Medics Prepare for Olympic Crowds

BY ANDRÉ FECTEAU

Mar 15, 2009

Vancouver will undoubtedly be swarming with people in February and March 2010. In addition to the 2.1 million existing residents in the metropolitan area, an additional 1.2 million athletes, media and spectators are expected to find their way to the lower mainland for the Winter Olympics and Paralympics.

This sudden influx will put pressure on the city’s infrastructure, and emergency teams will have to be ready for anything – from mass protests to ruthless weather and possible terrorist attacks. And with the Games being held during one of Vancouver’s high flu periods, hospital staff may run out of gas before the Flame.

Dr Jack Taunton, chief medical officer for the Vancouver Organizing Committee (VANOC) is mandated with the challenge of handling the public health of Vancouver’s Olympian population – and with preventing the event from disrupting the daily medical service of Vancouverites.

Approximately 1,200 non-residents were hospitalized in Turin during the 2006 Olympics, and Salt Lake City’s hospitals received about 450 Olympic-related patients for the duration of the 2002 Games.

However, despite the huge influx of people to the host city, patient populations don’t seem to increase during the Olympic Games. Hospitals in both Turin and Salt Lake City observed a decrease of 20 to 25% in elective procedures (surgeries and investigations) when they hosted the Winter Olympics. Other Olympic host cities have noticed a similar pattern. “People want to see the Games,” explains Taunton, noting that the opportunity of having the Olympics in your backyard doesn’t come twice in a lifetime. Residents often delay their elective medical interventions until after the Games are over. “This allows hospitals to accept the surge of millions of spectators.”

In Vancouver, “our job is to triage individuals (…) to ensure that we have absorbed them,” explains Taunton, “we’ll try to do as much as we can inside the polyclinics.” Such facilities (complete with technology such as imaging, digital X-ray, and dental, eye and ear-nose-throat equipment) will act as mini-hospitals.

Random screening of the athletes for diseases such as oral cancer (a routine activity at every Olympic event) will also be done at the polyclinics.

Vancouver and Whistler, where the alpine events will be held, will each have such a facility. Smaller complementary medical stations will be set up in hotels and at every sports venue throughout Vancouver and Whistler.

A fleet of 55 brand new ambulances from the British Columbia Ambulance Service will be leased to VANOC for the duration of the Olympic and Paralympic Games. The Vancouver Organizing Committee will incur the running costs of these ambulances during the Games, and they will be redeployed around British Columbia afterwards.

There will be no net increase in cost for taxpayers, since the ambulances are part of the annual replacement cycle, says Les Fisher, executive director of provincial programs at the British Columbia Ambulance Service. The organization normally replaces about 60 to 65 of its vehicles every year.

“It’s a way that we can make use of our regular resources for such an important event for the province,” notes Fisher. Rather than buying the vehicles throughout the year as usual, they’ll be bought all at once prior to the Games. VANOC will pay for the amortization cost as well.

Speedier patient transfers from one medical facility to another will be made possible thanks to an electronic patient system. The patient’s condition will be recorded and used by nurses and doctors at polyclinics and other Olympic medical stations.

The system, designed by French information technology provider, Atos Origin, was used at the Turin Olympics and during the Beijing Olympics.

If a patient must be transferred to one of Vancouver’s hospitals, the information recorded on Atos’ system will be communicated to CareConnect, the electronic patient record used in Vancouver, says Dr Patricia Daly, chief medical health officer at the Vancouver Coastal Health Authority. Atos and her team are currently working on making the two systems interoperable with each other.

The electronic patient system will play an important role in disease surveillance, since the situation created by the Olympics and Paralympics of massive crowds within small areas will most likely affect the evolution of diseases that spread easily, such as influenza and meningitis.

“It’s a matter of having eyes and ears in different places,” says Dr Bonnie Henry at the British Columbia Centre for Disease Control (BCCDC). “We need to be able to find people rapidly.”

Data such as the patients’ symptoms, where they have been, where they sleep, what they ate, and with whom they have been in contact, are the type of information that will be aggregated and transferred to Vancouver Coastal Health, VANOC’s main partner in public health.

The challenge is to determine what will happen, but in February and March, “there’s likely to be influenza during the Games,” says Daly. If Vancouver Coastal Health notices an increase in the number of flu cases, it could treat the patients with an antiviral agent, better known under its commercial name, Tamiflu, to reduce the spread of the virus to other people. “It is being used all the time in Vancouver,” claims Daly.

Flu shots are not effective in outbreak conditions as they only become active two weeks after their administration. In order to reduce outbreaks, “we’ll make recommendations to all Olympic teams to receive flu shots (before coming to Canada),” says Daly. She says the World Health Organization sanctions flu shots used in Vancouver, so the 2010 version should be available to all countries in the Northern Hemisphere.

As for visitors, “the opportunity to fight the flu is limited,” she says, especially if they don’t receive a shot before coming to Vancouver. Health messages will be put at strategic locations to remind visitors to wash their hands, for example.

The Norwalk virus (or norovirus), a highly contagious virus that causes gastro-enteritis, is also in the line of sight, says Daly. Vancouver Coastal Health will target the hospitality industry and teach them how to recognize the spread of the virus.

If things do get out of hand, VANOC will be able to rely on the Public Health Agency of Canada (PHAC), which is mandated to act only upon requests from the government of British Columbia, according to Dr Theresa Tam, director general for the Centre for Emergency Preparedness and Response at PHAC.

PHAC will deploy more quarantine officers at the international border and in Vancouver for the duration of the Games. “We’ll have to pay more attention to travelers (for infectious diseases),” says Tam.

She says PHAC can provide a vast array of services, such as extra laboratory facilities and experts. A level-3 biosafety laboratory will be available in case of chemical or biological incident, including terrorist attacks.

The National Emergency Stockpile Supply – a reserve of medical supplies ranging from water decontamination tablets to generators – will be open in case of natural disaster.

The size of the city of Vancouver is a major advantage when it comes to emergency preparedness. “We have more experience than maybe other cities… it will help us manage the Olympics,” notes Daly from Vancouver Coastal Health.

Vancouver is not foreign to special summits and conferences drawing large influxes of people either. Successful annual events such as the Celebration of Light, a fireworks festival with attendance peaking at close to half a million people, show that Vancouver can overcome the people-factor.