A story of fire and ice

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A group of northern nurses had to ‘hurry hard’ to transform a curling rink into a health centre following a devastating fire.

A large section of the Moosonee Health Centre was smouldering. The charts of nearly 9,000 patients were covered in soot. It was December 2012, and the Weeneebayko Area Health Authority (WAHA) had no choice but to send out an alert that read: “To all residents of Moosonee: Please be advised that due to fire and smoke damage…Moosonee Health Centre is closed for all medical treatment effective immediately.”

The small town near the southern tip of James Bay, inaccessible by road, was without a health-care facility. The nearest hospital is a 10-minute helicopter flight away on Moose Factory Island. No one was injured in the blaze, caused by an electrical fire that ignited in a storage room, but 70 per cent of the centre’s supplies and equipment was lost.

The nurse-led Moosonee Health Centre employed 12 RNs and an NP working on rotation. They provided primary care, emergency services and dispensed medication, but were now without a roof over their heads. “We’re thinking ‘what happens next? What if we have an emergency, what are we going to do?’” says RN Weena Saunders, director of patient care. “We wanted to get (re)established quickly, so people would feel safe and have a place to go.”

Fire may have destroyed the centre, but the solution would soon come on ice.

With the help of the close-knit Moosonee community and Ontario’s Emergency Medical Assistance Team (EMAT), Saunders and her colleagues now provide care in the unlikeliest of venues – the town’s curling rink.

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Mike Merko and his eight-member EMAT deployment team, specially trained in disaster management for all kinds of medical emergencies, put boots on the ground in Moosonee roughly 24-hours after the fire. They boarded a plane in Toronto on a mild, late-autumn day, and stepped off into a bone-chilling minus 32 degrees in Moosonee, proclaimed The Gateway to the Arctic by its railway station sign. “The cold was the first shock,” recalls Merko, EMAT incident commander. He would soon discover that cold would be a constant challenge throughout this deployment.

The team found patients temporarily diverted to the ORNGE helicopter hangar 10 minutes outside of town, where nurses performed triage, and some patients were airlifted to Moose Factory Island. Other local nurses had started the process of setting up shop in Moosonee’s curling rink, part of a larger facility which includes a skating rink and community hall. It was chosen because it already served as the town’s emergency meeting point.

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Though it hadn’t been used for years and the ice was gone, the rink was designed for temperatures barely above the freezing mark. “Our biggest challenge was to take something that was designed to be cold and make it hot,” Merko says. EMAT is trained in everything from fighting outbreaks to resuscitating critically injured patients, but heating and cooling was outside of its expertise.

At first, they could only raise the temperature to 14 degrees despite an arsenal of heaters. “You can’t expose and assess a patient in that environment,” Merko says. When the team realized the heat was rising to the top of the rink’s seven-metre-high ceilings, they strategically placed six rotating fans to push the warm air down, and the temperature climbed to 24 degrees.

Merko says he admires the Moosonee nurses for their tenacity despite many constraints, including the town’s isolation. When the team needed an electrical breaker, they couldn’t just pop in to the local big-box hardware store. Everything had to be sourced and brought in by air or train. “They’re an amazing group of people,” he says. “We probably learned more from them and how they deal with logistical issues.” The nurses, with help from community members, wired the rink for electricity, built accessibility ramps, and addressed plumbing challenges.

The next major issues were infection control and privacy. EMAT came equipped with seven large positive/negative pressure tents, capable of refreshing a room’s air supply 15 times per minute. The light, plastic tents can be set up in less than 30 seconds, and served as the centre’s makeshift ER and examination rooms, providing much-needed visual barriers.

“It was like rebuilding a clinic from the ground up,” Saunders says. “You improvise and compromise; you try to make things happen.”

More than a year after the fire, nurses are still providing care in Moosonee’s old curling rink. Work to rebuild the old location has stalled, and it won’t be ready for months. Inside the arena, the huge blue and white EMAT tents are still dwarfed by the massive room. Medical supplies and equipment line all four walls. A makeshift staff lounge is cordoned off in a corner with drapes held up by PVC pipes and buckets. During the day, the crash of hockey pucks and slash of skates can be heard beyond one wall. Some evenings, music blares in from community dances held beyond another.

“You feel like you’re in a different world,” Saunders says. “(But) it’s business as usual.”

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Saunders says nurses and patients are getting used to their unusual surroundings. The number of patient visits, which dipped following the fire, is back to normal. The temporary centre is now equipped for nearly every procedure available at the old centre. Nurses are forever thankful for EMAT, who Saunders calls their guardian angels.

“They were like our drill sergeants, but in a good way,” Saunders says of EMAT. “They pumped (us) up and gave (us) something to look forward to.”

Sadly, the fire wasn’t the only tragedy to strike Moosonee that year. The attention of the country turned on the small town after the May 31, 2012 ORNGE air ambulance crash that killed four people. The helicopter took off from the Moosonee airport carrying two pilots and two paramedics and went down just 850 metres away.

“It really hit hard because we work closely with the paramedics,” says Saunders. “But the community came together. We put an orange ribbon on the door (of the health centre) so when everybody walks in the clinic, they think about ORNGE.”

Through it all, the Moosonee Health Centre hasn’t lost a single staff member. In a region where the average turnover rate is about a year, this is impressive. “It shows the staff is dedicated to the patients and the people of the region,” says Nicole Blackman, an RN and director of professional practice for WAHA. “To not give up and keep persevering and finding new options and working well with the options they were given, this staff is resilient.”