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 through 21 years of practice and lay dormant until the right words set it in motion.
Code Orange. Lots of victims. Be ready for anything.
There was an explosion at the Come By Chance refinery, about 45 kilometers down 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 the busiest cities in Canada, but it was dealt with quickly 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 responders saved lives that night.
“It was a humbling experience to be on a ward and see experts in action,” said van der Linde, head of emergency services at GB Cross Memorial Hospital in Clarenville. “I think the many teams on our staff are proud of what they accomplished during this event, and I think they have reason to be proud as well.”
The worst-case scenario came to life just after 4pm on September 2 – the end of a working day heading into a long weekend. When reports leaked of a possible explosion at the Come By Chance refinery, Fewers Ambulance Service paramedics were already on the scene.
When Dion Park, senior site manager for the hospital in Clarenville, was alerted to the situation, he called a Code Orange – a rare move activated only when an unforeseen disaster has occurred and large casualties are expected.
As the call went out, staff began pouring into the hospital.
“We had staff reporting to work who weren’t supposed to report to work. We had staff staying from the day shift, staff coming in early for their night shift,” Park said.
By 5 p.m., the first injured workers had arrived at the hospital. Staff are not authorized to release their condition, but witnesses at the scene said the workers were dealing with severe burns from the lightning fire. Eight were injured in total and seven had to be placed on ventilators.
The workers were met by “a total team response,” 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 support resources, all of whom played a critical role. .”
But as more victims began to arrive, it became clear that the full complement of the Clarenville hospital would not be enough. Most of the patients had to be sent to the Health Sciences Center in St. John’s, a two-hour journey by ambulance, about 30 minutes by helicopter.
Health Sciences Center began moving patients out of the intensive care unit and sent them across town to St. Clare’s Mercy Hospital in preparation for the arrival of the workers.
Call for air support
By 8pm, staff at GB Cross had stabilized three patients to the point where they could fly – but there was a problem.
The hospital only has a small helipad, not big enough to land the kind of aircraft they needed to transport the patients along with the medical staff and equipment that would go with them.
There was an unorthodox solution – the police moved quickly to block the road around the hospital and cordon off the Sobey’s parking lot next door.
By 8:45 p.m., a Cougar helicopter was touching down on the painted lines between the wagon enclosures, followed by a massive search and rescue swarm. The first three patients were loaded aboard for transport, flanked by medical staff, as dozens of traders and onlookers looked on.
“It was a somber experience. Everyone was thinking of the workers and their families, but the response of the emergency crews was impressive,” said Peter Troke, a Clarenville resident who was standing nearby. “The clearance of the Sobey’s car park was quick and efficient, but it also highlights the need for a proper, safe helipad in Clarenville.”
The patients were in the air at 10 p.m. and on their way to St. John’s. It is a moment that will stay with van der Linde forever.
“The success of this event involved these teams flawlessly, no one asked questions, they came in and were available,” he said. “An important thing for the public — when you need it, the system will spare no resources whatsoever to get you the care you need.”
The helicopters landed at the Health Sciences Center around 10:30 p.m., and patients – strapped to machines and covered with blankets – were transported into waiting ambulances. They were met at the emergency room doors by staff in scrubs, masks and gloves and taken inside.
Two more patients would be transported overnight. The five injured workers remain hospitalized at the Health Sciences Center as of Friday. Another is in hospital in Clarenville, while two have been treated and released.
Van der Linde says the response from his colleagues signals the capabilities of smaller hospitals in the province, but it also reveals vulnerabilities in areas where these facilities face severe staffing shortages.
“This is an event that makes you aware of how important it is to have rural care facilities open and available to take care of you,” he said.
Doctor shortages have led to temporary emergency room closures in towns such as Whitbourne, Baie Verte and Buchans – each close to industrial sites dealing with hazardous materials and machinery.
Every second counts in a mass casualty incident, van der Linde said, and driving past a closed emergency room could be devastating — especially in places where the next doctor can be more than 100 kilometers away.
He hopes the emergency rooms will find a way to stay open and is confident the powers that be will make them a priority.
“The rural population matters. They deserve access to urgent care, and they have a right to urgent care.”
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