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Canadian Journal of Rural Medicine
Spring '98

Rural docs deal with Canada's worst bus crash

Louisa Blair
Freelance medical writer living in Quebec City

CJRM 1998;3(2):111

© Louisa Blair 1998

All the rural physicians in the vicinity of Les Éboulements on Quebec's north shore remember exactly what they were doing when they heard the news that a bus full of people had just plummetted into a ravine. One of them actually heard the crash as he was jogging through the village. Another was putting up his winter garage, those long plastic tubes snaking out to the street that begin to adorn Quebec houses around Thanksgiving. A third physician was whacking a ball among the birches of the Malbaie golf course.

The worst road accident in Canadian history had just happened down the road, and the people there to deal with it were rural physicians working out of rural hospitals.

Robert Vallières, the hospital administrator at the Centre Hospitalier de Charlevoix in Baie-Saint-Paul, was on his way home to Quebec City when he saw a fleet of ambulances and journalists heading in the other direction. He turned around and went back. The hospital's emergency plan had already kicked in by the time he got there.

Hospital staff had learned from experience that emergency plans are not just theory; they are preparations for the real thing. The chronicle of past disasters in Quebec's beautiful Charlevoix region makes solemn perusal. In 1962, 23 died in a crash. In 1973, a military van crashed killing 4 and injuring many more. In 1974, another bus went off the road in the same spot as this crash, killing 13 and injuring 20. At that time hospital staff had to use the archives as a morgue, recalls Dr. Jacques Cloutier, family physician and medical director at the hospital in Baie-Saint-Paul. This time, they were prepared as never before.

"By the time I arrived at the hospital," said Cloutier, "there were 20 nurses, 8 family physicians, the surgeon, the anesthetist, as well as receptionists and secretaries already in place. We were expecting 15 people, badly hurt. In the event, there were only 5 survivors."

It wasn't just the medical staff who needed to be in place. The hospital's emergency plan called for a room for the police, a room for the press and a room for the family members, with people to look after them. "Those other accidents are in our collective memory. All the old reflexes came back, and we could act confidently," said Cloutier, who has been working in Baie-Saint-Paul since 1971. "ATLS helped, but experience helped more than anything.... Doctors were calling from everywhere, offering to help. We had the best telephonist on duty and the doctor on call knew all the emergency procedures. Everything was as good as it could be."

Hospital staff at Baie-Saint-Paul stabilized the 5 survivors, giving some of them as many as 5 blood transfusions. By 19:00 that night, about 5 hours after the accident took place, the victims had all been transferred to Enfant-Jésus, the tertiary care trauma centre in Quebec City. They made the hour-long journey in ambulances and were operated on immediately upon arrival.

The only problems were a lack of blood and telephones. The blood bank wasn't big enough, and Enfant-Jésus couldn't send down their supply. In the end, the Red Cross in Quebec City sent some. "If we'd had 15 victims instead of 5, we'd have been in trouble," said Cloutier. As for telephones, the lines were clogged with calls from media and victims' families, as well as medical personnel trying to pass crucial information along to one another. In the future, they plan to set up an emergency hotline "just for doctors to talk to each other."

Emergency plans clearly mark out everyone's roles so the doctors aren't stepping on the paramedics' toes, and the surgeons aren't having to field journalists' questions. The degrees of injury are colour coded for quick and appropriate action. The pay-off of regular meetings and fine-tuning of the plan for the past 7 years was realized that day. The head of the Regional Emergency Planning Committee, Dr. Eric Gagné, had everything organized within 20 minutes, before he had even left his home village. "There were good people, I had good information, so I was able to make good decisions," he said.

One of the decisions he made was that the dead should go to the hospital in Saint-Joseph-de-la-Malbaie, in the opposite direction from Quebec City. "Logistically, it made sense," he said. "That way Baie-Saint-Paul could concentrate on the living victims without worrying about the dead."

Meanwhile, Dr. Denis Samson, a young family physician, was on call that day at Saint-Joseph-de-la-Malbaie hospital when the dead began to arrive. "I was told there had been a major accident, so I started calling the family physicians on our list for big emergencies," said Samson. "Seven arrived right away, as well as the surgeon and anesthetist. Then we waited for the injured." But as the ambulances rolled in and the doctors got more information "we realised we'd be taking all the dead," said Samson.

At the hospital, the morgue's freezer had space for only 2 bodies, but that night 43 bodies arrived by ambulance. Ironically, it was thanks to hospital cuts from 56 to 34 beds that staff had anywhere to put them: the entire third floor was more or less empty.

Staff had to move the patients who were already in emergency beds, to spare them from watching the dead pass by. Others positioned themselves at the emergency entrance to persuade locals arriving that night to go home if their problem wasn't urgent. Still others went down to the kitchen to see if there was some spare plastic sheeting they could use to wrap the bodies once the hospital's linen cupboard had been emptied. Someone threw open all the windows on the third floor to keep the bodies as cool as possible. There weren't enough coffins at the local funeral home, so 43 cardboard cremation coffins were sent for from Quebec City.

The first thing Hospital Administrator Jacques Tremblay did was to go around the hospital bolting all the entrance doors except one: media control. He herded all the journalists and photographers into the emergency waiting room, and there they waited, forbidden to go anywhere else in the hospital. When 150 family members arrived to identify their relatives, it wasn't so easy. "We couldn't let them go and look," he said. "It would have been inhuman. Dozens of mutilated people on the floor — it was like TV scenes of war in Third World countries." Staff from the local community health centre and hospital volunteers counselled the families and sent them home, telling them to go to Quebec City the next day for identification.

On reflecting why things went so smoothly on the night of Oct. 13, 1997, Samson gives some credit to his family medicine training, which taught him to improvise. But most important, he said, was that the doctors who work at Saint-Joseph-de-la-Malbaie are not just colleagues, they are friends. They go skiing and dog sledding together in the winter, fishing and cycling in the summer, and do 2 annual CME retreats per year.

"We didn't save anyone," says Samson, "but we treated the dead with great respect and tried to help the families as best we could. Strangely enough, I'm glad I was there."