What happens inside a hospital when a city evacuates?

The medical staff in the hangar had a question for 440 Squadron. In the middle of August, could they find an ice fishing hut?

The armed forces returned, sooner than you’d think, with a hut. It served as a small booth to give patients privacy as they awaited a military airlift to safety.

Cabin Radio spent hours with staff at Yellowknife’s Stanton Territorial Hospital as they described one of the most daunting experiences any hospital might face: getting patients out as a wildfire approaches.

Yellowknife’s evacuation order arrived on the afternoon of August 16, 2023 with virtually no warning. Only a few western areas of the city had been on evacuation alert, and the order to leave by road and air represented a 180-degree swing from months of advice that if a wildfire came, the community of 20,000 would shelter in place.

That’s why Janie Neudorf found herself ordering an ice fishing hut – it’s a popular winter sport when the nearby bay freezes over – to help turn a military hangar into a field hospital.

Neudorf, a nurse practitioner, and a team of workers had just hours to turn the hangar into a staging post for dozens of patients heading to British Columbia aboard a Boeing C-17 military transport plane.

“You’ve got to picture this – there are aircraft on the other half of the hangar and we set up army cots with all the pillows and wool blankets from the hospital,” said Neudorf.

“We made sure we had a crash cart, drugs from the pharmacy, everything you’d need.” (A crash cart contains all the equipment needed to resuscitate someone.)

The order to evacuate Yellowknife came on Wednesday evening. The plane taking 39 patients to safety was due on Thursday – and eventually arrived on Friday.

All the while, residents fled the city and other services began switching off. A bus from the seniors’ centre and ambulances were used to ferry patients to the hangar.

“It was an all-night affair just getting people to the point where they were ready to get out the door,” said Dr Claudia Kraft, the territory’s medical director.

“It was a huge logistical undertaking, with ground transportation evaporating from under our fingers.”

The evacuation “was unexpected,” said Sean Whitcomb, a senior project manager who held responsibility for some of the hospital’s emergency response.

“Our assumption – based on what we had been told by our partners – was that an evacuation of Yellowknife was pretty unthinkable,” Whitcomb said.

“So we had to pivot around that quite quickly.”

He and Kraft together learned how you call for a Boeing C-17, not an experience either of them had previously had, figuring out the mechanisms through which a request passes to the NWT government’s emergency management team, then on to the military.

“There’s no 911 number to call for the operations person at the Royal Canadian Air Force who can just spin up a C-17 for you,” Whitcomb said.

“Learning how was a bit of an uphill battle and, thankfully, we were able to do that very, very quickly.”

“Moving civilian patients is not actually a thing that the Canadian Armed Forces would say that it does,” added Kraft. “It took quite a while for the formal approval, but in the background were some extraordinary people who understood our escalating time pressure – the capital was emptying. The services to support a hospital were leaving.”

Not ‘completely unprepared’

Evacuating Yellowknife was unexpected, but it wasn’t entirely unforeseen.

Senior staff at the hospital said they had started planning for an evacuation months earlier, prompted by a series of prior disasters. Staff also borrowed from lessons learned through multiple evacuations of facilities like the health centre in Hay River, where floods and fires have now forced an evacuation three times in the past two years.

“We started talking about it last summer when Hay River was evacuated,” said Kim Riles, the chief executive officer of the NWT’s health authority, referring to Hay River’s first – flood-related – evacuation in May 2022.

“That’s the first time in my experience that we’ve evacuated a hospital. It was on a smaller scale, obviously, but still,” Riles said.

“There had been discussions about lessons learned from Fort McMurray,” she added, referring to the Alberta community struck by a huge wildfire in 2016. “We had preliminary discussions with partner provinces about taking our patients if we ever needed to evacuate, and what that would look like for us in the event that we ever had to enact it.

“I don’t think any of us really seriously thought that we’d be putting it into action, but we knew we couldn’t be completely unprepared.”

As the summer of 2023 progressed, the prospect of evacuating Yellowknife’s hospital started, slowly, to appear less outlandish.

In late June and into July, a fire – the same one that would later threaten Yellowknife – triggered an evacuation of 2,000 or so people in Behchokǫ̀, to the west.

In the northern Beaufort Delta region, a fire briefly menaced the town of Inuvik, to the point where the health authority began drawing up plans to evacuate Inuvik’s hospital if need be.

And across Great Slave Lake, the communities of Fort Smith and Hay River were evacuated in quick succession on August 12 and 13 – setting in motion a chain of extraordinary events.

Fort Smith’s 28-bed long-term care unit had evacuated to Hay River. Then, with less than four hours’ notice, those evacuees and Hay River’s own patients had been brought to Yellowknife as the wildfire crisis escalated.

In the capital, the Stanton Legacy building – Yellowknife’s old hospital, replaced by the current facility in 2019 – has been refitted to provide long-term care and extended care beds, but it has yet to formally reopen.

Despite that, the legacy building’s doors were flung open to accommodate the influx of patients from Hay River and Fort Smith.

By August 16, those same patients were being moved to Alberta as Yellowknife itself prepared for an evacuation.

Where to eat, where to sleep

Code Green is the health sector’s term for evacuating a building.

A Code Green is not declared lightly, and – for a hospital of Stanton’s size – it usually means moving people either to another part of the building, or to a neighbouring facility.

In August, Stanton’s Code Green ultimately meant simultaneously evacuating the hospital while turning one ground-floor corner into an emergency room for essential workers and fire crews.

Jennifer Torode, the hospital’s chief operating officer, says she had faith in the almost brand-new building, despite some earlier concerns about the facility.

“One of the things that’s really fantastic about this building is that you could hold a torch to it and it’s not going to go up in flames,” Torode said.

“This is an amazing facility. We were looking at: will we actually need to evacuate or are we going to shelter in place? Little did we know we were going to do both.”

Out of concern that the hospital’s fibre-optic internet could go down – as had happened in the South Slave – staff set up a Starlink satellite internet dish on Stanton’s roof.

With the water switched off at several apartment complexes used by everyone from locum doctors to cleaning staff, those people were moved into the hospital and its paediatric unit was turned into makeshift housing. Dozens of people slept there.

Graeme Evans – the general manager for Dexterra, the company that manages the hospital – has worked at Stanton since a month after the building first opened.

Performing many of the cleaning tasks himself with everyone evacuated, Evans and his staff had also realized, in the days leading up to the evacuation, what might happen –and brought in extra kitchen supplies to cope.

Turning those supplies into three meals a day for the hospital’s skeleton staff fell to the likes of chef Sunday Sanyaolu, who moved to Yellowknife from Dubai in 2021.

“I never expected the wildfire. It was strange to me, I’ve never heard of that before,” said Sanyaolu, who grew up in Nigeria.

“It’s been an experience, but I’m happy to be of service to people even in these drastic conditions.”

Cooking through an evacuation hasn’t daunted Sanyaolu or put him off his adopted city.

“I love it here in Yellowknife. I prefer the weather,” he said. “It’s cold, but I prefer it to the hot weather in Dubai. I also like quiet places.”

What happens to the technology?

There are pieces of hospital equipment that don’t like quiet places.

“There’s a lot of electromechanical equipment that doesn’t like sitting unused. It tends to react badly when you’re trying to start it up after a few weeks,” said Kevin Taylor, the territorial manager of biomedical engineering.

Dialysis equipment is a good example, or the machines used to take X-rays or provide anesthesia.

Taylor and his team reached for reviews carried out after Fort McMurray’s fire to rapidly learn lessons as Yellowknife’s own crisis evolved. They acquired some vapour barrier – the kind of plastic sheeting used in construction – and set to work.

“Fort McMurray had serious problems with smoke and ash damage as well as water damage, because the hospital got water bombed, as I understand it,” Taylor said. “We ended up getting vapour barrier and covering everything.”

While some staff reprogrammed dialysis machines to wake themselves each morning, disinfect themselves and go back to sleep, others moved equipment either to the ground-floor emergency area or to the military hangar where patients were awaiting the C-17.

“Prior to the evacuation, in anticipation and in the planning stage, we had created a couple of essentially go-packs of fundamental equipment – defibrillators, suction units, IV pumps, vital signs monitors – and we had them ready to go,” Taylor said.

“Before I left on the Saturday, we moved extra equipment down to the emergency room and stored it in the ICU area – extra physiological monitors, in case they had a major trauma event.

“Now,” he said with a smile three weeks later, “I’m trying to find it and put it back where it was.”

‘We feel like no one is coming’

While Taylor says the equipment challenges of an evacuation were surmountable, the people challenges are different.

Moving out dozens of patients meant taking some Indigenous people, including Elders who may not speak English, and sending them south in a hurry – in some cases, before family members knew what was happening.

Meanwhile, staff were being asked to stay and help even as their partners and children were packing to leave, a problem that approached a crisis point when the C-17 originally scheduled for Thursday ended up being pushed to Friday, which marked the end of the territorially issued deadline to leave the city.

At the time, multiple members of hospital staff emailed Cabin Radio in states of frustration and panic.

“We actually feel like no one is coming to help us. We are not getting straight answers while working our asses off. Staff is exhausted. We are berated when we inquire about timelines,” one hospital employee wrote on the Thursday evening, requesting anonymity to speak frankly about their employer.

“As of right now there is no concrete plan for how we will ensure staff can evacuate, as it will be past the ‘noon on Friday’ evac order,” another nurse wrote, similarly requesting anonymity.

“The hospital and GNWT are not very transparent with their communication or planning.”

Health authority chief executive Riles acknowledged the circumstances had been, in her words, “a really challenging time for a lot of staff.”

“We asked many of them to continue with their duty of care to patients beyond when they were personally feeling comfortable, and also amid family circumstances that were challenging, with people evacuating, with a lot of uncertainty about the actual fire risk and the risk to their personal safety,” Riles told Cabin Radio earlier this month, as residents began returning to Yellowknife.

“Our nurses and doctors and other staff, they’re not firefighters. They didn’t sign up to stand in front of a wall of flame. So asking them to remain to care for patients? We knew we were asking a lot of them. I want to give a lot of credit because people just did it. They took care of the people, the patients.

“It was really an amazing time to watch people come together, knowing how challenging it was for them personally, with their spouses heading down the road with their dogs and their kids and their everything else, while they stayed behind.”

Asked about the stress and damage that might be caused by evacuating Elders without interpreters alongside them, Riles said the health authority recognized that problem and did what it could in the time available.

“Ensuring people were safe in the face of really uncertain fire circumstances was paramount, and we needed to get people to where they could still receive appropriate care but also not be at risk due to the encroaching fires,” Riles said.

“We moved Elders, long-term care folks away from community, away from family, away from language, culture, and we were really sensitive to that. We knew that these were difficult circumstances, and we would do our best, but we knew it wouldn’t be ideal.”

Riles said case managers were assigned “immediately” to contact families, while British Columbia put a family information line in place.

“We worked through a few language barriers and whatnot on a case-by-case basis to try to put supports in place – to have an escort go out if needed, where were those needs were identified – but we knew that this was going to be a really, really challenging circumstance for everybody that we moved,” Riles said.

Sending people, sending information

The challenges of moving people are exemplified by the task of getting dialysis patients the help they needed in the south.

Julie Purcell, the hospital’s manager of chemotherapy and dialysis, was at her brother’s wedding in Slovakia when Yellowknife was ordered to evacuate.

Arriving back in Canada days later, Purcell worked remotely to help secure patients access to all-important dialysis.

Dialysis runs normally happen three times a week, she said. To make that happen in Alberta, patients ended up being scattered across all kinds of different institutions throughout the province.

“Even the ones that, say, were in Calgary, were still getting their dialysis treatments in different facilities within the Calgary area,” Purcell said.

Complicating matters is the barrier between Alberta and NWT medical records, which run on different systems.

Early in the week of the evacuation, nurse practitioner Alietha McKay had the sense that a crisis might be brewing. McKay began getting the paperwork ready to transfer information to Edmonton and Calgary.

“Alberta is on a different electronic record and we have paper dialysis charts, so there was some organizing to be done,” she said, gesturing at a wall full of large binders.

McKay stayed in touch with patients throughout their weeks away. Her voice broke as she thanked Alberta colleagues, saying they had been “amazing in supporting us, getting our patients booked in for their appointments.”

“People have gotten their treatments. They helped organize transportation. They’ve just been amazing. I can’t thank them enough,” she said of staff in Edmonton and Calgary.

McKay drove to Calgary in early September to help some patients make the return trip north. Throughout the evacuation, a staff member who remained in Yellowknife was able to gather any missing information from the giant binders as staff tried to coordinate care.

“It was a big team effort,” said McKay. “It worked out well.”

Restarting the system

The return to Yellowknife brought its own issues.

In some cases, healthcare staff who spent weeks moving mountains to rearrange their systems were then given days to put it all back again.

Primary care regional manager Matthuschka Sheedy and family practice physician Dr Suraiya Naidoo had responsibility for turning the prescriptions system on its head during the evacuation, connecting physicians, pharmacies and patients to make sure everyone had access to refills.

They also helped to maintain the medical records system, since some urgent test results coming in from Alberta could have otherwise sat unnoticed.

“Now we all just came back and they’re like ‘OK, open up primary care again.’ So that’s been exciting,” said Naidoo, a gleam in her eye, sitting in the hospital’s café a day after Yellowknife’s evacuation order lifted.

Reopening primary care isn’t just about getting staff back in the right place and rebooking appointments, although there’s a lot of that. The buildings themselves had to be fit for patients to arrive.

“We had buildings that had been sitting empty for three weeks with systems shut down,” said Sheedy.

“We were basically given one day to prep these buildings and it was like, ‘OK, guess who’s taking out the garbage? Guess who’s cleaning our toilets?’ Because there’s no one else. But we’re doing it and people are very happy to do it, because they’re happy to be back and they’re happy to be working.”

“It’s huge,” said Naidoo. “We were just figuring out what was happening and now we’re back in town. But you know what? It’s been incredibly amazing. Our staff is resilient.

“Everyone showed up ready to work and that made it a whole lot easier, because we have people that are willing to go that extra mile for us as a team, and for our patients.”

One day after the evacuation order lifted, the city and the hospital remained eerily quiet.

As residents returned more slowly than anticipated, even with a quarter of their regular staff in place, hospital managers felt on top of proceedings.

Employees returning to their hospital, and those that had been there throughout, seemed eager – after weeks of upheaval – to simply have patients walk back through the door, so they could start doing their “normal” jobs.

From the back of the ground floor, early on the afternoon of September 7, came the sound of a telephone followed by a cheer.

A voice rang out.

“We just got our first ambulance!”