Planning for the worst: How hospitals prepared for the Stanley Cup riot in Vancouver

All eyes were on downtown Vancouver on the night of the 2011 Stanley Cup final. It had been 17 years since the Vancouver Canucks had made it to the finals and the city was looking for a victory. While fans gathered at public viewing areas across the downtown core, city officials, police and medical responders waited and watched, hoping the night wouldn’t end up in a repeat of the 1994 series.

Within minutes of the crushing defeat of the Vancouver Canucks by the Boston Bruins, throngs of troublemakers, fuelled by alcohol and disappointment, turned the normally sedate city into a disaster zone. The city skyline was tainted with clouds of billowing black smoke. In the thick of it, agitators who were looking for an excuse to act out began smashing windows, looting downtown shops, burning vehicles and wreaking havoc in an area overrun by crowds.

“I was following the rioting on the radio. As soon as I heard that people had burned and flipped over a car, I knew it was time to head to work,” says David Brown, operations leader, Emergency Department, St. Paul’s Hospital.

David Brown was just one of the many staff members at Providence Health Care’s downtown hospital who were calmly waiting to see how things would unfold on that night. Fuelled by memories of how the 1994 Stanley Cup riot caught the city by surprise, our St. Paul’s Hospital emergency preparedness team had been working on an emergency response plan even before the first hockey puck dropped in game one back in April.

This “worse case scenario” preparation was to ensure that St. Paul’s Hospital would be ready in the event that a Code Orange was called (a Code Orange is a hospital code for mass casualties and involves increasing staffing and preparing a hospital for a possible surge of patients).

Emergency preparedness planning is like the foundation of a house – the rest of your house (an emergency response) relies on this strong base (an emergency preparedness plan). Having a strong plan before disaster strikes ensures that the basic pieces of the emergency response are considered and taken care of, allowing staff and leaders to focus energy on responding to the situation at hand.

Beginning mid-May, 2011, Providence Health Care’s Emergency Preparedness Planning group started connecting with the City of Vancouver and municipal groups, including Vancouver Coastal Health, City of Vancouver, BC Ambulance Service and Vancouver Police Department, via conference calls to discuss the potential need for emergency response during the hockey playoffs.

In the beginning of June, our emergency planning team began to focus specifically on St. Paul’s Hospital – discussing issues such as: the development of a rapid response team, who would staff the Emergency Operations Centre (EOC), the usage of personal protection gear, security, and extra staffing levels – and from there, a detailed hospital contingency plan (five versions by the seventh game) was developed.

In case of emergency

Throughout each round of the hockey playoffs, the Emergency Operations Centre (EOC) at St. Paul’s Hospital was opened the day prior to a home game. Each time, the potential central command office was set up and phone lines and communication tools were tested, unit supplies were topped up, and available emergency decontamination supplies were confirmed.

Due to St. Paul’s Hospital’s proximity in the heart of downtown Vancouver, the possibility of an emergency incident with the potential for mass casualties was nothing new – the hospital had been well versed in emergency preparation as the official visitor’s hospital during the 2010 Winter Olympic Games, not to mention the annual Celebration of Lights spectacle that draws 400,000 people to the downtown core each night, and many other large spectator events.

A critical opportunity to have hands-on emergency response practice was during the Olympic Games. Providence has had extensive training, tabletop exercises and real simulated disasters as part of the Olympics emergency preparedness training – it would prove to serve us well.

Code Orange

By the time the final game seven rolled around, hospital staff and physicians were prepared. Previous games had drawn upwards of 75,000 people to the area, and with hot weather and alcohol consumption adding to the situation, they knew that the evening could go either way

“Even before the game began, we already knew it would be a busy night,” says Dr. Sunil Mangal, an emergency physician at St. Paul’s Hospital for over 10 years, who worked the night of the riot. “We were getting people coming in with alcohol intoxication issues even before the puck had dropped.”

By 10 pm, St. Paul’s Hospital, along with Vancouver General Hospital, had called a Code Orange, activating their Emergency Operations Centres in preparation for a mass influx of casualties. Approximately 60 patients were treated in the first two hours of the incident (between 10:00pm – 12:00am), for a total of 147 casualties at St. Paul’s Hospital resulting from the riot throughout the night. Only four patients were required to be admitted. Injuries included stabbings, minor head injuries, abrasions/lacerations, fractured jaws, sprained ankles, and of course, tear gas and pepper spray exposure.

“To help ensure that the emergency department didn’t get congested with minor injuries that could be treated on the spot (minor scrapes and scratches, tear gas exposure), we set up a triage system in a courtyard just outside of the emergency department,” said Dr. Mangal. “Those needing bandages or some water to flush their eyes out were able to do so outside, which enabled those with more serious injuries to receive care quicker in the emergency department.”

The triage system in the outside courtyard was also useful for keeping tear gas remnants from entering into the hospital where it could spread inside the emergency department and affect other patients and staff.

Call to Action

Hospitals are a 24-hour-a-day, seven-day-a-week operation. It is very satisfying to see emergency preparedness planning put into practice to help mitigate the impacts of a disaster, so we can continue providing care to our communities.

In addition to the coordinated efforts of the St. Paul’s Hospital emergency department staff and physicians, and members of the Providence Health Care emergency preparedness team, there were many key players who helped make the night a success. Hospital security ensured that everyone felt safe and able to do their jobs, a psychosocial support team provided support to friends and loved ones of those injured, and communications and public affairs staff fielded media calls and ensured that the correct information about the situation was available to the public – including one important fact – that the hospital continued to be open to the public throughout the incident.

“I’m so proud of how everyone really banded together and went above and beyond the call of duty that night,” says Brown. “It’s really a testament to the amazing staff here at Providence and everyone’s willingness to pitch in and help in a time of need.”

Teamwork, camaraderie and preparation helped St. Paul’s Hospital provide care to those injured during the riot and shine through as a bright spot during a dark night in Vancouver.