All hospital settings in Quebec have had to deal with outbreaks of COVID-19 for two years. Except one, unique in the province, who was able to fly unscathed over the six waves of the pandemic on the Quebec health system.
This hospital covers an area of one and a half million square kilometers – three times the area of mainland France – and takes care of patients at thousands of meters above sea level. This is the hospital plane of EVAQ, the aeromedical evacuation program of Quebec, mandated to make the most advanced care accessible, even in the most remote regions.
When an emergency requires treatment available only in major centers, the hospital plane takes off from Quebec or Montreal to pick up patients where they are. Kuujjuaq, Schefferville, the Magdalen Islands: the Challenger aircraft travels regularly to the borders of the territory, where severe complications often exceed the ability to treat them.
Burn victims as well as premature newborns embark on board this flying operating room to find, often hours of flight from home, the treatments that save them. EVAQ carried out 2,359 missions with its hospital plane in 2020-2021, including 92 with people with COVID-19. And this, without ever suffering outbreaks.
“Zero contamination in two years,” says Mélanie Gosselin, a nurse who has worked voluntarily in the program for 13 years. It’s still a source of pride! »
A “concrete” protocol
Accustomed to turbulence, the EVAQ team was able to mobilize quickly to perpetuate its mission despite the headwinds blown by the pandemic. “We had to get organized, and quickly: we didn’t have two and three and four weeks, we had a few days,” says the Dr Simon Kind, affiliated with the CHU de Québec and member of the EVAQ crew for 10 years. At the start of the pandemic, we only slept a couple of hours a night! »
Cold, warm and hot zones have appeared in aircraft cabins. The staff on board also had to adapt their ways of working to protect themselves – even if it meant having to shout at the top of their voices to hear each other.
“At the beginning, with the N95 masks, the visor, the balaclava, the noise of the plane of about 80 decibels in the air… There were communication problems,” says the Dr Kind.
“It’s even sometimes part of our briefing starting point, adds Mélanie Gosselin. We warn each other: I’m going to scream, it’s not because I’m angry, it’s just that we have no choice if we want to get along! »
During COVID missions, protective equipment makes working conditions more difficult for personnel. Caregivers must each time put on a Tyvek garment that they remove only after landing.
“Tyvek is waterproof, so it doesn’t breathe and it’s really hot,” says nurse Mélanie Gosselin. When we have Tyvek on our backs, we can’t eat or drink. You can’t go to the bathroom either. »
The four-hour journeys to Kuujjuaq become long in these conditions. Never mind: as the sustainability of EVAQ has depended, for two years, on the health of its crew, it was necessary to impose a protocol “concrete until it becomes irritating”, explains the Dr Kind.
“We know it will be difficult: we will be hot, we will not have water, we will not go to the toilet and we will stay in the contaminated area throughout the mission, explains the doctor. The margin is slim: if we have an outbreak and we have four or five nurses who, overnight, can no longer work, that threatens the service. It is for this reason that it is extremely rigorous, to the point where on board, it can look like a virology laboratory! »
Essential service
Last year, one in five patients boarding the hospital plane was 28 days or younger. The Challenger also transported 176 patients who experienced difficulties during childbirth, an increase of 52% compared to the previous year, in particular due to the numerous closures of obstetric services caused by the pandemic.
An interruption of EVAQ, a service which blew its 40 candles in the midst of a pandemic, would have catastrophic consequences, according to the Dr Etienne Boiteau.
“Sometimes, we say that something is vital in the wrong way, illustrates the emergency doctor from the Magdalen Islands. There, the term is really not hackneyed: it is really a matter of life or death. »
The Dr Boiteau doubts that he would practice in the region if the service did not exist. “Without them, we would be reduced to doing a kind of bush medicine,” explains the doctor. I can’t imagine how people did it before! »
The hospital plane and the air shuttle services are such a part of the daily life of the islanders that the Madelinots have given them a small name. “People say they leave on the jet, explains the Dr Box. It has become commonplace: everyone knows here that there is this famous jet there to pick them up. »