NESS Mini-Clinics

When disaster overwhelms a Canadian community’s medical resources, a federal program called the National Emergency Strategic Stockpile (NESS) can deliver fast relief.

The capability was demonstrated last August in the Nunavut hamlet of Rankin Inlet during a disaster scenario under the Government of Canada’s annual event called Operation Nanook. The various emergency scenarios simulated fires and an explosion, generating casualties well beyond the response capacity of the regional hospital. A call for assistance soon followed.

Operation Nanook 2017, mass casualty exercise. (Photos: Richard Lawrence)

Tammy Delaney-Plugowsky of the Public Health Agency of Canada (PHAC) and Chief of the National Emergency Strategic Stockpile, accompanied the program’s assets to the Rankin Inlet Community Centre, where a complete Mini Clinic was quickly unloaded and installed. This capability is already in place in the Yukon and Northwest Territories, Op Nanook 2017 marked “the first time we’ve deployed it for training purposes in Nunavut,” she said.

“This is the first time we’ve jointly worked with DND in order to bring this asset up here in order to train the local emergency management team as well as to support the exercise objectives.”

A Royal Canadian Air Force cargo aircraft delivered the NESS assets to Rankin Inlet on one palletized aircraft load. “Normally, our system primarily focuses on land transport. Obviously, in the North, that’s problematic,” Delaney-Plugowsky explained. “It was a great collaboration,” she said of the airlift experience.

NESS was designed to provide surge capacity in the event of health emergencies in Canada, quickly delivering a range of social and medical assets. “It is in support of the provinces and territories and so we have a number of pharmaceuticals, chemical countermeasures, and assets such as this Mini Clinic. We also have emergency social services assets like beds and blankets. An example of that would be beds and blankets employed in the B.C. region to help address displaced people from forest fires.” 

Tammy Delaney-Plugowsky Senior Manager of the National Emergency ­Strategic Stockpile.

When the Mini Clinic is deployed, the Public Health Agency typically provides two staff members to support it from a logistics perspective. “So what they do is travel with the asset to help set it up in whatever community centre, school or other location the province or territory has deemed adequate to support this activity,” Delaney-Plugowsky said. 

A formal request from a provincial or territorial health emergency management authority is the initial action to trigger a NESS deployment. “We don’t move until they have asked for the assistance.” 

During the 2010 Vancouver Olympics, the NESS Mini Clinic was deployed at the base of Whistler Mountain to handle triage and minor treatments. PHAC has also pre-deployed the Mini Clinic to G8 and G20 summits and similar high profile events.

For safety and security reasons, the Public Health Agency does not disclose the location of its central depot or other warehouses that are strategically positioned across Canada. The various modules that make up any deployment are scalable and flexible to handle a variety of different circumstances in terms of treatment options and setup options.

National Emergency Stockpile System Mini-Clinic.

The Agency does not staff the Mini Clinic; “health personnel are a provincial and territorial legislative responsibility so the federal government really doesn’t get involved in the selection of the people that are going to be working in these environments,” Delaney-Plugowsky confirms. 

The goal of the stockpile program is to have assets in motion within 24 hours and to have them landed and set up within another 12 hours. 

In Canada, the emergency management response is local first, then provincial and territorial, and then federal, so that by the time the request for assistance arrives at PHAC’s Centre for Emergency Preparedness and Response, the emergency is usually well understood and the NESS team has had time to get organized.

Associated with the physical assets are agreements with the provinces and territories that allow for personnel to be moved between jurisdictions in case of need. “We do have the capability to reach out to our partner provinces or territories or partner federal government departments to see who has assistance, who can help out with this, who has staff they can ship up or ship south, according to the situation.” And so, the Public Health Agency worked with its provincial and territorial partners to develop an operational framework for mutual assistance system, and it has been working out very well. “We actually used that in the Calgary floods to get environmental health officers so there is a capability to reach out to other provinces and territories to provide that support,” says Delaney-Plugowsky.

Richard Bray is a FrontLine correspondent.