ith advances in technology, communications, and travel, the concept of a global village has become a reality. Time and distance no longer insulate or isolate people from events in other countries and on other continents. A crisis in a place most North Americans will never visit can and does have an impact on our home communities.
In March 2003 Toronto gained firsthand experience with the shrinking-world phenomenon when Ontario's chief medical officer of health and the World Health Organization (WHO) issued a health alert regarding severe acute respiratory syndrome (SARS).
This warning was to have a profound and lasting effect on Toronto and its economy, tourist trade, health system, and emergency services. The crisis put the city's emergency systems and emergency workers to the test in many ways.
Severe Acute Respiratory Syndrome (SARS)
Before March 2003, SARS was virtually unknown in North America. In fact, the name "SARS" had not yet been attached to the disease, which was initially known as "atypical pneumonia." Modes of transmission and routes of entry were not yet identified. The meager intelligence that was available indicated that SARS was a severe and virulent form of pneumonia accompanied by a high fever and general malaise. It was believed that SARS was spread through a droplet-borne virus exchanged during face-to-face contact with an infected person. Until this event, SARS was restricted to a small part of the world.
What we now know as SARS is characterized by the following symptoms:
- Sudden onset of fever
- Muscle aches and flu-like symptoms
- Possible sore throat, cough, shortness of breath, and difficulty breathing
On March 11, 2003, the first SARS-related death was reported, involving one member of a single family that had just returned to from China. Shortly thereafter, a second member of the same family died from a disease with similar symptoms. Before the outbreak ended, more than 800 people worldwide had succumbed to SARS, and in Ontario alone more than 40 people died. Hundreds of others contracted the disease but survived.
On March 26, 2003, the premier of Ontario issued a provincial declaration of emergency in accordance with the provincial Emergency Management Act. This was the first time in its history the province had declared a medical emergency. By this time, 25 cases of SARS had been reported in Toronto, and 23 suspected or probable cases were admitted to local hospitals. Three people had died from the disease.
Also on March 26, the province created a SARS executive group. The Toronto Police Service (TPS) participated fully in this partnership, and appointed a deputy chief of police and a staff superintendent (one rank below deputy chief) to the group. Mandated to provide oversight and coordination to ensure effective public service and protection with respect to the complete range of issues presented by the SARS pandemic, the executive group was made up of nine subcommittees:
- Operational Executive Group
- Facilities/Transportation Equipment Group
- Science Group
- Communications/Information Group
- Strategy Group
- Surveillance Group
- Operations Group
- Ministry [of Health] Action Group
- Community Support Group
The provincial Ministry of Health and the Toronto Public Health Department shared the lead role in the response to the emergency, but virtually every public and emergency services was affected by it.
The Police Command Center
The TPS immediately activated its Police Command Center (PCC) as part of its Emergency Preparedness Plan. The PCC became operational on March 27, and for the next several weeks, during the height of the SARS emergency, it operated 24 hours a day, seven days a week. It operated under the incident management system (IMS) command structure that is used in many jurisdictions across North America, and its main purposes were as follows:
- To deal with threats to the TPS and its members (the biggest of which was to operational effectiveness through employee contamination)
- To support TPS field units in the maintenance of normal police operations
- To acquire and disseminate information about the crisis and appropriate responses to it
- To capture and record all information relevant to the TPS for the duration of the event, both to respond to the crisis and to use in debriefing exercises after its conclusion
The key players at the Command Center were as follows:
- A police incident manager
- A police incident specialist and liaison officer (the manager of the Occupational Health & Safety Unit)
- A public information officer (from the Corporate Communications Unit)
- Communication operators (two per shift)
- Planning staff (two persons for situation reports, documentation, internal and external communication and research duties)
- Logistics staff (one civilian support person)
The PCC was fully staffed from 7:00 a.m. through 7:00 p.m. each day, and minimally staffed overnight to ensure that all needed information was properly recorded and disseminated. It fulfilled its mandate by doing the following:
- Communicating to police units about the purpose and function of the PCC
- Communicating daily by conference call with the Ontario Provincial Police and other local police agencies to consolidate and disseminate information of specific interest to police
- Establishing internal and external communication networks to capture and record all information pertaining to the event
- Providing scheduled briefings and information updates to TPS Command Officers, and alerting them to emergencies and situations with respect to SARS
- Disseminating approved, accurate information to TPS members
- Implementing and maintaining a major event log
- Providing a central repository for all SARS-related documentation
- Establishing and disseminating strategic objectives through TPS Routine Orders, the intranet, the Canadian Police Information Center (CPIC), and electronic mail
The TPS Emergency Management Operations Unit is an element of the Public Safety Unit. It facilitated operations at the Police Command Center and supported the Occupational Health and Safety (OHS) Unit, which took the lead role inresearching and analyzing information, seeking appropriate advice, and contacting police personnel regarding quarantine and safety practices.
OHS staff were in frequent contact with the city's Health Department Operations Center (HDOC) and also with provincial health authorities. As well as serving as a subject-matter expert during the crisis, the director of OHS continually consulted with medical doctors from the TPS, the city's EMS, and a local hospital. OHS staff members were also instrumental in obtaining needed safety equipment for field personnel, particularly the N95 surgical masks needed to prevent the transfer of the SARS virus.
Throughout the crisis, staff at the PCC wrote and distributed officer safety bulletins and security plans, analyzed and disseminated legislation for quarantine and health order execution, helped with case management duties, and supported the operational continuity of TPS units.
Accurate, Timely Information
A great deal of information flooded the city of Toronto about SARS through various media. Some of the information was at best misleading and at worst outrageously speculative, so communication among all command centers was vital to ensuring the safety and wellbeing of the police and the public. Effective communication-focusing on accurate information -helped to ensure that the TPS continued to deliver the broadest possible range of high-quality police services to the community without exposing its members to unnecessary risk.
The PCC worked harmoniously with partner operations centers across the province to ensure that efforts were coordinated and information disseminated and understood. The main partners of the TPS were the Toronto Emergency Operations Center, the HDOC (which operated out of the headquarters of the city's fire and ambulance departments), and the Ontario Provincial Police Operations Center in central Ontario. A TPS senior officer was deployed to the HDOC to work in partnership with counterparts from the fire and ambulance departments.
Crucial technical information from the HDOC was disseminated quickly to the command and field members of the TPS. Routine situation reports were disseminated that provided updates on anything of value. Also included in the situation reports was SARS-related information provided by all TPS stations.
At the same time, scientific advances often resulted in changes or new data that occasionally contradicted past information. To ensure consistency in reporting these changes, a medical consultant was identified to resolve medical questions.
One of the main priorities of the TPS command officers was to ensure that all members of the organization had the information needed to keep themselves safe, and to de-escalate the fear and concern they had on their own behalf and on behalf of their loved ones. Accordingly, the PCC communicated with all units daily, providing timely information about the status of the emergency and how best to protect themselves as they interacted with members of the community and other emergency workers.
To answer members' questions and dispel internal rumors, the service's intranet was used to distribute safety and information bulletins and videos. The internal e-mail system distributed information sheets from Toronto Public Health and other credible sources.
One key objective of all corporate communication was to create confidence among the membership that would overcome the misinformation facing them. A key phrase was repeated in each information sheet: "Effective risk management equals business as usual."
Exposure to SARS: Impact on TPS Members
Early in the crisis, TPS security plans were reviewed and legislation respecting quarantine and health order execution was analyzed. The priorities of TPS management were to safeguard the health of members, ensure continuity of police service, and assist in joint operations with public health authorities to ensure public safety.
In spite of the precautions taken by TPS members, the nature of police work is such that risky exposures cannot always be avoided. When the provincial health emergency was declared, two local area hospitals were closed due to the presence of SARS. Many TPS members had been to these hospitals while the disease was potentially present but before the closures occurred. The computer-assisted dispatch (CAD) system was used to identify the names and dates of visits of each member who had been to a hospital during the 10 days before the emergency was declared. Those TPS members were quarantined immediately.
The process that identified members exposed to affected hospitals was also used to identify those who had attended calls where they may have come into contact with people or places affected by SARS. On the advice of the medical officer of health for the city of Toronto, a risk tolerance scale was used to evaluate exposure risks connected with different police activities. The scale helped to determine appropriate medical attention or the need for members to be quarantined.
Quarantined TPS members (such as doctors, nurses, and others who thought they might have been exposed to the SARS virus) had to remain isolated for 10 days. They could not leave their homes and had to wear masks-changed twice each day-when in the presence of family members. They could not leave the house (except to an isolated back yard), and could not receive visitors for the 10-day period.
They had to monitor their health carefully, and notify Toronto Public Health if they experienced symptoms. In spite of more than 1,500 documented high-risk contacts, not one member of the TPS contracted SARS through an occupational exposure.
Nevertheless, being quarantined meant the members were unavailable for duty, which raised the question of how to compensate members who were in quarantine through no fault of their own. The provincial Workers' Compensation Board declined to provide coverage for the quarantined members unless they contracted the disease. The collective agreement was silent on this issue. A negotiated decision was made to pay members in quarantine as if they were at work. Consequently, no sick time was deducted from quarantined members.
In total, 307 members of the TPS were quarantined for 10 days each during the months of the SARS outbreak. Fortunately, with more than 5,000 sworn members, this did not prevent the delivery of core policing service to the public.
This is not to say that the TPS was unaffected by SARS-related illness. Many quarantined members came from two of the biggest divisions, both in Scarborough, which caused local staff shortages in that part of the city.
Another key objective was to reduce the risk of exposure and consequent quarantine through appropriate protective equipment and universal precautions, including frequent hand washing, N95 surgical masks, and antimicrobial gloves. Risk reduction through appropriate protective equipment is thought to have minimized the number of members in quarantine over time.
Due to the unfamiliar nature of SARS, however, the threshold of "appropriate" protective equipment and procedures seemed to change almost daily. EMS personnel began to wear surgical gowns in addition to N95 masks and gloves. This became the source of some concern among TPS members, who felt they were being given inadequate protection compared to EMS colleagues. The risk of exposure to SARS, however, had to be balanced against the hazard of being unable to access defensive options or to be identified as a police officer. The TPS reinforced decontamination and disinfection procedures rather than creating new risks by issuing surgical gowns to members.
Members of the TPS were not the only ones who were expected to quarantine themselves during the SARS crisis. Members of the community-and of other health-related and emergency service professions-also found themselves at risk of contracting SARS and of spreading the disease to others.
In the vast majority of cases, the people of Ontario were very responsible about SARS risks. Doctors, nurses, paramedics, police officers, hospital workers, and members of the general public who may have been exposed to the virus were, by and large, very cooperative about quarantining themselves voluntarily.
In unusual cases, though, extraordinary measures were needed to protect the public. Section 22 of Ontario's Health Protection and Promotion Act allows a medical officer of health to issue an order requiring a person to take (or refrain from taking) any action specified in the order regarding a communicable disease. Action under the order can include directing a person to remain at home while a danger to others.
Should the person refuse to comply, section 35 allows the Ontario Court of Justice to issue an order directing compliance, and may also require police to help to enforce it by taking the person into custody and admitting the person involuntarily to hospital.
The TPS agreed to act on behalf of Toronto Public Health to locate and apprehend the person named in such orders. Clearly, this would require close interaction with a person known to be infected and, from a risk management perspective, would require a higher level of awareness, the most appropriate personal protective equipment, and better training than was generally available. Accordingly, the Community Oriented Response (COR) Team (a citywide general assignment squad of uniformed police officers) was designated to work with Toronto Public Health in the event that a SARS quarantine order was issued under the Ontario Health Protection and Promotion Act.
On April 17, police were asked by medical personnel at the HDOC to help serve orders under section 22 on a community member who was considered to have been at risk due to SARS exposure. Although this was the only notice that the police were asked to serve, it was an example of the unusual roles that police must be prepared to assume under exceptional circumstances.
Role for Volunteers
The importance of volunteers during crises cannot be underestimated. The TPS has a large and active core of volunteers and auxiliary police officers who supported quarantined people by delivering packages of essential equipment, such as masks, protective gloves, and thermometers.
Police Role at Hospitals
Hospital staff throughout Toronto had their work cut out for them as they kept their facilities and staff SARS-free. Patients and visitors to hospitals were asked to take steps before entering the facilities, such as disinfecting their hands and wearing appropriate masks.
In the early stages of the crisis, police officers were deployed to hospitals to help ensure that only visitors and patients went through identified checkpoints and that everyone adhered to safety protocols. They also supported other police officers who attended the facilities for treatment or investigations or to escort prisoners.
To reduce the impact on front-line policing operations, paid-duty officers (off-duty officers who were paid by the hospitals) soon replaced on-duty colleagues, and ultimately, as hospitals adapted to the situation, security staff took over these duties.
Impact on the Police
The biggest operational impact of the SARS outbreak on the Toronto Police Service was on its own personnel. More than $560,000 was spent on quarantined members, overtime, and call-back expenses. More than 15,700 person-hours were dedicated to SARS-related duties.
Within a few days of the declaration of emergency, the reduction in available personnel resulted in a review of operational practices regarding some types of calls. For example, the TPS is part of the 911 tiered-response process, whereby police, fire, and ambulance respond to medical emergencies. During the outbreak, if police officers responding to a 911 tiered response were not required, ambulance or fire service personnel would cancel the police before they arrived. This reduced the potential for SARS exposure and allowed police officers more time to perform core service functions.
Totally avoiding SARS exposure was impossible, however, and despite the best efforts of the TPS to minimize exposure risks, it was inevitable that some exposures would occur. The risk tolerance scale mentioned earlier in the article was used to assess exposure risks and to avoid unnecessary staff quarantine while ensuring that high-risk exposures were addressed appropriately.
A second problem was the almost immediate shortage of N95 surgical masks and waterless antiseptic hand cleaner. The demand far exceeded Ontario's supply, and in the absence of these items the risk of exposure to TPS members would have been enormous. Through imaginative resource acquisition, sources in other provinces and the United States met the demand for these necessary items of personal protective equipment.
A problem involved prisoner management. The rudimentary health assessment that is part of the TPS routine prisoner intake process had to be modified to screen for potential SARS risks. The new health questions were crafted to avoid giving a prisoner clues about the purpose of the questioning, as this may have given a quick-thinking suspect a trip to hospital and delayed the investigation. At the same time, it captured enough information to satisfy risk management concerns.
Lessons Learned for the Future
The men and women of the Toronto Police Service responded well to the SARS emergency, and, along with members of the other emergency services, were praised by the media, politicians, and their own command officers. With any crisis of this magnitude, however, there is always a great deal to be learned, especially as TPS members had little relevant experience on which to base key decisions.
Using the SARS crisis as a learning opportunity, TPS managers have identified a number of changes and improvements for the future, including the following:
Training: Members need more training about communicable diseases and the legislation surrounding health crises. Many members also need more in-depth and practical knowledge of the incident management system (IMS), which is becoming the universal response standard across Ontario. This enhanced training is now being delivered by police and by city departments with which the police work during critical incidents. 1
Senior Officers (Inspector and Above): Senior police officers need practical training and experience in incident management. Accordingly, selected senior officers are being given relevant training through the Canadian Emergency Preparedness College in Ottawa and other suitable facilities.
Pandemic Disease Planning: As a result of SARS, a multidisciplinary team representing public health, hospitals, EMS, fire and police has been established to strategize a response to future communicable disease outbreaks.
Case Tracking: Prior to SARS, there was no adequate tracking program available to trace high-risk exposures or activities. Shortly after the emergency was declared, PowerCase, a computerized major case management tool, was introduced to track exposed persons, those in quarantine, and those suspected of having SARS. The rapid growth of the situation prevented the use of this program in 2003, but in the future a case-tracking program will be implemented at the onset of any provincial emergency.
Communication: One of the issues with which police dealt during the crisis, particularly during its early days, was the need for accurate information about the disease and the police department's response to it. For consistency, there should be, if possible, only one spokesperson to deal with the issue. The spokesperson should disseminate information only when sure of its credibility, and preferably after consulting with appropriate medical authorities.
Command Center: The SARS crisis was an ideal opportunity to review the operation of the Police Command Center, including its staffing, available technology, and relationship with emergency services. The lessons learned were incorporated into planned renovations to the PCC. In future, for example, handheld telecommunications technology will be provided to all key personnel. Other logistical issues will also be addressed, including access to petty cash, networked computers, printers, photocopiers, base-station police radios, presentation technology, and emergency contact information.
Staffing: While emergency management personnel were able to handle the tasks assigned to them, the staffing level was less than optimal to deal with an emergency of the magnitude of SARS. Accordingly, the TPS procedure on emergency incident management is being rewritten to make better use of staff and to improve the efficiency of the incident management system (IMS) when used by TPS members. It will also be more specific about the staffing of the PCC and the roles of members assigned there.
Emergency Preparedness Plans: Emergency plans are always works in progress, as new situations, technology, and threats arise and are included in the way police deliver their services. The crisis allowed the TPS to review and augment its corporate emergency plans to ensure operational continuity.
Partnerships: One of the biggest lessons that those in law enforcement and other emergency services learned from SARS (and, of course, from the disaster of September 11, 2001) is the need for a coordinated and cooperative partnership among all agencies that could be affected or called upon to act during large-scale or significant crises, emergencies and disasters. This includes emergency agencies, health-care organizations such as hospitals, government and politicians, works and other key city departments, the military, volunteers, and private industry. Protocols for communication and cooperation can mean the difference between success and failure when crises occur.
Resources and Equipment: Because the TPS had never had to deal with a medical emergency of this magnitude, it did not have as much equipment as it required to deal with the crisis. One example is surgical masks; 8,000 N95 surgical masks were distributed by and to police officers during the crisis, but there were too few on hand at the outset. The TPS ordered 10,000 masks to keep in reserve against future emergencies.
Police Leadership and Emergency Response
Local emergency responders will be the first on the scene of any major catastrophe. It is imperative that they be given the training, resources, and support they need to react appropriately when disaster strikes.
Today's society is essentially a global village, due in part to the globalization of crime, the threat of terrorism, and the reality of international unrest. These influences pose real threats to North American police agencies. Leaders must work together toward integrated systems that allow for the effective and efficient exchange of information and assistance, especially when disaster strikes.
When all is said and done, it is impossible to prevent many disasters, including epidemics and acts of terrorism. But police leaders can be aware of the risks posed by such events and can ensure that their organizations are prepared, trained, equipped, and sufficiently resourced to respond effectively to situations that threaten the safety and security of the citizens they serve. They can also appropriately take lessons learned from emergencies such as the SARS pandemic and apply them other crises, including bioterrorism and more local epidemics.
Using emergency situations as learning experiences is a responsible undertaking that improves the ability of the police and their partners to serve and protect the community during difficult times. ■
1 City of Toronto Department of Public Health, Learning from SARS: Recommendations for Emergency Preparedness, Response, and Recovery (September 2004): 4.