Dr. Etienne van der Linde spent his entire career preparing for the call his emergency room received on the afternoon of September 2nd. The protocol was massaged into muscle memory over 21 years of practice, lying dormant until the right words sparked it into action.
Code Orange Mass casualties. Be prepared for anything.
There was an explosion at the Come By Chance refinery, about 45 kilometers up the Trans-Canada Highway on the isthmus of Newfoundland’s Avalon Peninsula. Eight people were injured, some seriously.
What followed was an event that experts say had the potential to overwhelm emergency services in even Canada’s busiest cities, but was quickly handled by a collaboration of paramedics, firefighters , pilots and staff, centered on a small eight-bed emergency department in Clarenville.
Questions remain about what caused the explosion, but one thing seems certain: The actions of those who responded saved lives that night.
“It was a humbling experience to be in a department watching expert people in action,” said van der Linde, head of emergency services at GB Cross Memorial Hospital in Clarenville. “I think the multiple teams on our staff are proud of what they accomplished during this event, and I think they have reason to be proud as well.”
Dr. Etienne van der Linde, site head of the emergency department at Hospital Dr. GB Cross Memorial in Clarenville, says its staff have reason to be proud after responding to a refinery explosion on September 2. (Ryan Cooke/CBC)
The worst-case scenario came to life just after 4 p.m. on September 2: the end of a workday heading into a long weekend. As reports emerged of a possible explosion at the Come By Chance Refinery, Fewers Ambulance Service paramedics were already en route to the scene.
When Dion Park, the senior site manager at Clarenville Hospital, was alerted to the situation, he called a code orange, a rare move that is only activated when an unforeseen disaster has occurred and they are expecting mass casualties
Once the call was made, staff began flooding into the hospital.
“We had staff showing up for work that weren’t supposed to show up for work. We had staff staying from the day shift, staff coming in early for their night shift,” Park said.
Dion Park, senior site manager at Hospital Dr. GB Cross Memorial, was responsible for calling Code Orange. (Ryan Cooke/CBC)
By five in the afternoon, the first injured workers had arrived at the hospital. Staff are not authorized to discuss their condition, but witnesses at the scene said workers were dealing with severe burns from the fire. In all, eight were injured and seven had to be placed on ventilators.
The workers received “a total response from the team,” van der Linde said. Almost every health worker in Clarenville showed up to do their part.
“We had three ER doctors, an ER nurse, a surgeon, two general internists, an anesthesiologist, respiratory therapists, a team of approximately 16 to 20 nurses, X-ray technicians, laboratory and ancillary resources, who went play a crucial role.”
A Fewers ambulance is parked in front of Hospital Dr. GB Cross Memorial. The Menys Ambulance Service played a crucial role in the rescue of eight injured workers at the Come By Chance refinery. (Ted Dillon/CBC)
But as more casualties began to arrive, it became clear that the full complement of the Clarenville hospital would not be enough. Most patients should be referred to the Health Sciences Center at St. John’s, a two-hour trip by ambulance, about 30 minutes by helicopter.
The Health Sciences Center began moving patients out of the intensive care unit, sending them across town to Mercy Hospital in St. Clare in preparation for the arrival of the workers.
Calling for air support
By 8pm, GB Cross staff had stabilized three patients to the point where they could fly, but there was a problem.
The hospital only has a small heliport, not big enough to land the type of aircraft they needed to transport the patients along with the medical staff and equipment needed to go with them.
There was an unorthodox solution: Police moved quickly to block the road around the hospital and cordon off the Sobeys parking lot next door.
Pictured here is a Cougar landing in a Sobeys parking lot in Clarenville, preparing to take injured workers to St. John’s. (through pic.twitter.com/AbyWnRBpKY
—@ryancookeNL
At 20:45, a Cougar helicopter touched the painted lines between the cart pens, followed by a large Cormorant search and rescue. The first three patients were loaded aboard for transport, flanked by health workers, as dozens of shoppers and onlookers watched.
“It was a sad experience. Everyone was thinking of the workers and their families, but the response of the emergency personnel was impressive,” said Peter Troke, a resident of Clarenville who was nearby. “The clearing of the Sobeys parking lot was quick and efficient, but it also highlights the need for a proper and safe helipad in Clarenville.”
A Cormorant helicopter from the search and rescue fleet arrives at the Health Sciences Center in St. John’s, with two injured refinery workers on board. (Ted Dillon/CBC)
The patients were in the air at 22.00 and headed for Sant Joan. It’s a moment that will stay with van der Linde forever.
“The success of this event involved these teams impeccably, no questions asked, coming in and being available,” he said. “One important thing for the public: When you need it, the system will spare no resources to get you the care you need.”
Paramedics escort an injured worker to the emergency room at St. John’s Health Sciences Center. John’s. (Ted Dillon/CBC)
Helicopters landed at the Health Sciences Center around 10:30 p.m., and the patients, attached to machines and covered with blankets, were transported to waiting ambulances. They were greeted at the doors of the emergency room by staff wearing scrubs, masks and gloves, and ushered inside.
Two more patients would be transported during the night. The five injured workers remain in the Health Sciences Center hospital until Friday. Three have been treated and released from Clarenville Hospital.
‘Rural Rocks’
Van der Linde says the response from her co-workers indicates the capabilities of the province’s smaller hospitals, but also exposes vulnerabilities in areas where these facilities face severe staff shortages.
“This is an event that reminds you how important it is to have rural care facilities open and available to serve you,” he said.
The shortage of doctors has led to the temporary closure of emergency rooms in towns such as Whitbourne, Baie Verte and Buchans, each near industrial sites that deal with hazardous materials and machinery.
Every second counts in a mass casualty event, van der Linde said, and walking past a closed emergency room could be devastating, especially in places where the next doctor could be more than 100 kilometers away.
He’s hopeful these emergency rooms will find a way to stay open and trusts the powers that be will make them a priority.
“Rural people matter. They deserve access to emergency care and they have a right to emergency care.”
Come By Chance Refinery Timeline
CBC’s Garrett Barry explains what happened, and when, at the Come By Chance refinery.
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