The development of the mass casualty procedure at the McGill University Health Centre (MUHC) has been ongoing for years. However, a critical component missing from the plan was that it had never been tested until the Agence de santé et des services sociaux de Montréal proposed involving the MUHC in a mass casualty simulation (Code Orange). Over the course of about 10 months, the MUHC worked with numerous internal and external partners to plan, execute and evaluate the simulation, which was conducted in October 2012. The challenge that required creativity, foresight and determination was conducting a large scale simulation in two very busy downtown hospital emergency departments that were still treating patients. The exercise involved 2 of the 6 MUHC sites: Montreal General (MGH) and Montreal Children’s (MCH) hospitals. Internal partners included: • MGH & MCH Emergency Department(ED) • Operating Room and Intensive care units • Medical imaging • Senior administration • Logistics • Public relations • Psychology, psychiatry, social services • Ombudsman offices. External partners included: • Urgences Santé • Canadian Armed Forces • Société de transport de Montréal • Service de Police – Ville de Montréal • Agence de la santé et des services sociaux Montréal. Employees from other local hospitals and students from a local high school and CEGEP acted as victims for the simulation, which ran from 8-11 AM. A total of 79 patients were staged, processed, treated and debriefed at both sites. It is important to note that during the exercise both EDs continued to treat patients. After the simulation, debriefing sessions were held at 3 levels: departmental sessions; site specific sessions; debriefing sessions of all internal and external partners. The overall conclusion was that the planning and development strategy for the MUHC code orange protocol was sound. Corrections to the protocol were identified and modifications initiated but overall, the simulation has raised the organization’s level of confidence. The debriefing sessions revealed that the event was a success and that both hospitals responded well to the test; collaboration with partners has been strengthened and has had a positive impact on the state of preparedness of the organizations in terms of emergency preparedness.

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