In the winter of early 2022, as the province navigated its way through the third wave of the COVID-19 pandemic, word started to spread that a convoy akin to the one that had been occupying Ottawa’s downtown core would soon be arriving in Toronto. Hospitals across the GTA were put on alert as they prepared to manage an influx of patients, should protests become heated.
At Sunnybrook Health Sciences Centre, Registered Nurse Marley Gimblett was set to be in charge of the Emergency Department (ED) that weekend. Marley worked with colleagues on Sunnybrook’s Emergency Preparedness team to run through every potential scenario that could arise, part of the hospital’s ongoing imperative to be ready for any emergency event. However, as the weekend approached, there was a sense of unease among ED staff.
“In the ED, we’re ready for anything,” Marley says. “But for this, staff said they felt underprepared, especially to respond to large numbers of patients coming in who may be teargassed or pepper sprayed, and how they would protect staff and other patients from being exposed.”
Though a large-scale emergency in Toronto never materialized, Marley seized the opportunity to enhance emergency preparedness training in the Sunnybrook ED to help staff feel more confident and prepared in making critical decisions during a mass emergency – and to ensure proper procedures are in place to protect patients and staff from dangerous contaminants.
In September 2023, Marley enrolled in Sunnybrook’s Practice-Based Research and Innovation (PBRI) TAHSN fellowship, specifically to focus on improving preparedness among ED staff responding to chemical, biological, radiological, nuclear and explosive (CBRNE) events. The fellowship provides point-of-care health professionals such as Marley the opportunity to lead practice-based quality improvement projects that enhance patient care.
“My motivation for pursuing this came out of wanting to be a resource for staff, and wanting to have more knowledge about this topic,” Marley says. “When you’re getting involved in a fellowship project like this, you have to love your topic.”
Since completing the initial fellowship, Marley is now the inaugural PBRI advanced fellow at Sunnybrook, allowing her to continue her work. As an advanced fellow, Marley will support the implementation of a formal CBRNE response procedure, with a focus on training and education for clinical staff in the ED.
Among the initial training topics that Marley put together, and inspired by the convoy in Ottawa, was decontamination procedures for patients arriving in the ED with injuries or exposure to pepper spray and teargas.
“The focus was on Registered Nurses, as they’re typically the most hands-on in the ED,” Marley explains. “We trained staff on basic principles on CBRNE response and how to set up the decontamination room to prevent further staff and patient exposure to chemical substances like teargas and pepper spray,” adding that this protocol could be applied to other CBRNE exposures.
“For biological threats, that might be like having a patient with Ebola come in. For radiological or nuclear, it might be if someone has radiation poisoning or if there was an event at a nearby nuclear plant. Responding to explosives would be similar to a trauma, but on a different scale.”
Surveys following the training showed significant improvement in how confident and prepared ED staff felt about responding to CBRNE events.
Through the advanced fellowship, the project will continue and expand to support the implementation of dedicated CBRNE response training for Registered Nurses and Charge Nurses in the ED. Marley’s goal is to keep working with the Emergency Preparedness team to educate ED staff and have more ongoing training sessions. She says that would include further CBRNE preparedness education, proper personal protective equipment training, running a CBRNE simulation and further evaluating preparedness across the hospital as possible outcomes of her work.
