IceStorm 98 Study

The Health Unit realized on Thursday morning that they needed to take measures about their own staff and looking after vaccines that were there. The Health Unit had no power. Dr. Ian Gemmill describes the storm as an "evolving power emergency" that varied from hour to hour. Over Thursday and Friday, "it was one step forward and three steps back as the trees fell down." The extent of the emergency only became clear as people observed what was happening.

The Health Unit did not want their staff on the roads with downed lines, with ice that could cause accidents and with trees blocking the way. They did, however, have to get their vaccines to a secure place because there were tens of thousands of dollars worth of materials that could have spoiled. They first took the vaccines to Dr. Gemmill's garage which was at 3 degrees Celsius on Thursday. Because there was no guarantee that the temperature would stay in the proper range, they were then moved to the Kingston General Hospital pharmacy.

There were also a lot of vaccines in physicians' offices around the City. While some of the physicians were "quite on the ball" and removed their vaccines to safe places, there were other vaccines that were "potentially spoiled" because there was no guarantee they had been stored at the proper temperatures. There was no way to contact physicians at that time so it was up to their personal judgment, and many of them did exactly what they were supposed to do.

Ms. Pam Carr recalls that as soon as the public emergency shelters were set up, the public health inspectors became involved. (Unfortunately, Peter Moccio was unable to attend this interview.) Some of the public health nurses also volunteered to help at the Hotel Dieu shelter.

They contacted City Hall on Thursday but, as Dr. Gemmill says, the main focus for the first couple of days was restoring power. "It was a power emergency." After power had been out for 48 hours, other ramifications from the fallout of lack of power were creating other kinds of emergencies. This is where the role of the Health Unit really began, including such things as what to do about elderly friends and neighbors (particularly those with medical problems), what to do about food security when 'fridges aren't working, when people can't cook, and so on. As time progressed and it got colder, there was the problem of hypothermia and the problem of "people who wanted to heat their houses in desperate ways" such as with barbecues and kerosene stoves and other things which are supposed to be used in a well-ventilated area. "So it was really the fallout of hours without power that triggered our [involvement]."

Ms. Carr also mentions the concern about the water supply and whether the power could be restored and maintained. There was also concern on Saturday about whether the water was safe and whether it was being treated properly. People couldn't boil water, of course, because they didn't have the power to do so (unless they had a gas barbecue outside).

Also, sometime on Saturday, there was a rumour that started with a situation in Montreal where they did not have safe water. There was bacterialogical contamination there and it became an issue here. Dr. Gemmill had to assure people that any concerns had been quickly addressed and that Kingston water was never jeopardized. This had all started because CBC radio had made a report that the water had to be boiled. The Health Unit responded by sending out news releases very quickly. On the 11 o'clock news, again, the erroneous report had been on and people began calling in again so the PR person from the Health Unit again made another news release and contacted the station that had made the report. Ms. Carr says, "So we certainly were following fairly closely what the people were listening to and responding to it so that they had accurate information as soon as they could."

Peter Moccio was quite involved in putting out information such as "don't open your freezers" and kept telephone contact with City Hall. The inspectors at the various shelters were also answering many questions for people.

Both Peter Moccio and Dr. Gemmill were involved with keeping media contact once the emergency was declared. It depended on who was available "to do what at what time". It also depended on which cell phones could be answered because it was so difficult to get through the cell lines. Some of the towers were down. Because of this, Dr. Gemmill didn't have any personal beeper communication for quite a long time. They did have two phones at City Hall. Dr. Gemmell says, "The saving grace of this one was that the power station on Barrack Street was still functioning and therefore downtown, including City Hall, had power. So we were able to use the telephone system there."

Because they had no power at the Health Unit, they were given a couple of stations at City Hall out of which to work. Some of the time the phone was being used to help the shut-ins and they spent a lot of time assisting people who were at risk who were in their homes, who needed supervised shelters and weren't sure about leaving their homes. There were a lot of concerns for people about leaving their homes for a variety of reasons, whether they thought their homes would be vulnerable, or they were independent people who didn't want help from others. "There were all kinds of these agendas going on here."

They also used the phones at City Hall to communicate with each other. Dr. Gemmill says that one of their challenges was that there were five municipalities in Frontenac County and one or two in Lennox & Addington with which they had to liaise and, of course, "one can't be in all places at all times". They quickly set up a system in which they had inspectors and public health nurses who were assigned to liaise with the smaller municipalities and they kept in touch with them throughout. About three-quarters of the population that the Health Unit is concerned about lives in Kingston, which is also where the majority of the particular concerns during the storm were. One of the mayors from one of the townships up north, who is also on the Board of Health, commented that people there are very independent and help each other, which doesn't always happen in an urban centre. So even though they were very hard hit up north, the need was possibly more urgent here where people don't know each other, etc.

By Saturday it had been clearly identified that the volunteers who were answering the phones at City Hall weren't equipped to deal with the health-related issues so the Health Unit became quite involved at that point and set it up so that public health nurses would answer the phones for these issues. They had a fairly extensive meeting that afternoon via tele-conference with K.G.H., Hotel Dieu, St. Mary's, and K.P.H. They were trying to figure out some system by which they could know where there were beds, what kind of beds they were (e.g. a hospital bed compared to a medical bed), what kind of staffing would be needed, and what the mechanism might be to get the people funneled from the community into the various beds appropriately and to get them out of those beds when the need changed.

They decided that if the phone call came in through City Hall, people would be somewhat triaged at that point to determine what their needs were. The next step was that they would go to Hotel Dieu who would maintain a complete list of the beds, what kind of bed was available and they would match the bed to the need of the client. This system seemed to work fairly well. It was a little confusing on the Friday when people were massing into the Hotel Dieu and they were put into medical beds when they really didn't need that kind of care. The new system seemed to work fairly well into the next week.

Ms. Carr says that unless it was a health-related issue, then they tended not to get involved as much. "We answered most of the calls where there was a concern regarding things like 'Mum has diabetes, can she still go to one of regular shelters or should she be at the Hotel Dieu shelter?' so you had to make some call on that." So they were more involved in the hospital shelters in regard to locating people appropriately.

Another issue that was coming up was nursing homes where, if the power went out, the whole home would have to be moved. Ms. Carr is not sure if that actually happened totally but there certainly were instances where part of the home would have to be moved. So K.G.H. and St. Mary's were determining which of their wards could be set up for full service where a nursing home plus all of their staff could be moved into one of the facilities with power. The hospital administrators had to make those major decisions but the Health Unit was involved "because we may have gotten the very first call from the nursing home to City Hall to say 'we're in this fix, what can we do' and then they would have to be funneled accordingly. So we were part of it. We were one of the players."

There were many calls coming in to City Hall for various issues but calls such as "my neighbour is in the house, she's refusing to leave, I think she's becoming hypothermic" were directed to them. They worked with the volunteer drivers, the police and anybody else they needed to in order to assist people in making the decision to stay in their home or to leave, whatever was the best for them. They were alerted to people who might be in need by neighbours, relatives, volunteer drivers, and the military who were going door to door.

The Health Unit has a disaster plan and they took bits and pieces from it that were applicable to the ice storm. For example, they had plans for what they would do in the evacuation shelters and their nurses and public health inspectors became involved there right from the start. But, as Dr. Gemmill says, "It's hard to design a disaster plan to deal with ice." Each kind of disaster, such as toxic waste or explosions, etc., has different components. This one had to do with the ramifications of not having power when it was very cold. It had to do with the medical side of it, when people are very vulnerable, and it had to do with how you communicate. "Communications, by and large, failed. The technical hardware side of it failed, to a large degree."

Dr. Gemmill thinks that they learned that a disaster plan should look at "what should you do, for example, if you have no electricity; what do you do if you have no telephones; what do you do if you have no way of moving people around...". "It wasn't like if a bolt of lightning struck or a plane crashed, done and over - it went on for a long time. And it's dealing with how you are able to address the problems that come up when the resources that you normally use aren't always there. That, to me, was kind of the lesson of this one." He feels that planning for an ice storm would not be the best thing to do, rather that planning for the loss of electricity, or a natural gas emergency or any other symptoms of an emergency, would be more appropriate (no matter the cause). This caused people to realize how dependent we are on electricity. People couldn't get money out of banks, they couldn't get gas for their cars, etc., so it's not just the problem of not being able to cook.

As things unfolded, the Health Unit had to be on top of it and to think of what the public health concerns were "at this point in time". Ms. Carr says these concerns were different from day to day. As power started to come on, things shifted from the concern of the elderly and hypothermia to the problem of people opening their 'fridges and what food they were using. So they had to shift their focus to what were the concerns of the day. She says that "Dr. Gemmill was just excellent at that, being on top of it, getting the news releases out, brainstorming around what are the issues, what do we have to watch for in the public."

Dr. Gemmill says they have a very good team. For example, the people answering the phones would advise him and others as to what kind of calls they were getting. These were not all just about shut-ins. One question that came up was "What you do if you've taken an elderly person away from their house.... They have no idea when they get back how long their freezer has been out because they weren't there. They have no idea if their food became unthawed and now is re-frozen. What can we advise those people?" The answer was that if you weren't sure, you had to get rid of it. That was hard for some people, especially those from the older generation who have a different mind-set about thrift and wastage because they lived through hard times and this was hard for them to do. "I don't know if everybody followed the advice, but the advice had to be there." So food safety was a big issue. Dr. Gemmill recalls one story where a fellow did a very smart thing, which was to put saucepans full of snow inside his refrigerator, which helped to keep his food cold like an old-fashioned ice box. It is interesting that there was no increase in gastrointestinal illness after the ice storm, indicating that people were taking the messages seriously.

Dr. Gemmill says that the media did a very good job at getting messages out. He went over and did about three or four tapings at the radio stations. At one point, only one station (CFLY) was in operation and "to their credit, they were dedicating all their time to advise people of the ice storm". They would take the tape and play it over and over again. When the television station was back up, they were also very good at keeping people informed. "The media is key and critical....We can have all the knowledge and tell it to people on the phone but that's one at a time. Mass communication in this kind of situation is absolutely key." The issue of what to do in a disaster if mass communication goes down is another important thing to consider.

Ms. Carr was involved in crucial calls regarding hypothermia and carbon monoxide poisoning, which was a concern particularly with children. Media communication was increasing the public's awareness of these two issues, which meant more calls were coming in. The concern about carbon monoxide was that people were using barbecues and propane heaters in their house. Children and the elderly are the most vulnerable to any health insults. In Gananoque there were two men poisoned by a generator outside in their stairwell and it was the older one who died simply because he was more vulnerable to the lack of oxygen. Ms. Carr says there were a number of cases of people being tested for carbon monoxide poisoning (they kept in touch with the hospital emergency departments about this) but she does not know the overall results. There were certainly some children whose limits were higher than what they would recommend but there were no fatalities in our area. There were two or three evacuations to Toronto for treatment. (Dr. Rob Grayson has done a study on this.)

Public health inspectors at the shelters were involved with food handling. One thing that happened a lot was that people would take large amounts of food to the shelters, which was very generous of them, but they had to be told not to bring the food in because of safety precautions regarding how the food was prepared, etc. Pots of stews and chili are exactly the kinds of things that can cause massive food poisoning in shelters if not prepared properly.

Inspectors also dealt with other communicable disease issues like scabies, head lice, and hepatitis "C". Although hepatitis "C" is a blood-borne disease, the Health Unit had to calm people down about it to help them know that they were secure.

They were also called in to one shelter where a man had been identified as being HIV+ because some people were panicking about that. The public health nurses went out to provide information to the shelter so that people would know how this illness is transmitted, what the risks are, and could calm down about it.

We were lucky here that we didn't have influenza in any of the shelters (which Quebec experienced) but the public health nurses were liaising with the inspectors and the Health Unit just in case this should happen.

The Health Unit was involved with the various emergency teams. One day, for instance, they called a special meeting to discuss hypothermia because they knew the temperature was going to plummet. That's when somebody came up with the idea of buses going out. This came up when the City asked the Health Unit what to do about it when temperatures went down to -17 degrees Celsius. The Army had been scanning repeatedly through various areas of the City and the surrounding country areas so the Health Unit felt fairly secure that vulnerable people had already been identified. Buses were sent out to many areas with coffee and hot chocolate so people could get warm and "get a bit of a break". This was done for two nights.

Regarding sanitation in the shelters, people were instructed to take their own bedding and pillows. They were provided with a cot. Public health inspectors were monitoring all aspects of sanitation and hygiene including how the food was being cooked and making sure that everybody had potable water. (Up north, there were many places without water because the wells operate on an electric pump system.) Toilet facilities had to be adequately maintained as well.

Dr. Gemmill remarks that "on balance, I think that we saw the better part of human nature. I know there were some sad stories but we didn't see that kind of thing. We saw the helpful side of it, fortunately."

The only real difficulty they had was getting hold of some of their own staff who were without means of communication. They might consider arranging ahead of time that, in the event of another disaster, all staff who are not affected would meet in a certain place to organize so they would know who was available and who wasn't.

They only had two phones and two desks at City Hall to work with. Ms. Carr was responsible for establishing the schedule for staff they knew were all right. Some of their own workers did not have power for 10 days or 2 weeks.

Ms. Carr says that the one thing she feels they might want to look at is communication in varying aspects and how that might be improved. Of course, there were problems with communication that were unavoidable during this disaster, but perhaps this should be thought out ahead of time in order to have a backup plan. In this modern day, one does not expect to lose access to telephones, radio and television.

One cost of the storm to the Ministry of Health was the number of vaccines that were lost. This loss was minimal, so it probably amounted to "the low thousands". Lost time is hard to quantify. And there were staff who worked on the weekend and at nights. A lot of this was put in by management staff so it is not recorded anywhere.

Dr. Gemmill comments that, "I think that the way people go through a crisis situation, they tend to bond a bit. I think that was good. [In the brand new City], we got to know people very quickly."

Decisions were made by a management team at the Health Unit but they responded to and worked with each municipality, primarily the City of Kingston since that's where most of the population is.

Ms. Carr recounts a story from one night when "the shelters were full, the temperature was dropping, there was a lot of concern about elderly" and a call came in from a neighbour about an elderly lady. "A volunteer driver went out and this lady just adamantly refused to leave and she'd been without power since the beginning." The volunteer driver was a young woman who had had some experience in counselling people "and she really felt, with all her skills, that she couldn't get this older woman out of the home. And there was some problem with feces on the floor from the animals that she hadn't been able to care for 'cuz she couldn't see where the feces was.... She hadn't eaten, she had no hot food." The volunteer went back to talk to Ms. Carr about it. She had left the woman at home, wrapped up in her bed with lots of blankets. "I think she had a phone but she wouldn't answer it. There was something like that. She had these kerosene lanterns. They left one on, up high because they were afraid the cats would jump up and knock it off. She had a toque on so she was well wrapped. And they left the door open when they left the house because they were afraid that they might have to get in later on. And they asked if she would mind if one of them stopped around later in the night to check on her. She wasn't too keen on it but she said 'well, maybe'." So they talked about it with the head of the volunteer drivers who had a fair bit of experience with trying to get people out of the house. They then talked to the police and asked if they could take the woman out of her home if she refused to leave. They wanted to know their legal stance. The policeman felt that she was not capable of making appropriate decisions, she probably was somewhat hypothermic and she should not be staying in the home. The police went out with the volunteers. "The lady had been up out of bed and had locked the door. So the policeman went to her bedroom window and banged on the window and quite startled her but she did open the door and he came in. He had a talk with her and she agreed to leave the home. So they took her into the Hotel Dieu and she was put into a bed there." She stayed there for a couple of nights. Ms. Carr thinks that the woman was scared by seeing the policeman there and that was enough to get her to leave. The policeman told Ms. Carr that he was prepared to call an ambulance (if she wouldn't go in the police car) and forceably remove her from the home because older people become confused with hypothermia and stop making rational decisions. "And he was prepared to do that, to save her life, rather than leave her there to freeze at night." When the volunteers went back to the Health Unit to tell them what happened and that the woman was safe, "we all cheered" because they were all quite concerned that she wouldn't last the night.

"It breaks your heart. And you understand why these people don't want to leave their homes, they don't want to leave their pets. They're very frightened of these situations...."

The Health Unit's involvement was as part of a team with the various municipalities who, Dr. Gemmill says, were "running this". They had a very good relationship and worked well together.

Ms. Carr remarks that "We were very proud of our staff. The way they responded and the extra hours they put in was just phenomenal."

Regarding stress, they were cautious about who was working and how long they were working. They were on 4-hour shifts so nobody had to work a long period of time. If they were having personal crises, they tried to help them solve their own personal issues as well.

Ms. Carr had power the whole time and had two staff living with her. Dr. Gemmill did not have power. With humor, he says, "But Mayor Bennett had power less than I. He was out of power for a longer time than I was, and that guy was down there all the time. He was down there more than anybody so I don't think anybody could feel that they were hard done by when you saw that kind of dedication."