Caring for 16 Lives at Once
Just 17 minutes after the STARS Emergency Link Centre® (ELC) began receiving reports from frantic callers about multiple stabbings at James Smith Cree Nation, flight paramedic Brett Cowden and flight nurse Shawn Silver lifted off in a STARS helicopter.
They had packed all the blood available at the Saskatoon base for transfusions, and stuffed their trauma bags with gauze, bandages, pain medication, intravenous tubing and tranexamic acid to help stop the bleeding.
It was 7:11 a.m. on Labour Day Sunday, 2022, when the crew touched down near the First Nation’s band office, unsure of what to expect. There were four patients, two ground ambulance crews and an RCMP officer on site. This would soon become the staging area.
One minute later, RCMP issued a dangerous persons alert, advising people to shelter in place.
“Private vehicles were arriving with patients, one after another, it seemed endless,” said Cowden. “People were still in their pyjamas, distressed, bleeding with multiple, catastrophic injuries. At one point we had more than a dozen patients staring at us, looking for help.”
With the critically injured outnumbering resources, it was apparent to the medical team it would need to pivot from providing immediate critical care to patient triage. Tapping into their collective experience, specifically high-stakes, high-fidelity simulation training in mass-casualty incidents (MCIs), they took a commanding role.
“We had to get eyes on every patient and make quick decisions,” said Cowden.
The team created a triage area, spreading blankets on the ground in a 30-by-30-foot area, where the injured were directed.
Together they assessed patients, assigning each a number and recording demographic information and level of care needed.
“It was challenging because this was penetrating trauma, and so many patients needed an operating room,” said Silver, adding they had to carefully consider what resources were on the way to move patients and avoid overwhelming nearby hospitals.
“People were crying and yelling, upset we weren’t immediately taking their loved one to hospital. I remember making eye contact with a woman who wanted to take a patient in her car. I told her I understand the situation is horrible, but if she did that and her patient became sicker along the way she may not have anyone to help her.”
As they worked, Silver and Cowden were fully aware many people were already dead, and the assailants had yet to be apprehended. Unlike other MCIs that are largely contained, no perimeter was established as no one knew how many more patients were coming. Everything about this mission was different.
“Emotions were running high,” said Silver. “We kept our heads on a swivel and remained composed.”
The two STARS pilots kept watch.
Meanwhile, STARS transport physician Dr. Schaana Van De Kamp had made her way to the rooftop heliport at Jim Pattison Children’s Hospital. While she was collecting extra blood and medical supplies, a second four-person crew from the Saskatoon base was enroute in a STARS helicopter to pick her up and head to the staging area.
Transport physicians are part of every mission; sometimes they assist over the phone and other times in person. In this case, Van De Kamp did both.
From the time she was awakened by the ELC to news of the stabbings, the doctor was on the line with the Saskatchewan Health Authority’s coordination centre to update teams at Prince Albert, Nipawin and Melfort hospitals, as well as the trauma centre at Saskatoon’s Royal University Hospital (RUH).
“I advised them to plan for a worst-case scenario,” she said, noting that within minutes there were two aircraft with Saskatchewan Air Ambulance (SAA) on standby at the airport. Multiple ground units were enroute, staffed with basic and advanced care paramedics.
The entire community mobilized, as did our team in the STARS ELC, a 24-hour communications dispatch hub in Calgary, which coordinated hundreds of incoming and outgoing calls that morning.
“They are an integral piece of this horrific puzzle,” said Van De Kamp. “As soon as I had an inkling this was going to be a massive event, I reached out to the ELC for help coordinating trauma teams, specialists, physicians, emergency rooms. We cannot care for patients the way we do without their ability to link us together.”
As other ground paramedics arrived, they joined Cowden and Silver in assessing patients. Those whose lives were hanging in the balance were triaged as “red,” while the less critical were labelled “yellow”. To avoid naming confusion, all patients were numbered between one and 16. Most, ranging from teenage to elderly, went by ground ambulance to Prince Albert and Melfort hospitals, with some of the units carrying more than one patient. Some of those patients were then flown by airplane to RUH.
By 8:08 a.m., the second STARS helicopter and crew from Saskatoon arrived, including Dr. Van De Kamp, who took over from Cowden and Silver as incident command. Not long after, the three helicopters transported one patient each to RUH. Two patients were flown directly from the staging area, and one was transported by STARS from Melfort Hospital after initially arriving by ground.
By 9:14 a.m., Cowden and Silver arrived at RUH with critically ill patient #14. Because the incident happened at the end of their night shift, the two had been working more than 18 hours.
Over three hours, 14 STARS crew members cared for 16 patients, including administering pre-hospital blood transfusions, pain control for the stab wounds and providing transportation.
Ten innocent people were killed that morning following the attacks in 13 different locations. Another 18 were injured.
All STARS personnel involved in the incident have received thorough support. From taking days off, to counselling services and ongoing conversations and debriefings with their peers, their safety and mental health remains an organizational priority.
“It might be hard for people to understand the gravity of the situation,” said Silver. “Both Brett and I have acknowledged this was very traumatic. At the same time, we are proud to have been able to help the people of this community.”
Dr. Dallas Pearson, STARS medical director for Saskatchewan, notes that several crew members who responded to this incident were part of the response for other MCIs, including the Humboldt Broncos bus crash and the La Loche school shootings.
“Like the other times, we went into this scene feeling that this is our community too, and we weren’t going to let them down.”
IT TAKES A COMMUNITY TO SAVE A LIFE.
AGENCIES RESPONDING TO INCIDENT:
- MELFORT EMS
- MELFORT HOSPITAL
- NIPAWIN EMS
- NIPAWIN HOSPITAL
- PARKLAND AMBULANCE
- PRINCE ALBERT VICTORIA HOSPITAL
- ROYAL UNIVERSITY HOSPITAL
- SASKATCHEWAN AIR AMBULANCE
- SASKATCHEWAN CONSERVATION
- SYSTEM FLOW COORDINATION CENTRE (SFCC)
- TISDALE EMS