

"We were indeed able to confirm that that was the largest number that we had ever received," Hébert said.

At the moment the code orange was declared, the Civic campus was already treating 100 patients, 24 others had been admitted and were waiting for beds, and the waiting room was busy.

A typical trauma centre can handle about three to four seriously injured patients at any given moment, but doctors knew that this time, there would be more.

"We knew bad things were coming in, and we were getting ready to work together to save lives," said Dr. Andrew Willmore, the Ottawa Hospital's medical director of emergency management, who was in Texas for a conference when the crash happened.

Accommodations had to be made, and fast.

Resuscitation bays cleared

"What a code orange does is it allows us to create the space in which we can actually treat patients. We move patients and clear our resuscitation bays," Willmore told CBC Radio's Ottawa Morning on Monday.

"It realigns the way the hospital functions to really support the emergency department, and rapidly increases the number of staff available to look after patients."

By about 4:20 p.m., the Ottawa Hospital had eight resuscitation bays fully staffed and ready for treatment, with as many as 150 medical staff standing by, waiting to snap into action.

Paramedics called the hospitals in advance, letting them know the age of each patient, their injuries, vital signs and estimated arrival time.

"As they rolled through the door, we were able to immediately assign them to a trauma team. Every single patient that came through our doors were immediately, within the first 15 seconds, at the bedside, surrounded by a dozen people to begin the assessment and treatments," Hébert said.

Cases involved 'every organ system' 

Every patient was dealing with blunt-force trauma, Willmore said.

"With the speed at which the bus collided, it affected pretty much every organ system in these patients. From head to toe, there were multiple injuries and multiple different organ systems affected in each one of those patients," he said.

There were head injuries, chest injuries, pelvic injuries, abdominal injuries, spinal injuries and "a whole slew of different kinds of ... injuries to the arms and legs," Hébert added.

Some amputations had to be performed, he confirmed, and the hospital quickly exceeded its supply of special equipment to treat limbs. Other hospitals stepped in to lend what was needed.

"This is something that we've rehearsed before. We have regular training to prepare for these kinds of events. We're no strangers to difficult situations ... but this is something that we don't deal with on a regular day-to-day basis, so there was definitely a level of intensity to the initial preparation of this," Willmore said.

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As of Monday morning, every patient in critical condition had been upgraded to serious or stable condition, but the work isn't over yet.

Many patients have required additional surgeries, Willmore said.

As the dust settles at the hospital, those involved in Friday's response have time to reflect.

"It's afterwards, when it all sort of sinks in, when the human side of things start to hit us, start to hit home, there's no question that what we saw was quite graphic and quite heartwrenching. It can't help but affect us in a significant way," Hébert said.

"It makes us think about how fragile is life, and how an event like this can happen all of a sudden and be so life-changing. We as caregivers are naturally empathetic to that, and naturally we see this kind of human tragedy so often in our day-to-day, and it can't help but impact us."