“ The Great flood of 2014

In This Issue
Message from the Editor
announcements
Pgme update
resident research night
welcome to kidzone
Pg 3
Pg 5
Pg 8
Pg 11
Pg 14
A Department of Anesthesia and Perioperative Medicine Publication
Winter 2014
The Great flood of 2014
Dr. Chris Christodoulou
“
Each of us as human
beings has a responsibility
to reach out to help our
brothers and sisters affected by disasters. One day
it may be us or our loved
ones needing someone to
reach out and help.
The cold temperature of -27C on January 23,
2014 coupled with a critical failure of the OR
air handling system resulted in multiple reheating coils in the ceiling of the Operating Room
complex to rupture and burst with the resultant
water damage to many areas. Anesthesia Induction Attendants recall an explosion (rupture
“
MichaelW. Hawkins, American Red Cross
H
ospital disaster planning in
Winnipeg due to the threats
of rising water levels in the
Red River basin have not been uncommon over the last twenty years. In 1997
and 2011 significant floods threatened
the clinical operations of St. Boniface
Hospital. Few including myself could
ever have envisaged that on the 23’rd of
January, 2014 the entire Operating Room
complex (14 Operating Rooms, PARR,
Preoperative Holding and MDR) at St.
Boniface Hospital would be closed for
a period of three weeks as a result of an
intrinsic flood disaster. Two additional
intrinsic flood disasters affecting operating
room closures were reported in Canada
in 2014, however none were of the scope
and magnitude of the St. Boniface Hospital
disaster.
of the heating coils) followed several minutes
later by a torrential flood of water through
the ceiling tiles into the OR corridors and OR
suites. My first hand experience revealed all OR
health care team members working collectively
in the chaotic environment to move patients
out of the OR’s and complex, protect valuable
equipment and supplies from water damage.
Initial efforts were focused on countering the
threats of electrical, water and fire hazards. Our
Obstetrics unit including OR’s were thankfully
unaffected by the disaster.
The Hospital Incident Command System
(HICS) at
St. Boniface
Hospital led by
Chief Nursing
Officer, Wendy
Rudnick was
immediately
activated. Multiple individuals
with assigned
leadership roles
(Operations,
Logistics, Planning, Communications etc.)
were immediately tasked
with developing
a coordinated
plan in response
to the disaster.
The St. Boniface Hospital Property Maintenance and Management team led by Stephen
Cumpsty were leading efforts to ascertain the
scope and magnitude of the multifactorial system problems that precipitated the disaster.
Cont. Pg 4
Winter2014
Page 1
M e s s ag e f rom T h e D e pa rtme nt He ad: Dr. Eric Jacobsohn
T
his late fall/early winter
edition of Gaslines gives
me an opportunity to
highlight some of our successes
and our challenges.
The undergraduate academic mission of our Department
continues to evolve. With the
redesigned Med 1 and 2 curriculum, our Department has been
able to secure increased time in
the curriculum. We have taken
a significant leadership role in
teaching clinical reasoning to Med
1 students. We anticipate that
success in this course will lead
to even more opportunities in
teaching clinical reasoning in the
2016-2017 year. The Department
is now probably approaching the
level of engagement in undergraduate curriculum that is seen
as a reasonable contribution by
the University at-large; however, I
believe that it is imperative for the
Department to “own as much of
the undergraduate curriculum as
possible”. This clearly has important long-term positive effects for
the Department and our specialty.
The feedback we have had from
the faculty teaching the clinical
reasoning course, is that this is
a very rewarding and positive
experience. We are hopeful that
several more faculty members will
become engaged in future years.
Our Department’s engagement
in the Clerkship remains robust.
The increasing number of medical
students rotating through the
operating room means that we are
all increasingly teaching medical
students. In general, evaluations
by the students remain very positive. I wish to thank all the faculty
members who have made such
an effort, and also wish to thank
Dr. Marshall Tenenbein and his
undergraduate leadership team.
The residency program remains
very robust under the leadership
of Dr. Craig Haberman and Tara
De Castro. As we are approaching
CaRMS season, I encourage as
many faculty members as possible
to take this opportunity to be part
of the process of choosing our
future colleagues. The residency
program will continue to evolve
over the next few years, especially
as it relates to competency-based
medical education. Dr. Raj
Rajamohan has been appointed
as Associate Program Director to
assist the program in the transition to competency-based medical
education. We welcome Raj to
this important role. Dr. Sanjay
Sareen will also be working closely
with the program in this transition
to competency-based medical
education, and we welcome him
to this role.
Our Fellowship programs have
been very active over the last
12 months. They are currently
accepting applications for our
Fellowship programs for next year,
including Perioperative Medicine,
Simulation, Pediatrics, Neuroanesthesia, Cardiac, Research and
General. We are also pleased that
the Department has been able
to procure the funding for two
Donalda Huggins advanced study
scholarships next year. These are
in the amount of $25,000.00 to
fund advanced clinical or research
activities. We have had several
good applicants for the scholarship, the results of which will be
announced towards the end of this
calendar year.
vices. The Canadian Anesthesiologists’ Society, the American
Society of Anesthesiologists and
several other national societies
recognize the critical role of anesthesiologists outside of the operating room. We established our first
perioperative medicine service at
the Health Sciences Centre 6 years
ago. This unit has been an overwhelming success and has served
as an important role in providing
clinical care to high-risk surgical
patients. It was important for us
to try and duplicate perioperative
medicine service at community
hospitals, but understanding the
scope and type of a perioperative
medicine care would vary from
hospital to hospital, depending
on patient characteristics and
local conditions at each hospital.
With this in mind, we successfully created our first community
hospital perioperative medicine
service at the Concordia. The
perioperative anesthesiologist
covers a partial day in preoperative clinic, in-house consultations,
rounds on complex postoperative
patients
(such as
On the clinical front, the significant development in the
region has been
the institution of
Perioperative
Medical
Ser-
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sleep apnea or patients with other
comorbidity), emergency response
to the PACU and other hospital
units during the day, and is an “extra set of hands” in the operating
room as required. This model has
been an overwhelming success
at the Concordia; and similar
services have recently been started
at the Grace, Victoria and St. Boniface Hospitals. Similar plans are
in place for starting up a pediatric
perioperative medicine service in
February 2015. We are exploring
the feasibility of a similar service
at the Seven Oaks Hospital. These
models of perioperative medicine
reflect contemporary anesthesia
practice, are aligned with what
our specialty is aiming towards,
and are aligned with the vision of
‘perioperative surgical home of
the ASA’.
Finally, I would like to remind
faculty and residents/fellows of
our Annual Gala to be held on
April 25, 2015 at the Fairmont
Hotel. This is one of the highlights of our year and allows the
faculty to recognize the graduating residents, the residents receive
their certificates of completion of
training from the University of
Manitoba, and we get to meet the
parents, spouses, etc. of our graduating class. Similarly, the faculty
are recognized for their teaching
efforts and the annual teaching
(resident and medical student)
awards are presented. We are
also honoring Dr. Bill Pope with a
special award in recognition of his
long career as a faculty member in
our Department.
Wishing you all
a healthy and
happy holiday
season.
mes s ag e f ro m t h e E d i to r: Dr. Amit Chopra
W
elcome to the 2014
fall edition of our
University of Manitoba Department of Anesthesia
Gasline newsletter. Anesthesiologists are trained to deal
with perioperative emergencies.
The scope to expertly deal with
these issues has broadened. The
unique skill set Anesthesiologists
possess translates well in areas of
crisis and disaster management.
Naturally, Anesthesiologists have
provided important leadership in
such areas. This edition of gasline
focuses on such an example. The
excellent work and leadership of
Dr Christodoulou, and others, in
minimizing the damage to patient
care and coordinating an effective
response during the SBGH flood
reflects the role and importance of
Anesthesia leadership in disaster
management. To complement Dr
Christodoulou’s article, Dr Cannon has written an excellent piece
that highlights past, present and
future challenges to Anesthesiologists in the context of natural and
man-made critical events.
This edition of Gasline also
features an article by Dr Greg Klar
that outlines some of the global
issues Anesthesiologists have to
contend with. It touches on topics
from developing comprehensive strategies to treat Ebola, to
international medical education
and health care work done by our
Department.
We also have decided to do a departmental profile of the Pediatric
Anesthesia program including the
retirement of Dr. Leena Patel. For
faculty outside of HSC, they may
be disconnected to what happens
at Childrens. Fortunately, Dr Sabapathy has provided a nice overview
of the ongoings at the kidzone.
Our alumni profile was Dr Paul
Tenenbein. He has generously
provided us with an update of how
he is doing. From his leadership
role as Chair of Ontario Anesthesiologists to his BEYOND THE
MASK initiative, I am sure you
will all be proud to read about a
University of Manitoba department of Anesthesia alumni doing
well outside the province.
Finally this edition of Gasline has
important contributions from Drs
Jacobsohn, Kowalski, Haberman
and Brown. There are interesting
reads about competency based
medical education, highlights
from resident research night and
expansion of perioperative medicine service to community sites
among other topics I hope you
find interesting.
We hope you enjoy this edition
of Gasline, and from our team, we
wish everyone Happy Holidays.
Ane s t h es i a Ac l s U p dat e : Dr. KelvinWilliamson
W
e have completed a
total of 8 Anesthesia
ACLS courses. So far,
the response and feedback have
been positive. Please allow me to
share some of the feedback with
those of you who have not yet
participated in the course, and
also answer some of the questions/comments.
As of late, the sign ups for the
courses (which occur monthly,
on a Wednesday evening, at the
Sim Centre in the basement of the
Brodie Centre) has been low. The
November class was cancelled due
to low enrolment. Hopefully, the
eagerness will pick up again.
Based on feedback, allow me
to shed some light onto the expectations prior to showing up to the
Sim lab. And having said that,
directions to get there.
Firstly, Corina sends out monthly email reminders about signing
up, which is through the CPD
department. The dates, of future
courses, and the link to the CPD
website can be found from our
departmental website (from main
site, click “CPR/ACLS Portal”,
found on list on left, then choose
“ACLS Page”).
Once registered and paid, there
is a downloadable PDF, which is
notes for course with a short set
of questions at the end. You are
expected to read over the slides
and complete questions prior
to attending Sim lab. These are
abbreviated notes, for further
reading, I direct you to the formal
Heart and Stroke ACLS Provider Manual (Available at U of M
bookstore).
For those of you who are
hesitant to participate in the Sim
process, let me assure you, it is a
positive experience. Those who
have participated and who were
hesitant at first, now praise the
process. The course is meant
to stimulate discussion while
working through scenarios. In
addition, although everyone gets
a turn in the “hot seat”, the team
approach is also emphasized.
Post participation surveys so far
have been positive with regards to
timing of course, length of course,
and quality of product vs a regular
ACLS class. The scenarios are
considered relevant and pertain
to our every day practices. When
asked, participants overwhelmingly believe the program should
stay as it is.
Having said that, there will be
an evolution with regards to pre
Sim review, test questions, and
Sim scenarios. We will continue
to strive to make the scenarios as
realistic as possible, while making
them pertinent to everyday anesthesia encounters. We encourage
participants to show up in scrubs
to give the scenarios a more “real
life” feel to the environment.
Lastly, one of the main critiques
has been how to get to the Sim
lab. When you walk into the Brodie centre main doors, walk to the
bookstore and take a right to
the set of elevators (a staircase
is just past those elevators). go
down to basement where the
Sim lab is located.
If you take the glass elevator
in the middle of Brodie, you
will end up i the wrong part of
the basement and find yourself at the Brodie gym.
The future for the program
involves updating to reflect
new guidelines (Emergency
Cardiovascular Care document, expected to be released
in Dec, 2014). The current
style will remain in place until
we have cycled through our
staff.
Our faculty for sessions are:
Dr. Bohn, Dr. Tenenbein, Dr.
Young, Sean Jardine, Jared
Campbell, Mark Ratz, and
Regina Kostetsky, and myself.
Winter2014
Page 3
Th e G r e at F lood of 2 0 14
All patients in the OR complex
were immediately evacuated
including a cardiac patient in
surgery who required stabilization
and transfer to the Health Science
Centre for an emergent coronary
artery bypass grafting procedure.
In hospital contingencies
included the identification and
infrastructure support required to
open three emergency operating
room suites located in Diagnostic
Imaging, Cardiac Catheterization
Lab and the Cardiac Surgical ICU.
All of these sites were prepared
with Anesthesia machines and
equipment to deal with any surgical emergency during the closure
of the OR complex. In addition
new Anesthesia supply lines and
inventory maintenance procedures
were put in place to support our
Anesthesia mission in the hospital
at large. Several urgent cases were
performed in these contingent
OR’s during the course of the next
three weeks.
The WRHA Leadership Team led
by Dr. Brock Wright in collaboration with the St. Boniface Hospital
HICS team developed a coordinated plan to deal with the diversion
cont inu e d
of all urgent surgery to alternate
WRHA Hospitals and the approximately 350 elective surgical cases
that needed to be rescheduled in
the WRHA region.
The Cardiac Sciences program
was able to establish elective and
urgent surgical services at the
Health Sciences Centre due to
the outstanding collaboration
of Dr. Scott Mackenzie (Cardiac
Anesthesia Medical Director),
Dr. Prakashen Govender (Anesthesia Site Leader, HSC), Cardiac
Anesthesiologists, the HSC OR
and ICU Teams, and the SBH Cardiac Surgical and Nursing Team
members. Acute Care Surgical
patients were diverted to the Grace
Hospital and many urgent and
elective surgeries were completed
at the Concordia, Grace, Seven
Oaks and Victoria Hospitals over
the ensuing weeks.
monitoring systems. (Please see
the image of the new OR suite
monitoring panels.) Additional
enhancements to the maintenance
of OR suite air quality included the
development of a policy related to
the human and behavioral aspects
related to OR access including the
avoidance of maintaining doors
in the open state for prolonged
periods during cleaning, entrance
and exit maneuvers.
Excellent communication strategies led by Dr. Michel Tetreault
(President and Chief Executive Officer of St. Boniface Hospital) were
coordinated delivering factual and
up to date information regarding
the disaster to patients, families,
health care team members, WRHA
and regional partners, local and
national press. I am pleased to report that no patient or health care
team member suffered harm as a
The repair of the OR complex
air handling system also resulted in many significant upgrades
to the OR suites to enable the
monitoring of the number of air
changes (minimum 20 per hour),
improved door seal mechanisms,
temperature, humidity and alarm
result of the SBH Flood Disaster
2014. It is truly remarkable given
the scope and magnitude of the
disaster. I would like to personally
thank Dr. Eric Jacobsohn, Reid
McMurchy, Dr. Scott Mackenzie,
Dr. Prakashen Govender, Dr.
Trevor Lee, all my Anesthesia
colleagues, St. Boniface Hospital
leadership in particular Dr. Michel
Tetreault, Wendy Rudnick and the
HICS team, WRHA Leadership,
Anesthesia Residents, Anesthesia Clinical Assistants (image
attached of the SBH Anesthesia
Induction Attendant Team, Jack
Kress and Larry Mudge who
did a remarkable job during
the disaster), Regional Surgical
Teams, Nursing Team members
and Regional Schedulers within
the entire WRHA system for their
outstanding contributions and
collective team work that enabled
St. Boniface Hospital to deal with
the disaster, minimize patient and
staff risks and develop new systems
that will continue to foster patient
safety in the future!
Dr. Chris Christodoulou
Site Leader, SBH Department
of Anesthesia and Perioperative
Medicine
H ai l to th e C h i e f : Dr. Brian Gregson
A
s the end of
2014 approaches the
resident group has
many positive things to
look back on, including
a wonderful cohort of
new residents
starting in
July, the
arrival of
several
new
babies
for residents, and a very successful accreditation review
by the Royal College.
Many of the residents have
been busy with research this
year, and at another successful
research night awards were given to Yara Bychkivska for
the best completed
research project
and to Raegan
Cleven for the best
research project
in progress. Congratulations!
We continue to have residents
participate in several ongoing
overseas projects. In January Mehdi Sefidgar (now completing his
pain fellowship) joined Dr. Reimer
on a Mercy Ship mission, and Raegan Cleven has just returned from
a trip to Nicaragua with Operation
Walk. We all admire the residents
who are giving of their time and
energy in this way, but also the
faculty who mentor them in these
endeavors.
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Finally, we have been enjoying an
increasing role in undergraduate
medical teaching at pre-clerkship
and clerkship levels, and we are
fortunate to have another strong
connection to the medical students
through the active Anesthesia
Interest Group. In particular, we
are looking forward to meeting
applicants as we begin to prepare
for the CaRMS process again this
year, including the new Brandon
Stream.
Mess ag e f ro m t h e E d u c ation S e c tor: Dr. Rob Brown
M
ake no mistake,
CBME is coming.
The mere utterance
elicits anything from eye-rolling to
predictions of the end of medical
education. Of course speculation
is rampant, and it behooves us to
clarify what CBME is and what it
is not. It is neither a panacea nor a
curse. CBME will be a huge step.
Whether it is forward or backward, depends on how we as an
educational community manage
it. CBME simply means holding each trainee accountable to
demonstrate competence in all of
the competencies required of their
discipline. The astute educator
will point out that good programs already focus on
criterion-referenced,
demonstrable goals
and objectives.
So, how is CBME
different?
CBME
emphasizes evidence of
proficiency and
puts the onus on
the trainee
for its
collection. (ie You are competent
at x when you show me n assessments by different staff stating that
you performed x competently- not
when you finish the x rotation).
CBME lays out all of the competencies and tracks them more
explicitly. The truth is that current
assessments tend to be Gestalts,
often overlooking substantial
weakness in a few objectives as
long as the overall rotation performance is ok.
A few key myths/issues demand
specific attention in any discussion
of CBME:
CBME is data intensive. A great
deal of assessment data is required
to support CBME. However, in
the end it is no greater that
what would be required to
implement our current
system properly.
CBME = time-free.
The rhetoric from
the RCPS insists that
CBME means allowing
trainees to progress
independent of time. This
conflation goes back to the
early pundits of CBE. CBME
makes it possible to remove
time from the design of programs,
not necessary. Even the infamous
RCPS orthopedic experiment admitted (sotto voce) that it is not
realistic to remove time from
the structure of programs.
Trainees will finish sooner.
Dearly held by CBME proponents,
this also has no basis in fact. Even
without timelines, the only way the
average trainee finishes sooner is
if we mess it up by succumbing to
the following risks.
CBME = striving to suffice. This
is a legitimate risk. At its base,
CBME only requires a trainee to
demonstrate a minimum level of
proficiency in all areas. Where is
the drive to excel? It can be preserved, but will require thoughtful
program design. For example, a
trainee might have to demonstrate
excellence in 10% of the competencies and superiority in a further
10%, with the bare minimum in
the remaining 80%.
CBME is reductionist. Another
huge risk, this is also subject to our
diligence. The fear that we will
lose some ineffable professional
attributes rests upon the absurd
belief that we promote their development by leaving goals nebulous.
It is precisely those holistic attributes that we most consistently fail
to instill. Though challenging, any
attempt to identify and assess these
competencies is a step forward.
The risk here is in not trying and
thereby codifying their irrelevance.
itudinous assessment. If we as a
community continue to call suboptimal performances adequate, we
will generate a cadre of incompetent people with proof of competence. CBME assessments will be
concrete and criterion-based, and
really do hold the promise of a
great improvement, but whether
that happens is entirely contingent
upon us.
Lest I leave the impression that
I am a CBME skeptic, I am not.
CBME is a more pedagogically
sound approach to professional
education. If we do it well, it will
be an improvement. Moreover,
all caveats aside, doing it well is
well within our grasp. The biggest
threat to CBME is the same as it is
to non-CBME- poor assessment.
The reasons that we have trouble
providing good assessments are a
topic for another issue. However,
the hard work is in program design. Day-to-day implementation
is really business as usual.
CBME is data intensive. The
biggest risk to CBME is not data
volume but quality. Medicine is
plagued by the curse of the plat-
D epart men t A n n ou n c e m e nts
Dr. Eric Jacobsohn received the
award for CAS Teacher of the Year
2014. Congratulations on this
Canada wide honor.
Dr. Archie Benoit and Dr. Trevor
Lee have assumed Co-Site Leadership at the Misericordia Health
Centre April 1, 2014.
Dr. Leanne Docking has assumed
the position of Medical Manager,
Obstetrical Anesthesia, HSC effective July 1, 2014.
Dr. Marshall Tenenbein has
assumed the position of Anesthesia Co-Site Medical Manager at the
Victoria General Hospital effective
July 1, 2014.
Dr. Raja Rajamohan has been
appointed as Associate Postgraduate Program Director for the
University of Manitoba Anesthesia
Residency Program.
Dr. Ruth Graham has assumed
the position of the Medical Manager of Pediatric Anesthesia and
Section Head of Pediatric Anesthesia, University of Manitoba.
Dr. Lena Patel retired from childrens OR with 40 years of service.
Dr. Ainsley Espenell assumed
the role of medical director for the
Malignant Hyperthermia registry.
Winter2014
Page 5
P OT E N TI A L CHALLENGES TO AN ESTHESIA DEPARTMEN Ts IN THE 2 1­s­­t CE N TU RY
Dr. Jack Cannon
T
he headlines in the news
for the last 6 months have
been dominated by three
stories: (1) the conflict between
Russia and Ukraine, (2) the violent
incursions of the ISIS in the Middle East, and (3) the growing Ebola
virus outbreak in West Africa.
Recently, terrorist acts in Quebec
and Ottawa by radicalized Canadians have hi-lighted the spectre of
terrorism at home.
Last January (2014), the operating rooms at St. Boniface Hospital
(SBH) were shut down for almost
two weeks, due to failures in the
environmental systems. The
surgeries performed at SBH had
to be cancelled, or shifted to other
hospitals within the Winnipeg Regional Health Authority (WRHA).
Concurrently, I read the book Five
Days at Memorial 1, which detailed
the challenges faced by the staff
and patients at a hospital in New
Orleans during and after Hurricane Katrina (2005). These events
led to a departmental presentation
2
, and to a presentation to senior
administrators 3 at SBH. This is an
updated and abridged summary of
that presentation.
Events that may challenge the
hospitals within the WRHA (and
our anesthesia departments) fall
within two broad categories: (1)
events that cause the hospital to be
overwhelmed by patient numbers,
and (2) direct damage the hospital
that disables facility infrastructure,
equipment, or staff, OR events
that limit the ability of the staff to
perform their duties. Two broad
categories encompass the events
that might result in these problems: (1) natural (e.g. – weather-related events, natural disasters,
and medical incidents, likely
infectious), and (2) man-made
(e.g. – accidents, acts of terrorism,
and war).
Weather remains a likely cause of
potential interference with health
care delivery in Manitoba. Blizzards can disrupt staffing in hospitals, interrupt food and supply
delivery, and create power failures.
Some of us remember March 4,
1966 (36 cm snowfall), which
brought the city to a standstill for
days. November 7, 1986 (38 cm)
and April 4-7, 1997 (48 cm) are
two other examples of heavy snowfalls which caused major problems.
Virden was buried under 76 cm of
snow on April 19, 1992. Manitoba
has not experienced the ravages of
an “Ice Storm”, such as suffered in
eastern Canada in 1998 (25 dead),
with its attendant widespread
power failures (up to 4 weeks) and
transportation disruptions (staff
and supply).
Floods remain the weather-related disaster Winnipeg is best
known for. The spring of 1950 saw
large parts in Winnipeg underwater, including all the area around
SBH. The Red River was 30.5 feet
above the winter average (datum:
727.6 feet above sea level), and the
Red River flow was 3060 m3/sec
(avg. flow rate 244 m3/sec). This
was the driving force behind the
creation of the Red River Floodway. However, the “Flood of the
(20th) Century” (1997) pushed the
Red River to a flow rate of 4600
m3/sec, and the river rose to 34’ 4”
above datum. Though Winnipeg
was not substantially damaged,
fear of flooding forced cancellation
of many elective surgeries at SBH
for two weeks. The Floodway was
expanded after that to withstand
potential “500 year” floods. The
flood of 2011 was worse than
1950 (3300 m3/sec, 31’ 2” above
datum), though the damage was
more severe in western Manitoba.
However, global climate change
may change our flood patterns,
and the “Flood of the Century”
may become more routine in the
21st century. It has been estimated
that the Red River Valley flood of
1836 was accompanied by a Red
River flow rate of 6400 m3/sec, and
a water height of 36’ 5”.
Violent summer weather in
Manitoba now includes tornadoes. Again, changing continental
weather patterns are bringing
“Tornado Alley” north. Manitoba
now averages 15 tornadoes each
summer. So far, only property
damage has occurred, but 27
people died, and 253 were injured
when a tornado hit a trailer park in
Edmonton in 1987. In 2007, only
two Fujita Scale (F0-F5) F5 tornadoes occurred in North America,
one in Texas, and the other in Elie,
Manitoba (June 22) – property
damage only.
A geophysical analysis of North
America demonstrates that Manitoba has historically been more
stable than anywhere else. There
has not been a significant documented earthquake in Manitoba
in hundreds of years. However,
North Dakota has become a
hotbed of hydraulic fracturing for
oil and gas trapped in the Bakken
shale gas formations. Recently,
areas that have been subjected
to intense fracking activity have
seen subsequent increased seismic
activity.
The spreading Ebola virus epidemic in West Africa is grabbing
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headlines world-wide. We know
that modern airline travel can
deliver anyone, anywhere in the
world, to Winnipeg within 24
hours. The recent experience in
Dallas, Texas has demonstrated
that this is not just an African
problem. With proper equipment
and protection protocols, the
infection is not easily transmissible
from person-to-person. Historically, airborne infections have been
more deadly. In 1918 and 1919,
upwards of 50 thousand Canadians
died in the world-wide Spanish
Flu pandemic. More recently
(2003), Severe Adult Respiratory Syndrome (SARS) arrived in
Toronto (from China), eventually
leading to 17 deaths, including
3 health-care workers. One was
an anesthesiologist, presumably
infected during the intubation
of an infected patient. Several
metropolitan Toronto hospitals
were functionally closed for up to
two months. Mosquito-borne infectious diseases (Western Equine
Encephalitis, West Nile Virus) are
endemic to Manitoba, and the
infections have remained sporadic. The National Microbiology
Laboratory (Public Health Agency
of Canada) is located in Winnipeg, and all serious pathogens of
national concern will be brought
to Winnipeg.
What of man-made disasters?
Fires, with mass casualties are,
thankfully, rare. However, in
1974, the Haselmere Apartment
fire, killed 9, and injured 25 in
downtown Winnipeg. In 1977,
the Town and Country Lodge
Apartment fire left 8 dead, and 17
injured. Airline crashes, again, are
rare, but mass casualties are possible. The “Dryden Air Disaster”
(March 9, 1989) killed 24. Winnipeg hospitals were put on alert, as
45 were injured. Eventually, little
local impact occurred. Since 1960,
11 single and twin-engine aircraft
have crashed within the city limits,
leaving 15 dead and 16 injured.
Train derailments, leading to
death and injury, also occur. Toxic
spills can extend the damage and
threat to life. The largest of these
was the Mississauga train derailment (Nov. 1979). The subsequent
explosion, fire, toxic spill, and
chlorine gas cloud, led to the evacuation of 200,000 citizens from
west Toronto, and the evacuation
of the Mississauga and Queensway
General Hospitals. Other metropolitan Toronto hospitals were
recruited to take their patients,
causing disruptions for days. More
recently, the train derailment in
Lac-Mégantic (June 6, 2013) killed
47 and decimated the downtown,
including disruption of the water
supply. Toxic spills are not limited
to trains or trucks. The warehouse
fire at Speedway International in
St. Boniface (Oct. 2012) was fueled
by large stores of methanol. Other
toxic chemicals were suspected,
leading to an 800 metre evacuation
zone. No casualties were reported.
Other transportation disasters
are possible. Bus crashes can lead
to multiple injuries. The MS River
Rouge carries up to 400 passengers on its cruises. Infrastructure
failure; the collapse of the I-35W
Bridge in Minneapolis (2007) left
13 dead and 145 injured.
The nuclear power plant disasters
in Chernobyl (1986) and the
Fukushima Daiichi facility (2011)
caused widespread environmental
damage. Immediate injuries were
related to the effects of the physical
explosions. The two small nuclear
reactors at the Atomic Energy
of Canada Limited Whiteshell
Laboratories (Pinawa) are now
decommissioned. The closest
nuclear power generating facility
to Winnipeg is the Monticello
Nuclear Generating Plant, 56 km
north of Minneapolis, on I-94.
Power grid failures are possible,
with wide-spread loss from hours
to days. The power outages on the
eastern seaboard of the USA and
Ontario in November 1965, and
August, 2003, were both triggered
by human errors; one in Ontario,
the other in Ohio.
Terrorism, either home-grown or
internationally driven, carried out
by a deranged loner or fanatical
believers, is now an everyday
occurrence. Mass shootings
seem to be an American thing,
but they are not. The shootings
at École Polytechnique (1989) in
Montreal produced 14 dead and
14 injured. Whether it be Columbine, Virginia Tech, or Sandy
Hook Elementary School, threats
to education institutions are now
routine. Home-grown terrorists
(Oklahoma City, 1995 – 169 dead,
675 injured) and international
extremists (New York City, Washington D.C., Shanksville, PA, 2001
– 2,977 dead, thousands injured
or seeking medical attention) are
equally deadly with conventional
explosives, used conventionally or
asymmetrically. Public gatherings,
like transportation hubs (London
– 2005 – subway bombings – 52
dead, 700 injured) or sporting
venues (Boston – 2013 – marathon
bombing – 3 dead, 264 injured) are
inviting targets.
Weapons of mass destruction
remain most western government’s
greatest fear. Could a terrorist
group build or obtain a fission
weapon? Almost as dangerous
would be the detonation of a
“dirty” bomb in an urban centre.
I suggest you view the movie
Dirty War 4. It is a most realistic
representation of the detonation
of a plutonium dirty bomb in a
London subway station. Weaponization of pathogens like Yersinia
pestis (the Plague), Variola major
(Smallpox), Bacillus anthacis (Anthrax), as well as the production of
biological toxins (botulinum toxins, shellfish toxins, ricin) are real
threats. In 2001, someone weaponized Anthrax spores, and mailed
them to various government and
public personalities in the USA.
Five eventually died, and 17 others
were infected. Chemical weapons
have been used by military (Iraq,
Syria) forces against their citizens
in recent years. The terrorist
group Aum Shinrikyo manufactured the nerve agent sarin, and
used it in two attacks in Japan in
2004 and 2005. Most infamously,
on March 20, 1995, they released
sarin simultaneously on 5 separate
subway trains in Tokyo. Twelve
died, and 3227 were intoxicated or
sought medical attention. Eventually, 493 were hospitalized.
Cyber-attacks, by state-sponsored
hackers, criminal organizations,
or individuals, are considered the
new frontier of terrorism. Not
everything is identity theft. Large
targets, like the North American power grid, or local targets,
like Manitoba eHealth, are both
possible. Within the computer
systems of WRHA hospitals, theft
of personal information is obvious.
However, corruption of the system
could lead to wide-spread failure
of function or malicious injury
to patients (e.g. purposeful drug
errors).
Lastly, do not forget that much of
US military’s land-based nuclear
arsenal is within several hours
driving distance from Winnipeg.
One of the two active B-52 nuclear
bomber bases is located in Minot,
ND. It also houses the command
of the 91st Missile Wing, which
controls the 150 Minuteman III
ICBMs buried in the ground over
22,000 km2 of northwestern ND.
Another 150 ICBMs are buried in
north central Montana. If these
areas were attacked by Russian
ICBMs, the area of nuclear fallout
would readily spread across the
border into Manitoba. One
assumes that the east-west confrontation over Ukraine will not
escalate. However, it is clear that
the “Cold War” is back.
Potential challenges to the
WRHA are varied and real, if
unlikely. The greatest threat, however, is the thought that “it can’t
happen in Winnipeg”. Though the
staff at all the hospitals undergo
periodic training for various scenarios, many possibilities remain
unprepared for. Facilities are also
underequipped for mass casualty scenarios. As seen in other
jurisdictions, some staff may fail to
report in certain emergencies.
References
Fink S. Five Days at Memorial:
Life and Death in a Storm-ravaged
Hospital. New York: Crown Publishers; 2013.
Cannon J. Health care provision
challenges for SBH & SBH Dept.
of Anesthesia – 2014: a discussion
presentation. Paper presented at:
SBH Department of Anesthesia &
Perioperative Meeting; March 6,
2014; Winnipeg, MB.
Cannon J. Health care provision
challenges for SBH & SBH Dept.
of Anesthesia and Perioperative
Medicine – 2014. Paper presented
at: SBH Executive Team; April 14,
2014; Winnipeg, MB.
Alkin L. (Producer), & Percival
D. (Director). (2004). Dirty War.
[DVD]. United Kingdom & United
States: British Broadcasting Corporation Films & Home Box Office
Films.
Winter2014
Page 7
PG ME U p dat e : Dr. Craig Haberman
W
ith the new academic year in full swing
there are a lot of
exciting things going on in the
Postgrad department. One of the
highlights of the academic year
is always the Resident Research
Symposium which occurred on
November 18th. I am sure that
all who attended would agree that
it was a great night. I would like
to extend my congratulations to
all of the award recipients from
that evening and to all of the
presenters as a whole for a job
very well done. I would also like
to extend my thanks to all of the
preceptors and the people in the
research office who make such a
great evening possible with all of
their hard work.
From a news standpoint many
of you will already know that we
have welcomed Dr. Raj Rajamohan to the postgrad team in the
capacity as associate program
director. I am very excited to
have Raj come on board and look
forward to working with him
in this new role. As we begin
to learn more and implement
some of the positive aspects of
Competency Based Education
as well as CaNMEDS 2015 into
our program we will need this
extra support. As such Dr.
Sanjay Sareen will also be helping
us to modify and implement
some of these changes into our
program and curriculum. The
postgrad team will learn much
more about this initiative over
the next few months in meetings
and workshops with the Royal
College as well as other Anesthesia programs from across the
country. Together the Postgraduate section of ACUDA is working
on what this means for anesthesia
education as a whole and areas
where things can be standardized
from a national standpoint.
Also new for the 2015 academic
year will be a Brandon stream
for Anesthesia residents. This
comes as part of an initiative to
expand the educational role of
the Brandon hospital as a whole
and an attempt to attract and recruit applicants to a more “rural”
medical practice. For
the 2015 academic year
we are offering one
spot for a resident in
the Brandon stream.
The program will still
be administered by the
University of Manitoba Department of
Anesthesia, however,
up to 18 - 24 months of
training over the course
of 5 years will occur in
Brandon. Much of the
first year of training
will occur there as well
as further anesthesia
time, some ICU time
and some internal
medicine months may
be done in Brandon.
Arrangements have been made
such that the resident will be
able to participate in lectures
and academic half days either in
person or via teleconferencing
while in Brandon. Dr. Leonard
Skead will be the site lead for the
Brandon anesthesia stream and
Dr. Charles Penner serves as the
associate dean for the Brandon
site.
We look forward to a couple of
very important upcoming events
in the academic schedule. First
CaRMS interviews will occur on
January 23 & 24 and as always we
are extremely thankful to those
of you who volunteer your time
for this event. This is a crucial
event for us as it is how we both
attract and choose our future
colleagues for our department.
Secondly the Resident Gala will
be held on April 18, 2015 and we
look forward to seeing as many of
you there as possible. It is a great
time of celebrating with our graduating residents and recognizing
their accomplishments as well
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
as those of many of the teachers.
In that regard we are making
a change to the post-graduate
teaching awards this year and will
only be awarding the YK Poon
award for overall best teacher.
This comes as a result of many
discussions and primarily for
the reason that most people are
working at 2 - 3 sites and the
historical “geographic” breakdown of the awards is no longer
as applicable.
As always I am very grateful to
the residents for all of their hard
work as well as the faculty for
their efforts in the postgraduate
program. We are very fortunate
to have such an engaged and
enthusiastic group of teachers
and mentors. If I could make
one plea it would be that faculty
continue to fill out the daily
evaluations and particularly the
comments as this feedback is
vital in how we help the residents
to develop and improve.
The Annual Resident Retreat
took place on September 19,
2014. The day included a trip
to the Fort Whyte Centre and
SkyZone where the residents
engaged in some friendly & competitive dodge ball. Thankfully
no one was injured participating
in the activities. The retreat was
concluded with a social gathering at Dr. Haberman’s residence.
This is an annual event which is
held to recognize and encourage
resident wellness and allows
residents some time to network
with the entire resident cohort
in a much more informal and
relaxed atmosphere as colleagues.
This yearly event is well received
by all who participate. (Photo of
residents at SkyZone provided).
Ob s t et r i c a l U p dat e
T
he baby business
is booming. The
Province of
Manitoba is experiencing a high
growth rate
and we have
suddenly
found ourselves racing
to keep up. By 2020 we
will see approximately
12 600 deliveries in
Winnipeg
with maxi-
mal regional capacity of 12
000. We are eagerly anticipating the opening of the
new Women’s Hospital
at HSC with its capacity for 6100 deliveries. At St Boniface
hospital we are
also looking for
ways to increase
our capacity to
5800 patients
per year as
soon as
possible. We
currently
have a
seven bed high risk Labour
and Delivery unit and a low
risk LDRP unit in which
we have four labour beds
and twelve post partum
beds. One proposed plan
to increase our delivery
capacity (by about 300 deliveries per year) involves the
amalgamation of these two
units to create a sixteen bed
high risk delivery unit. All
post-partum patients will
recover in an inpatient ward
after. We have identified
several non-patient rooms,
that, when renovated, will
create an extra eighteen
semi private post-partum
beds. This new amalgamated unit will be created on
LDRP. The current L&D
unit may be converted to an
expanded triage area. We are excited about these
developments and are actively preparing to address
the anesthesia manpower
issues that this expansion
will create. work with Pharmacy Logistics
to contingency plan for these
shortages.
Specialized and basic equipment 2014-2015: The acquisition and installation of Philips
Vital Signs monitors at SBH
has been completed. We look
forward to the acquisition and
installation of Philips Vital
Signs monitors at the Misericordia Health Centre. Mr. Reid
McMurchy and I will also be
attending the specialized and
basic equipment meetings for
2015/2016, on your behalf.
Provincial Surgery Information System (SIMS) Advisory Team: The Equipment
program continues to be
actively involved in the strategy
and planning for the WRHA
regional OR computerized
management system, with a
future goal of incorporating an
Anesthesia Information Management System (AIMS) into
this project. Meetings with
Dr. Diamond Kassum and the
SIMS Team are in progress.
Dr.Tamara Miller
CLI NI CAL O P E R AT I ON S : DR.Trevor Lee
T
he Clinical Operations
program, together with
the WRHA Anesthesia
Site Leaders, continues to focus
on incorporating incoming
Anesthesia Faculty, Fellows
and locum staff into the clinical
services map for the 2015-2016
academic year.
As well, Clinical Operations
has an ongoing initiative with
the WRHA Surgery program to
more closely examine operating room slate utilization.
Additional clinical practice
guidelines (CPGs) have been
successfully introduced into
the WRHA, including the
updated Preoperative NPO
guidelines. Also forthcom-
ing will be the standardized
Venous Thromboembolism
Prophylaxis CPG.
Gasline UM/WRHA Anesthesia Equipment and Drug/
Supply and Acquisitions
Report for November 2014
For the 2014 fiscal year,
there are a number of ongoing
equipment and drug projects
that UM/WRHA Anesthesia is
involved in:
WRHA medication shortage: The WRHA continues to
experience ongoing shortages
of various Anesthesia medications. The UM/WRHA Anesthesia program continues to
Thank you for your continued
support of the Equipment and
Drug/Supply and Acquisitions
program.
Winter2014
Page 9
R e s i d e n t R e s e arc h Award Dinne r
Ben Shell Award: Dr. Brian Gregson
Best PGY 4 Presentation: Dr. Raegan Cleven
Best PGY 5 Presentation: Dr. Yaryna Bychkivska
Joe Lee Award Winner Dr. Brian Gregson
Joe Lee Award Winner
Dr. Joseph Bednarczyk
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
R esi d e nt R e s e a rc h N ig h t: Dr. Stephen Kowalski
T
his year’s adjudicator
was Dr. Andrew Klein
from the Papworth
Cardio-Thoracic Centre in
Cambridge, England. He
is a cardiac anesthetist and
intensivist. He is no stranger
to Canada having done part of
his post-graduate training in
Toronto at the Toronto General
Hospital. He has an extensive
curriculum vitae with more
than 60 peer reviewed publications. He has recently been
appointed as the editor-in-chief
for the journal “Anesthesia”.
We were indeed very fortunate
to have someone of his caliber
at our research evening. He
provided insightful, constructive comments for the various
resident presentations. He
was genuinely impressed by
the infrastructure and support for resident research at
the University of Manitoba.
This is not available to British
residents during their training.
Moreover, he was very complimentary of the quality of the
work presented.
This year there were six
poster-discussion presentations by the R4 residents and
four oral presentations by the
R5 residents. All the residents
acquitted themselves very well.
Congratulations, once again,
must be given to all the residents for the work done and
the professional nature of their
presentations.
Dr. Klein selected Dr. Raegan
Cleven’s poster, “Ability of
Inflammatory Biomarkers
to Predict Postoperative
Complications in High-Risk
Patients Undergoing High-Risk
Non-Cardiac Surgery” as the
best R4 presentation, Dr. Yara
Bychkivska’s project “The Role
of Timing of Dexamethasone
Administration on Pain Scores
and Quality of Recovery in Cesarean Section.” as the best R5
oral presentation. The winner
of the Ben Shell Award for the
best overall research project was Dr. Bryan Gregson’s
project, “Brain MRI CO2 Stress
Testing: A Pilot Study in Adolescent Concussion Patients”.
There were two co-winners
of the Joe Lee Award for a
physician who exhibits both
great clinical skills as well as
mirroring Joe’s caring and
humanistic nature. They were
Dr. Bryan Gregson (Anesthesia) and Dr. Joseph Bednarczyk
(Critical Care).
The overall evening was a
great success with over 100
attendees. We were fortunate
in that family members of the
late Dr. Shell and the late Dr.
Joe Lee were also able to be in
attendance for their respective
awards presentation.
Bergmann’s catering was the
perfect host, as always. Once
again, the evening could not
have gone forward without the
tremendous work and organization of Ms. Linda Girling
and the other members of the
research office, Ms. Regina
Lagaspi, Ms Marita Monterela,
Ms Devina Govender and Ms.
Divia Parveen.
We are already planning for
next year’s event tentatively on
November 17, 2015 with the
planned adjudicator being Dr.
Simon Mitchell from Auckland, New Zealand.
Dr. Andrew Klein
Anes t h es i a C l in i c a l A s s i s tant Graduation
C
ongratulations to our 3 newly graduated ACAs. After a
long year of hard work including long days and nights,
the Department of Anesthesia is proud to welcome
our 3 hard working clinical assistants into our family. Sarah
Lazaruk, Will Owens-Krahn and Grant Beck all successfully
completed their training program graduating into practice in
September. They will be rotating around the region with a primary focus on the tertiary centers over the next year.
Our Anesthesia Clinical Assitants now total 13 for the region
and cover every operating room including newly added Seven
Oaks within the WRHA. Thanks goes out to our hard working
and dedicated management team Dr. Shawn Young and Bruce
Knoll for making this happen.
Please join the department in congratulating our new ACAs
on a job well done.
Winter2014
Page 11
Far e w e l l D r . Pat e l
Leena Patel has decided to “retire”.
Needless to say she is missed. To be honest, we didn’t always know where she was when she was working
at Children’s. Was she on the phone arranging for an emergency? Was she moving the slate around to fit
someone in? Was she helping a colleague in another room? Wherever she was, she was always caring for her
patients.
Since 1975, Leena generously, cheerfully and capably shared her experience, knowledge, judgement, skills
and support to all who asked....students, residents, colleagues both anesthesia and surgical, ACAs, nursing
and support staff. She taught almost all of us our Pediatric Anesthesia; she was full of energy and fun to work
with. She was also at times mischievous, or could be a bee in your bonnet. Ultimately, she was loyal, trustworthy and fair.
It was a privilege to have Leena as a friend, a teacher and a colleague. Our lives and the care of our patients
are that much better.
Watch out...have laryngoscope, will travel!
GasLine - A P u b l i c a t i o n o f t h e D e p a r t m e n t o f A n e s t h e s i a a n d P e r i o p e r a t i v e M e d i c i n e
Wh e r e Ar e T h e y N ow: Dr. Paul Tenenbein
I
t is hard to believe that over 7
years have elapsed since I left
Winnipeg - it feels more like
yesterday. Since leaving, I’ve been
living in Toronto and working at
Toronto Western Hospital, part
of the University Health Network
which includes Toronto General
Hospital and the Princess Margaret Cancer Centre. I am the site
lead at the latter. Our Department
recently started providing clinical
care at Women’s College Hospital
so I spend a lot of time (stuck in
traffic) in downtown Toronto.
My major clinical focus remains
NeuroAnesthesia although I spend
a considerable amount of time on
administrative and political work.
I am the Chair of the UHN MSH
Anesthesia Associates. We have 90
partners across 3 sites, employ 40
fellows and have an office staff of
6. In many ways we run a medium
sized business. While maximizing
revenue is obviously a major goal,
we also have a major mandate
to support research. Our group
ranks as one of the most successful
in Anesthesia research productivity in North America. I also
sit on the Executive of the Mount
Sinai Hospital – University Health
Network Academic Medical Organization which is the body which
administers the Alternate Funding
Payments to the 700 physicians at
those two hospitals.
More recently, I became the
Chair of Ontario’s Anesthesiologists. This is the provincial
body which represents the 1300
Anesthesiologists in Ontario. We
recently held a strategic planning
exercise and launched a new
initiative entitled BEYOND THE
MASK, Anesthesiology 20.20.
Our vision is to raise the profile of
our Specialty over the next 5 years.
Anesthesiologists in Ontario have
a proud track record of being
perioperative physicians, in managing resources at the system level
and in being innovative. However,
in the upcoming years, we must
both contribute to – and be seen to
be contributing to the Health Care
System in more ways than from
behind a mask in the operating
room. If we fail to do so, we will be
left out when policy and funding
decisions are made. We must be
more visible and raise our profile
by engaging at the local, regional
and provincial levels. We must
promote, advocate for and elevate
our roles in patient care. We must
develop and measure the metrics
which show our value. If we don’t,
we run the risk that others will
shape our future, undercutting our
autonomy and professionalism by
defining when, where and how
to practice. I also recently joined
the Board of Directors of the CAS
where I will be sharing our plans
and inviting them to participate.
We are just building our website,
please visit us at www.beyondthemask.ca.
Rachel recently completed her
PhD in Child Psychology and
has started a private practice so I
expect our recreational time will
start to evaporate with 2 busy
professionals.
Toronto has become home and
moving here has turned out to be
a great decision for me. However,
I remember fondly my time in
Winnipeg. I received fantastic
training and made great friends – I
will always be grateful.
My Best Regards
Paul
Although work keeps me busy,
my main focus remains my
personal life. My wife, Rachel
Gropper and I have been married
just over 4 years. We spend our
free time up at a family cottage in
Muskoka and travel extensively.
C on t i nu i n g P ro f e s s i on a l De ve lopme nt Update
O
ur academic year is
well underway. Our
schedule is also complete and I am starting to work
on next fall’s schedule presently
(trying to stay ahead of the
game!). We have many excellent Visiting Professors lined
up for the upcoming academic
year however I am always
looking for more suggestions
so if you have anyone in mind
please forward me there name
and contact and I will try my
best to arrange a visit.
One suggestion for the
resident and fellows is at the
beginning of the academic year
to look at your date assigned
and if there are conflicts to
contact us early to make appropriate changes if there is an
issue. Making changes at the
last minute is often difficult as
there are many “moving parts”
and there are limits to backfilling the schedule when there are
unexpected gaps. We do appreciate the efforts of our residents
and fellows in producing such
excellent talks and generating
discussion.
The university’s department
of CPD has suggested that the
morbidity & mortality type of
rounds is an important aspect
of ongoing learning for each
discipline. They feel that more
effort should be made to have
regular sessions dedicated to
appropriate review of challenging cases and the associated literature. We will have a
few of these types of rounds
scheduled after the New Year
in order to fulfill that suggested
requirement. I thank those assigned in advance for preparing for these talks. The nature
of these presentations is such
that the approach will need to
be more sensitive and they
will not be broadcast or
archived on our website.
That’s it for now. I could go
on however I need to keep
it brief… Always looking
for ways to improve so if
you have suggestions (or
criticisms) let me know.
Joel Loiselle
Director CPD
Winter2014
Page 13
W e lco me to K id zo n e !
F
or those of you who do not
know what exists on the
other side of the double
doors from the adult operating
room at Health Sciences Centre,
you are about to be enlightened.
How to find us? We are on the
2nd floor of the Ann Thomas
building inside the ‘Teal zone’ at
the Health Sciences Centre. To
be very precise, the co-ordinates
are the same as that of HSC i.e.
49.9039° N, 97.1597° W. Even so,
most of you don’t know where
we work or what we do; even
our patients and parents are lost
between the cafeteria and the
waiting room! If you really want
to find your way, call 7872240 for
directions. Enough said!
A lot of us (pediatric anesthetists) are unaware of what
happens in the adult world and
I am sure the feeling is mutual.
Through this article, I hope we
can shed some light on the ‘who
does what’ in pediatric anesthesia
at our centre.
Similar to other anesthetic
sub-specialties, the Pediatric Anesthesia service is manned by pediatric anesthesiologists and allied
departments which play a crucial
role. Our sites for delivery of
clinical care includes the operating
room at the Children’s and at the
Misericordia Hospital; the latter
has a daily elective dental slate. We
also provide off-site anesthetic services at sites that includes radiology (CT, MRI, IMRIS, radiotherapy
at Cancer Care, angiography),
cardiac catheterisation laboratory
including St. Boniface, PICU and
the NICUs at Children’s Hospital
and at St. Boniface Hospital.
The section of pediatric anesthesia is headed by Dr. Ruth
Graham; she recently took over
from Dr. Heinz Reimer who was
our fearless leader for about eight
Dr. Karthik Sabapathi
years. Thanks Heinz, for all the
hard work! Dr. Graham works as a
full-time pediatric anesthetist with
a sizable chunk of her time dedicated to laboratory research. She
is currently collaborating with the
Manitoba Centre for Health Policy
esthetic clinic in collaboration
with our child life specialist. Dr.
Ann McNeill dedicates her time
to medical student teaching and
curriculum. Dr. Harley Wong has
been an integral part of the Acute
Pain Service at the Children’s since
looking at educational outcomes
in healthy children undergoing a
general anesthetic before 3 years of
age. Recently, she has also finished
a collaboration with Dr. Moodley (Perth, Australia) looking at
stem cell treatment in a porcine
model of ARDS. Dr. Reimer
continues to oversee management
of the section’s manpower and is
also involved with planning and
development of the upcoming
Diagnostics and Imaging Centre.
He devotes a good month of his
time every year to voluntary missions on ‘Mercy ships’; anesthesia
residents have been accompanying
him on a regular basis on these
missions and the experience has
proved invaluable to them. He is
off to Madagascar soon! ‘Smile and
wave boys, smile and wave!’
it’s ‘infancy’, very literally! He is the
manager/liaison for pharmacy and
therapeutics and has facilitated the
process of securing approval for
the usage of newer/ more useful
drugs. He is also the medical
director for the ‘Pseudocholinesterase’ registry.
Dr. Jo Swartz is a PALS instructor; she is also involved with
running the mock codes in the
operating room. She has developed
an autism care plan for our pre-an-
Dr. Heather Tulloch has served
as a resident co-ordinator for a
number of years. She is currently
the manager of pediatric anesthesia at the Misericordia Hospital
an elective pediatric dental slate
occurs daily. She also co-ordinates
and runs the pediatric simulation
sessions for the residents with
an equal contribution from Dr.
Raghavendran. Dr. Jassie Pretorius
works part-time at the Children’s.
He is a keen teacher within the
section of pediatric anesthesia
and is in-charge of the pediatric
anesthesia library.
Dr. David Lambert wears two
(fancy) hats! He works as a pe-
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diatric anesthesiologist and also
does symptoms management and
palliative care. He is the director of
Acute pain Service at our hospital.
Dr. SreeKrishna Raghavendran
and Dr. Karthik Sabapathi both
work as full time pediatric anesthesiologists. I have put our names
together just to further confuse
all our colleagues who still use the
names interchangeably. Haven’t
been able to solve this issue for
the last few years; not sure it is
going to change! ‘Krishna’ is the
Fellowship Director for Pediatric
Anesthesia; he is also one of four
anesthesiologists on the Acute
Pain Service. He is also involved
in co-ordinating the simulation schedule for the anesthesia
residents on their pediatric stint.
‘Karthik’ co-ordinates and teaches
PALS at the Children’s. The PALS
courses have been fairly busy with
residents and OR nurses keen on
being certified. He also co-ordinates and runs the mock codes
in the operating room with Dr.
Swartz and is involved with co-ordinating operating room slating
and scheduling.
Dr. Ainsley Espenell and Dr. Ian
McIntyre spend half their clinical
time as a pediatric anesthesiologist. Ainsley is the resident co-ordinator for pediatric anesthesia
and also the medical director for
the ‘Malignant hyperthermia’ registry. Ian co-ordinates many of the
‘pediatric chapter’ of the oral exam
sessions with the PGY5s. He is also
co-ordinating the organisation of a
more structured pediatric anesthesia curriculum for the residents,
with the help of other colleagues.
Dr. Kristin McCrea spends the
majority of her clinical time as
a pediatric anesthesiologist. She
is the medical director of the
pre-anesthetic clinic at the Children’s and is part of our acute pain
service team. Dr. Daniela Goldie
Welcome to Kidzone cont.
is currently working part-time as
a locum pediatric anesthesiologist.
Dr. Elia Peled visits us a few times
a year to work within our section.
Dr. Erika Bock is currently doing
her fellowship in pediatric anesthesiology at the Children’s.
Our support staff and allied
services play an integral part in
co-ordinating and helping out
with our daily activities. Thanks
to all the Anesthesia Clinical
Assistants especially those who
come on a regular basis to the
Children’s; their service is much
appreciated. Actue Pain Service at
the Children’s is one of them. Drs.
Lambert, Raghavendran, Sabapathi and McCrea are the physicians
on the service with a key pillar
which is Colleen Weppler who is
our pediatric acute pain service
nurse. Jim Kenny is our high-risk
nurse in the operating room with
some valuable PICU experience
under his sleeve. Sheri is our respiratory therapist and anesthesia
equipment technician. Our APAC
(anesthesia pre-anesthetic clinic)
does a great job in co-ordinating pre-anesthetic visits for our
increasingly complicated patient
ON T h e I nte r n at i on a l F ront:
E
bola:
Ebola has been the focus
of national and international attention. As per the CDC
and the WHO, the current
Ebola outbreak is the
largest Ebola outbreak
resulting in close to 6000
deaths. Second to the
current outbreak, other
large epidemics include,
280 deaths in 1976 in
Zaire (currently DRC)
and 250 deaths in Uganda
in 2001. Ongoing preparatory efforts are being
implemented at hospitals
in Winnipeg. Dr. Funk
has published a detailed
review of treatment considerations for intensivists
and anesthetists who may
need to care for patients
with Ebola. Personal preparatory work should be pursued
by physicians to be accustomed
to protective equipment in case
of an Ebola epidemic. A University of Manitoba publication is
pending which will review the
ethical concerns for anesthetists
and intensivists that may be called
to treat Ebola. This article may be
accesses through contacts at the
Anesthesia International Health
Department.
International Health Education:
With the support of Dr. Jacobsohn
and the department, the Anesthesia International Health Depart-
population. The APAC nurse
manager is Karen Amos who has a
great bunch working with her; The
team includes Roberta, Mary Jane
and Michelle who are registered
nurses, Lisa, Ashley and Paula who
are clerks and Mirna Brindas, who
is a child life specialist. We are
thankful to the contributions from
our OR nurses headed by Leslie
Galloway and PACU managed
by Lin. Last but certainly not the
least, Joanne McGorman is our anesthetic secretary whose help with
the MH and pseudo-cholinesterase
registries amongst other things is
invaluable.
This document will be incomplete without acknowledging and
thanking Dr. Leena Patel and
Dr. Suzanne Ullyot who retired
recently. Their contributions to our
section in numerous domains will
always be appreciated.
That is a lot of names with no
faces to match them with. Apologies if anyone has been missed out;
it is purely coincidental! Of course,
we do also socialise. Make it to our
upcoming ‘Children’s Hospital Operating Room Winter party’ this
February and be impressed!
Dr. Greg Klar
ment has developed an anesthesia
International Health Curriculum.
The curriculum will be available
for residents who wish to take
part in an
international
health elective.
Furthermore
the department
encourages all
residents to
present a short
synopsis of
their international experiences during
an appointed
grand rounds
presentation.
Thanks to
Sean Jardine,
the international health
website is
being continuously updated. The
website provides a brief overview
of the curriculum along with other
educational contacts. The website
is a good resource for conferences, international health courses
along with masters and fellowship
programs. We encourage residents
who wish to pursue international
health as a career, to consider an
international health elective.
Ongoing international work:
The anesthesia department took
part of the annual Operation Walk
program in November. “Operation
Walk Winnipeg” is one of two Canadian “Operation Walk” arthroplasty programs with current privileges in Managua, Nicaragua. Dr.
Kelvin Williamson organized the
last mission and was accompanied
with Dr. Raegan Cleven who was
a valued asset on the trip (https://
www.youtube.com/watch?v=vbd040xmSbg). In January, Dr. Heinz
Reimer will join the Mercy ship in
Madagascar thesurgeryship.com.
Current Mercy Ship missions have
been temporarily stalled because
of the Ebola outbreak. Dr. Genevieve Lalonde will be travelling to
Chandigarh, India as part of her
Cardiac Anesthesia fellowship.
Several other international health
opportunities continue to be offered to staff and residents and we
hope to increase our international
involvement.
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H I G H L I G H T I N G O U R 2 014 - 2015 ANE S THE S IA F E LLOW S
Dr. Roshan Raban completed his undergraduate training at the
University of Peradeniya in Peradeniya, Sri Lanka and his Anesthesia
training at the University of Manitoba finishing in June 2013. Roshan
will be completing his Neuro Anesthesia Fellowship in September 2014
and commencing a second Fellowship year in September 2014.
Fellowship Director: Dr. Duane Funk
Dr. Daniel Dubois completed his undergraduate training here in
Winnipeg at the University of Manitoba and did his Anesthesia Residency at the University of Ottawa, where he completed his Anesthesia training June 2014. We are happy that he has made his way back to Winnipeg
to commence his Perioperative Medicine Fellowship July 2, 2014.
Fellowship Director: Dr. Heather McDonald.
Dr. Erika Bock received her Bachelor of Science in Biochemistry at
the University of Winnipeg and completed her Doctor of Medicine at
the University of Manitoba. Dr. Bock completed her Anesthesia Training
June 2014. Dr. Bock will be commencing a Pediatric Anesthesia Fellowship July 2, 2014.
Fellowship Director: Dr. Krishna Raghavendran
Dr. Mehdi Sefidgar completed his training at the University of
Manitoba, he then joined the Anesthesia Residency Program in 2010. Dr.
Sefidgar transferred from Physical Medicine Rehabilitation to Anesthesia
completing his Anesthesia training June 2014. Dr. Sefidgar will be commencing a Pain Management Fellowship July 2, 2014.
Fellowship Director: Dr. Jamit Dhaliwal
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Dr. Genevieve Lalonde completed her Anesthesia training at the Université
Laval in Quebec June 2014. Dr. Lalonde holds her Master’s Degree in Epidemiology and has completed many research projects. Dr. Lalonde will be commencing a
Cardiac Anesthesia Fellowship July 2, 2014.
Fellowship Director: Dr. Scott MacKenzie/Dr. Hilary Grocott
Dr.Vasudha Misra completed her training in Anesthesia in the UK. Dr. Misra
has a special interest in Regional and Obstetrical Anesthesia. Dr. Misra completed
her advance training in Regional and Obstetrical Anesthesia and was pursuing her
MSC in Regional Anesthesia from the University of East Anglia in the U.K. Dr.
Misra will be commencing an Obstetrical Anesthesia Fellowship.
Fellowship Directors: Dr. Tamara Miller (SBH) Dr. Leanne Docking (HSC)
Dr. Jagroop Gill completed his undergraduate training here at the University
of Manitoba and completed his Anesthesia training and Pain Residency at the
University of Alberta in June 2014. We are very happy to have him back here in
Winnipeg to commence an Obstetrical Anesthesia Fellowship.
Fellowship Directors: Dr. Tamara Miller (SBH) Dr. Leanne Docking (HSC)
Dr. Nitin Ahuja has joined the University of Manitoba, Department of Anesthesia from the United Kingdom. He completed his Anesthesia training in April
2013. He has a wide range of Anesthesia training and practice. Dr. Ahuja will be
commencing a Neuro Anesthesia Fellowship July 2, 2014.
Fellowship Director: Dr. Vincent Wourms
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C o f fee T i m e
EDITOR IN CHIEF: DR. AMIT CHOPRA
CO-EDITORS: BRUCE KNOLL
SEAN JARDINE
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