Proceedings of the Standing Senate Committee on
National Security and Defence

Issue 26 - Evidence for the morning session

TORONTO, Thursday, October 30, 2003

The Standing Senate Committee on National Security and Defence met this day at 9:10 a.m. to examine and report on the need for a national security policy for Canada.

Senator Colin Kenny (Chairman) in the Chair.


The Chairman: Good morning, colleagues, ladies and gentlemen. It is my pleasure to welcome you to the Senate Standing Committee on National Security and Defence. Today we will hear testimony from city officials about Toronto's ability to respond to natural or man-made emergencies.

My name is Colin Kenny. I am a senator from Ontario and I chair the committee. On my immediate left is the distinguished senator from Nova Scotia, Senator Michael Forrestall. Senator Forrestall has served the constituents of Dartmouth for the past 37 years, first as their member of Parliament and then as their senator. Throughout his parliamentary career, he has followed defence matters and served on various defence-related parliamentary committees, including the 1993 Special Joint Committee on the Future of the Canadian Forces.

On my far left we have Senator Tommy Banks from Alberta. Senator Banks is well known to Canadians as one of our most accomplished and versatile musicians and entertainers. A Juno-award-winning musician, he also received the Grand Prix du disque Canada, and has been a guest conductor with symphony orchestras throughout Canada and the United States. He was appointed to the Senate in 2000. Senator Banks is the Chair of the Senate Committee on Energy, the Environment and Natural Resources. That committee is looking at the implementation of the Kyoto accord.

Beside him is Senator Meighen from Ontario. Senator Meighen is a successful lawyer and businessman who has contributed to a wide range of charitable and educational institutions. He is the Chancellor of the University of King's College in Halifax and was appointed to the Senate in 1990. He has a strong background in defence matters and is the Chair of our Subcommittee on Veterans' Affairs. This subcommittee is presently studying commemorative activities, and will be visiting Sunnybrook Hospital at ten o'clock tomorrow morning. Senator Meighen is also a member of the Senate Standing Committee on Banking, Trade and Commerce that is examining the state of Mexican and international financial systems.

On my far right is Senator Norm Atkins from Ontario. He came to the Senate in 1986 with a strong background in the field of communications and with experience as an adviser to former Premier Davis of Ontario. Senator Atkins is a member of our Subcommittee on Veterans' Affairs and also the Senate Committee on Internal Economy, Budgets and Administration. He also serves as Chair of the Senate Conservative Caucus.

Our committee is the first Senate committee mandated to examine questions of security and defence. Over the past 18 months, we have completed a number of reports, beginning with ``Canadian Security and Military Preparedness.'' This study, which was tabled in February 2002, examined the major defence and security issues facing Canada.

Then the Senate asked our committee to examine the need for a national security policy. So far, we have released four reports on various aspects of national security: first, ``The Defence of North America: A Canadian Responsibility,'' was published in September 2002; second, ``An Update on Canada's Military Crisis, A View From the Bottom Up,'' published in November 2002; third, ``The Myth of Security at Canada's Airports,'' published in January 2003; and most recently, ``Canada's Coastlines: The Longest Under-defended Borders in the World,'' which was published yesterday.

The committee is continuing its long-term evaluation of Canada's ability to contribute to the security and defence of North America. As part of this work, the committee has been holding hearings on the federal government's support of the men and women who respond first to emergencies or disasters across the country.

Last month, just a few days before Hurricane Juan hit Halifax, our committee heard from representatives of the Halifax Regional Municipality and the Province of Nova Scotia. This morning, we will hear from officials from the City of Toronto.

Our first witness is Dr. Sheela Basrur. Dr. Basrur is Toronto's Medical Officer of Health, in charge of one of the largest public health bodies in North America. She leads an organization of 1,800 staff committed to disease prevention and community health promotion.

Prior to accepting this post, Dr. Basrur served as Medical Officer of Health for the East York Health Unit for six years. Dr. Basrur practised medicine as a general practitioner in Guelph, Ontario, before entering public health. She holds a Masters of Health Science degree from the University of Toronto and is a specialist in community medicine. She is also a graduate of programs at Western Ontario and Dalhousie. She is an Assistant Professor in the Department of Public Health Sciences, University of Toronto.

I welcome you to the committee, Dr. Basrur.

Dr. Sheela Basrur, Medical Officer of Health, City of Toronto: Thank you very much, senator, and thank you to all members of the committee for this opportunity to address you this morning. My comments this morning will focus primarily on the recent experience with SARS, severe acute respiratory syndrome, which was the subject of a major emergency incident, not just in Toronto but also in a number of jurisdictions around the world, and which had ramifications right across Canada.

It brought home many lessons in emergency preparedness and response that I think are illustrative of the need to prepare for events, whether they are natural, man made, biological, chemical or what have you, because the infrastructure and the generic responses are similar, albeit somewhat unique, given this particular bug.

I have condensed a huge amount of information into one brief slide that says, ``This is what happened.'' Phase 1 was March 13 to April 20. Just when we thought it had gone away, the World Health Organization issued a travel advisory. We thought that was ridiculous, but in fact it had not yet gone away and we had what we called phase 2, between May 20 and June 24.

During that period, the province declared its first public health or health emergency and opened its provincial operations centre. I believe you will be hearing from provincial officials later this afternoon, so I will not go into the details of their response, but suffice it to say that it was a necessary and welcome step, from my perspective, and we could not have managed the local circumstances of this emergency without provincial, and to the extent we had it, federal support.

Overall there have been about 438 cases of SARS across Canada, about half of which occurred in Toronto; 44 deaths, the vast majority of which occurred in Toronto; and almost half of the cases of SARS occurred among health care workers, including three of the deaths.

That represents the major impact that SARS had on our city, because it literally led to the shutdown of a number of hospitals and/or their subsidiary units, which has major implications for the care of people who do not necessarily have an infectious disease, but have burns, have suffered trauma, require ICU care and need access to local emergency rooms. When their local hospital, which happens to also be a regional trauma centre, for example, is shut down because we cannot control an infectious disease, there are major ramifications for the provision of health care right across the board in ways that we may never be able to measure accurately.

Nonetheless, it is worthwhile noting that we were lucky, ironically, with this bug. First of all, we were lucky in that it hit Toronto, which always thinks it is unique and different and special and so forth, and sometimes it is right. It happened to be the case here, because we had more expertise, more resources, more infrastructure, relatively speaking, than if this bug had hit Kapuskasing or some other smaller centre, where I can guarantee it would quickly have overwhelmed the local capacity: if ours was overwhelmed, others would have been as well.

The second thing that is notable is we did not have significant community spread — and that was just an act of God, so to speak — from having this virus jump the species barrier from animals to humans in such a way that it was transmissible person to person, but not that easily in people with a mild illness. It was definitely a threat in hospitals, because that is where the sickest people are, and sick people happen to be the most contagious. However, people with mild illness or those with an asymptomatic presentation conceivably were not able to transmit this disease efficiently, and therefore we did not have it being spread through the subway systems in the way it might with something more transmissible. Just luck, but thank goodness.

The public health role was bread-and-butter public health work from a hundred years ago, and then some. We were basically trying to, as best we could — there are myriad stories in each of these points, of course — do surveillance for disease, report to the province and, through the province, to the federal government.

I would note that our information systems were sorely lacking, and I will have some slides on lessons learned towards the end, when I will speak to that in more detail.

Our number one function, which was surveillance and reporting, we performed, albeit with substantial difficulty because we did not have the technological preparation necessary to do this properly.

Under investigation of cases, we figured out who is sick, who is exposed, who is still healthy and unexposed, and tried to keep all those people separate, keep track of all of them, make sure that the sick people have been put into proper care facilities, that the contacts have been put into quarantine, so if they do get sick they do not expose others in the early part of their illness, and that healthy people can get on with their lives and try to keep the city running, whether it is driving the subway train or working in one of our local banks or anything in between.

Where necessary, we issued isolation orders, and I want to emphasize that it was not necessary in the majority of cases. I will have some statistics on this in a moment.

A very important role was health-risk assessment. People worried about whether they should use the subway. Will they catch the disease from someone who perhaps has not washed their hands or is coughing in their face? We were getting questions 24 hours a day from the media, the general public, health providers, subway drivers, TTC management — everyone you could possibly think of — asking for my opinion on something that had never existed on the world scene previously.

With the need for rapid response and immediate turnaround, exercising our best professional judgment was a huge responsibility and we did the best we could with the information that we had and the expert advice that we could get.

Public communication was extremely important, as was managing community relations, because it is not just the germ that causes havoc, it is the fear and the panic and all of the collateral implications that surround the emergence of a potential pandemic that have an ability to close down hospitals, infect your loved ones, or even you.

Now, there are a couple of indicators of the volume of this incident. We opened up a hotline. This was to be a counterpart to the provincial hotline, but our city hotline got more calls than the provincial one; over 300,000 calls during a 14-week period, with a peak of almost 50,000 calls in one day. Those are huge numbers. There were over 1,200 media calls in phase 1 alone. I think at that point they stopped counting and just tried to deal with them as best they could.

I mentioned that there were some 224 cases in Toronto, but over 2,000 people actually needed to be investigated to determine whether they had SARS or not, and there were many people who fell into a grey zone where we could not be sure, but we had to treat them as though they were cases, even though there were substantial issues related to that. We might have someone with a fever and respiratory symptoms who had recently attended a banquet or been in a workplace while they were ill, implying the need to place hundreds and hundreds of people in quarantine right away, because we were already five days into their illness and people who had been exposed for that period of time might already be becoming sick and exposing other people.

Every new case represented more people who were potentially already being exposed and infecting someone whom we had not yet found.

I mentioned an almost 10-to-1 ratio of investigations to confirmed cases. Each investigation took, on average, about nine hours. That is a tremendous amount of work to be done under extremely difficult and time-sensitive circumstances.

I mentioned the contacts. Over 23,000 people identified themselves to us as potential contacts of a known case or a facility that had had SARS transmission within it, and over 13,000 were put into quarantine. That meant that in true Canadian fashion, we said to the public, please co-operate with us, wash your hands, do not cough in public and if you have been exposed, please quarantine yourselves at home and we will call you once, if not twice, a day to make sure that you have masks and thermometers and that your symptoms are not SARS-like; if they are, we will refer you to an assessment facility; if they are not, we will try to make sure you have access to groceries, laundry, money to pay the bills or whatever other social supports or kinds of assistance that might be needed for people who were suddenly isolated from family, friends, workplace and everything that had made their lives normal previously.

Twenty-seven orders were issued to enforce the isolation requirement on 13,000 people. I think that speaks very well of the level of co-operation that existed. I have to say the co-operation was highest in phase 1. There was a lot more skepticism, anger, frustration and concern in phase 2 that this had not actually been beaten; and frankly, if it comes back again and we are not prepared, I do not think we will see just 27 orders issued, because the dynamics will change with each wave that we experience.

I mentioned that Toronto has more capacity than other units in Ontario, and certainly elsewhere across Canada. We had 700 staff involved in this incident over a period of 14 weeks, with up to 400 people being scheduled to work every day, 7 days a week, between 8 and 11. Those are not normal government working hours, as you can imagine, and as luck would have it — in some ways, luck played well for us and in some ways it played ill — the incubation period, in other words the time between initial exposure and onset of symptoms, was a maximum of 10 days, but roughly 5 to 7.

Statistics can vary, but our first wave occurred on Fridays. Every Friday, every time we were going into a weekend, we would have another huge wave of activity. That meant calling in people to do shifts or double shifts, with no time off, going into each weekend, week after week, month after month, which was a tremendous strain that people managed. People rose to the occasion more than I can ever describe to you, but it was not a sustainable response and we were lucky to have no other public health emergency going on at the same time.

There were many others who came to help, but I note that there were no shared services agreements in place, either with our own unions or other employers, so it made it that much more challenging to accept these offers of help. Who would cover everything from Workers' Compensation to liability insurance? When you are dealing with potentially life-and-death situations, those issues do need to be dealt with. Leaving aside compensation rates and from whom they take orders, if we have people from the federal level assisting us but they are seconded through the province, what is the chain of command, and who talks to whom? How do we make sure that federal officials are hearing information in a timely fashion, but not before we have heard it because we are the ones managing the operation on the ground?

There were lots of issues that we had to just deal with as the event unfolded hour upon hour, but the lesson is, let us put some of these agreements in place, based on our experience, and not have to figure it out in the middle of the next event.

This was one organism that was, by all estimates, a natural occurrence, not a terrorist event or a multi-centred attack, and it still resulted in widespread cancellation and deferral of needed community services. Some organizations estimated the economic hardship at $2.5 billion. Substantial numbers of people lost income and employment. There was a lot of social isolation and ethno-racial discrimination. Students were affected because, in some cases, schools had to be closed or college classes cancelled. There were many impacts, and this is just a high-level summary examination.

It is important to note that even though this was a physical illness caused by a virus, there were tremendous psychosocial impacts, and that will be true in any emergency, whether it is a forest fire that devastates a residential neighbourhood or a terrorist act or what have you. We had to put people in isolation, and that meant that staff members working in hospitals, who might have been in working quarantine, already exposed, still had to go to work because we could not afford to shut down the hospital while they all stayed home. They were not allowed to eat lunch together, to have coffee together, and they had to have their masks and paraphernalia on all the time. When they walked down the street, people would avoid them even if they were not in working quarantine.

We heard stories of EMS workers who were shunned by their neighbours, even though they were asking for assistance. There were very difficult circumstances at a psychological level, over and above the potential pulmonary scarring and other chronic sickness that may result from this virus.

I mentioned that the acute event itself lasted for 14 weeks, which is far longer than your typical — if there is such a thing — building collapse or other natural disaster. The hurricane blows in and eventually blows out, it does not keep blowing week after week after week; but in fact that is what happened here, and as a result, we had some pretty exhausted staff. We had people who were afraid, not of coming into work so much, but that doing so would lead to them infecting their families. That was a primary theme in the hospital setting and in the public health setting, and we had people experiencing symptoms of post-traumatic stress disorder because of the high tension and the feeling that they were literally dealing with life-or-death situations when they did not always have the necessary experience or technological support.

I do want to say, after all those negative effects, that the experience of going through the emergency was extremely valuable. I am not wishing SARS to come back or wishing this on any other organization, but if you are in the business of emergency response, there is nothing like actually living through the experience to teach you what works and what does not. You become stronger and sadder and wiser. You become stronger and wiser if you do not just document the lessons learned but actually change your workplace, change attitudes, knowledge, behaviours, infrastructure, all the rest of it, and do not have to repeat the same mistakes in the future.

I have perhaps more lessons slides than descriptive slides, because I think that is the real key for the committee. We did not have good information technology, and that is a reflection of the fact that in communicable disease control we ought to do things in a similar way. Therefore, Toronto should not have its own system separate from the province. The province should not have its own system separate from the rest of the country. How do you get ten provinces, three territories and the federal government to all agree on the functional requirements, who will pay for it, how many workstations are needed and what the actual capabilities should be at the federal, provincial or local level?

The discussion has been going on endlessly, and at the end of the day, when this thing hit, we had to go back to paper and flip charts, pencils and pens and colour-coded Post-it Notes. If you wish to see any of this, I do have pictures of some very exhausted-looking staff, surrounded by boxes of paper and backed up by flip charts and Post-its showing the daily status report on different hospitals, for example. There are a myriad of examples of how we had to rely on manual systems to compensate for the lack of technological support.

I will not go so far as to say that people died as a result of lack of computers, but I will say that we had to spend many hundreds, if not thousands, of excess staff hours, time, headaches, energy and exhaustion to compensate for what should have been in place.

Therefore, if we are looking to the future, we absolutely must have a common database across jurisdictions that deals with communicable diseases, and that is not easy, right? You are talking about people with pretty sensitive conditions, whether it is a case of infectious syphilis, SARS, influenza or some such. When you provide your health record to your doctor or get a drug from a pharmacy, you do not necessarily want to think that the MOH in Kapuskasing will be able to access that if necessary, but frankly, from a public health perspective, maybe there are times and places and circumstances, with the appropriate security controls, where it is essential and in the public interest that that information be available.

We were building our database in the middle of the SARS outbreak, so we were literally building the fire truck and figuring out how long the hose should be while the forest was burning. We did not have the capacity to transmit or share information electronically, either with other jurisdictions that also had cases and contacts and health care workers and a lot of cross-border travel and disease management issues, or even with the province, which is the body that we report to, because their system did not support SARS.

Therefore, we built one that did, and then had to fax and photocopy and do duplicate data entry. It was really quite something.

There is some work going on at this moment, but in my opinion, it is not consolidated enough or fast enough to give me comfort that we will actually see the light at the end of the day. I will go for light at any time of the day, even if it is at the end.

I mentioned IT systems in the context of outbreak management. You do not know what the next hazard will be that comes around the block. Therefore, designing something that is generic enough, flexible enough or can be built upon in a fairly expeditious manner is really the key to this, rather than creating the world's perfect model that becomes obsolete as soon as you plug it in because it took five years to develop.

In addition to all the technology, there also need to be protocols. That is, not just shared service agreements to make sure that staff can cross borders and so on, but that data can cross borders without having to figure out, in the middle of the crisis, what do we do about freedom of information and confidentiality requirements that apply differently to a government institution as compared with a hospital. How do researchers get access to data in a way that is useful, ethical and respectful of the privacy rights of people who were sick, some of whom are living, and some of whom are deceased and their survivors might have to give consent? There are all kinds of complicated issues that surely we can figure out in advance of the next incident, rather than having, as we did in this one, no data, or haphazard research, in comparison with other jurisdictions that were learning from the event and publishing information so that they could inform not only their own efforts, but those in other parts of the world. We did not do a good job in that department.

Human resources are an area of critical shortage in the health sector generally, and in public health in particular, and I mentioned the ones who are germane to my field, which would be community medicine specialists, people like myself. More people like me — hey, why not? That is, doctors who have training in what we call community medicine, which is a royal college specialty that focuses on public health and a variety of related disciplines. We also need more people experienced in communicable disease control, outbreak investigation and management. It is partly the job of people like myself to make sure that more of our own staff is cross-trained, because while these things come only periodically, they do come and you have to be prepared.

There is an internal responsibility, but there is also a cross-border, cross-jurisdictional responsibility. Most important all of these recommendations is to build surge capacity, because we cannot keep decimating all our other programs whenever an emergency comes around or we will never be on top of the curve; we will always be behind it somehow or other. We had to cancel all kinds of public health programs, and many opportunities have been lost forever because we were not able to counsel a pregnant woman about her high-risk pregnancy, for example, or we had to cancel parenting classes for low-income families who really need that support and are very socially isolated. Why should their needs have to be put on the back burner because we need nurses to do more communicable disease investigation?

Frankly, if you have a crisis, you deal with it, but it always comes at someone else's expense, and typically, it is at the expense of those who can least afford to bear it.

One thing that was a real eye-opener for me is that our public health mandate in Ontario for infectious disease control in hospitals is woefully inadequate. We have the provincial government mandating health programs and services that all boards of health in Ontario must deliver, and infectious disease control and surveillance in hospitals in particular is extremely weak and must be strengthened. Certainly it is a provincial responsibility, but we need federal assistance in creating common standards across the country on something as common as communicable disease control. It should not be any different in St. Paul's Hospital than it is in Sunnybrook, for example, when making sure that you have a standard ratio of beds and rooms with negative pressure ventilation, so that you are not blowing the germs through other parts of the hospital, and ensuring a standard number of infection control practitioners per so many active beds. These standards have been published; they have just never really been met because, firstly, they are voluntary, and secondly, not funded.

It is a question of getting what you pay for; we do not pay for much and we get less, frankly.

Finally, on emergency preparedness, as I mentioned in numerous ways, we need dedicated time and funding and, I would say, senior management attention between events, so we do not have to re-create the wheel. Come to think of it, is a wheel what we need in the middle of actually dealing with an event?

We must have shared services agreements for financial assistance and staffing, and especially coordination of effort. There was a lot of sort of people bumping into each other among the local jurisdictions, the provincial government and the federal government, and gaps and duplication that are too detailed to get into at this point, but that definitely need to be addressed — and they can be.

Finally, I will say that the province did move very quickly to give us the legal authority that we needed. I am not sure that it is in place in the same way across Canada, and that needs to be dealt with soon, because you cannot create either new regulations or statutory powers to deal with the unexpected on a dime. Having broad provisions is very helpful, and in this case we did, for which I am very grateful.

In conclusion, as I say, documenting the lessons is easy. You can do it in 12 easy pages. The challenge is putting them into practice, and my favourite quote of all is the only thing more difficult than planning for an emergency is explaining why we did not. On that note, I will open it up for questions.

The Chairman: Thank you very much, Dr. Basrur. It helps us to focus in a rather dramatic way, and the clerk tells me you have two additional presentations to make today?

Dr. Basrur: Yes.

The Chairman: Not to us.

Dr. Basrur: Three additional, two of which are on this topic.

The Chairman: I see. Well, once you have to start doing the full day's work, let us know.

Senator Forrestall: Some of us have been known to say that what we are really seeking is a means of identifying a very good bus driver, but you need much more than a bus driver in Toronto because you are driving the nation, in terms of communication above all. There is no question that no one has come anywhere near experiencing the challenges that you people here in Toronto faced, and we are grateful for your having gone through it and that we had enough souls around to persevere.

We want to try to correct that. We want to know whether the concept of a good bus driver is useful. We wonder what you think, for example, of the bottom-up approach, where the fellow in charge is the first responder on the scene and has perhaps the capacity to look after it; if he does not, he passes it on to a variety of specialties. That breaks down the line of effective communication, and if any of us in Canada learned a lesson, it was the absolute necessity for quick, uncompromising decisions taken by, the very special word here is, ``authority.''

Could you tell me if, at any time during this crisis, and if it was commonplace that is understandable, too, you were at a loss in your own mind as to where to turn for the quickest, best decision from someone with authority on the subject matter? I was not really looking for examples, although if you have them that would be fine, but to emphasize the need for the bus driver to know what on earth to do this morning, not later tonight or when somebody gets back from the golf course.

Dr. Basrur: Yes, there were many times when we had questions, concerns, issues or problems and no single, reliable source of expertise to draw upon, except ourselves. A lot of other jurisdictions, both locally and across the country, frankly, were looking to Toronto for some of the answers, for updates on status and so forth.

I have some of my staff in the room, including Dr. Bonnie Henry, Associate Medical Officer of Health for our Emergency Planning Unit, who was hugely involved in SARS. One of the things she did, for example, was send an e- mail to a list of people who were in regular contact with the public health department on such issues as pandemic influenza planning, and she also informed all the MOH's in Ontario of the status in Toronto.

I heard from a number of people that if it had not been for her sending those e-mails, they would not have known what was going on and would not have had the kind of clinical insight that they needed to anticipate and prepare for SARS in their communities, for example.

Number two, the provincial public health structure is hugely under-resourced and absolutely needs to be strengthened. I realize that is not a federal responsibility, by and large, but frankly, you have the capacity, as I say, to get what you pay for and to attach some strings to the money that you do transfer.

As I understand it, there have been a number of health transfers amounting to $60 billion over eight years. It seems unusual to me that there would be no strings attached for public health purposes that would make a material difference for us, and I can point to a recent report of the National Advisory Committee on SARS and Public Health, ``Learning from SARS,'' and we hope to be the parenthetical title, ``Renewal of Public Health in Canada.'' This report was commissioned by Minister McClellan in May this year. This is a marked-up copy, unfortunately, but I can make sure that, through the clerk, members of the committee receive a copy. It is an excellent examination of the issues and the need for renewal of public health infrastructure across the country. It proposes a structure, a funding model and all the rest of it.

The Chairman: Excuse me, doctor, but do you endorse the recommendations?

Dr. Basrur: I was a member of the committee, so yes, I do. The committee was chaired by Dr. David Naylor, the Dean of Medicine at the University of Toronto, and a number of people who are experienced in health matters, including public health, were members. It generally got a very warm reception, albeit with no commitment to funding, at the federal level, and if it will be more of the same in terms of how they have not funded emergency preparedness, that is a concern for me.

As to Senator Forrestall's question about does the bottom-up system work, it does if the money flows from the bottom and trickles up, but of course it does not, does it? We rely on the bottom. Why is it ``the bottom''? It is like we are bottom feeders or something. The money starts to flow at the top. If it trickles down and we can catch a pellet every now and then, that is terrific.

It does not work, and I can speak to examples of where announcements on emergency preparedness from the federal level have not been matched by actual cash received at the local level.

Senator Forrestall: Give us one example.

Dr. Basrur: The JEPP funding, which we applied for as a city in concert with other jurisdictions in the fall of 2001. I will rely on my city colleagues, who are in the audience, to speak to it when their turn comes later this morning, but suffice it to say we applied for a three-year commitment on something called CBRN, with which I am sure you are quite familiar.

Senator Forrestall: I will refer this to the Chair.

The Chairman: We have a rule.

Dr. Basrur: The no acronyms rule?

The Chairman: We would be happy if you would, for the record, say what it stands for.

Dr. Basrur: SARS is an acronym, so forgive me for all of those references.

The Chairman: No, we have been keeping track of it.

Dr. Basrur: It stands for Chemical, Biological, Radiological and Nuclear Terrorism activity, by and large. We had applied for funding for that program, for Heavy Urban Search and Rescue, and for the infrastructure for our own emergency planning within the city and within public health. We feel that public health is one of the key planks in the infrastructure that keeps people well in society and functioning, and we need our own, whether it is proper computer systems or people with expertise who can be mobilized to not only prepare and plan pre-event, but actually be mobilized during and help us recover post-event.

We received no federal funding for our emergency services unit. We are funding a three-year program with city money. We applied on a three-year basis for the Chemical, Biological, Radiological and Nuclear Terrorism program; we received notice 10 months into the second year that we would not be getting funding for year two. Now, I do not understand why, when the United States has a major exercise called Top Off II — and that really is the full name — to test their capacity to plan and manage a multi-centred terrorist event, our funding is cancelled. They are spending millions, and we are supposed to have a common approach.

Senator Forrestall: Doctor, there is no answer to that question. In part, what we are trying to do is find an answer, or suggest one that will work.

You began a brief, if imperative comment or two about Canadian and U.S. systems. Is there anything succinct you could say about our two systems and where ours breaks down and the Americans seem to succeed? Is it money alone, or is it more?

Dr. Basrur: Well, it is interesting. It may be just a question of how many zeroes you have to the left of the decimal. I attended a conference recently in the United States, where municipal leaders were bemoaning the lack of federal funding, because the federal funding goes to the state and then sort of trickles down to the local level. They have more zeroes on the left of the decimal, but the issues are somewhat similar.

However, the United States has the Centers for Disease Control and Prevention; Canada does not. One of the recommendations in this report is that we develop a made-in-Canada solution that would provide what people have referred to as a ``CDC North.''

Second, we have many examples of two solitudes in so many dimensions. For example, we have communicable disease control and surveillance, management and outbreak control and so on, and in a separate corner we have emergency preparedness and response — different people, different paradigms, different funding streams; I do not know why the two are separate, but they are.

At least in the United States they have FEMA, the Federal Emergency Management Agency, which directly funds local governments so that they can plan and prepare for local emergencies. If something starts locally, you have to give them the tools and the resources that they need to actually do the job, and not rely on them to know, once they are overwhelmed, what number to call, and then that province phones the federal government and maybe something happens.

Senator Banks: You would be happier if the federal government had direct, hands-on funding channels to you at the point of the stick, bypassing, in effect, the province? Are you urging that?

Dr. Basrur: I do not know how easy it is to have everyone hold hands and agree that this is a good thing to do, and at the same time find a way out of the constitutional impasse that seems to create a real gridlock on the flow of funds or the making of reasonable decisions, which seems essential to me. Whether that means bypassing the province or offering a carrot so big that it cannot be refused, I do not know, but it seems to me that we are at the short end of the stick, if you want to use the analogy, and we are supposed to be the front line responders.

The second thing to note is that many of the discussions occur at the federal-provincial-territorial level. There is no local, municipal or regional input in that paradigm. We are creatures of the provinces, and they include or exclude us at their sole whim. I think, frankly, that large urban centres ought to be treated as entities of national importance. It does not make sense to me that we should be treated as invisible and irrelevant on matters such as this.

For example, there would be daily teleconferences between the federal, provincial and territorial representatives, and not to pick on my northern colleagues, but Nunavut, with a population of 25,000, would be guaranteed a seat at the table, while Toronto, with a hundred times the population and the epicentre of the outbreak, would not. I do not understand the logic behind that.

Somehow, some bright minds with a will should find a way to figure that out. I realize that there is a question of how large is ``large,'' what is ``medium'' or ``small'' or what have you, but surely we can work something out.

Senator Banks: You just used a word that is not in the normal lexicon of the kind of relationships that you are talking about, and that is ``logic.''

Dr. Basrur: Hope springs eternal.

Senator Banks: I have a view on that. I had the honour of being the Vice-Chair of the Prime Minister's Caucus Task Force on Urban Issues, and there are enormous constitutional impediments, as you say. I hate the phrase, but you are right, the municipalities of all sizes are ``creatures'' of the provinces, and our Constitution is right in that respect in 99.999 per cent of the circumstances in which it obtains.

Personally, I think that you are right, that questions of emergency response to a natural occurrence, to a terrorist one or to an accident or whatever, is the one circumstance — and that would include some belligerent act of a more symmetrical nature — in which those considerations ought to transcend our normal deference to constitutional questions. What I am getting to is that in this instance, I believe there has to be a hammer. There has to be a mandate. Somebody has to bite the bullet. I think the federal government must say, notwithstanding all of those constitutional issues — and I have no idea or expertise in how to get around those — we have to have a direct pipeline for the purposes of, first, establishing national standards, to the extent that that is possible, and secondly, as you said, a direct connection between the resources and the people who will answer the 911 call.

Sorry, I just gave a speech, not a question. However, I take it that you would more or less agree with that?

Dr. Basrur: Yes.

Senator Banks: When there is a natural or accidental or intentional occurrence that requires a massive response of the kind that you have been talking about, there is sometimes a necessity, in the public communication sense, to immediately inform the largest number of people possible of what is going on. I live in Alberta, which has a wonderful, almost magical way of doing that, in the form of an early warning system, if you like, in which every broadcast of every description on every medium, known or not known or yet to be discovered, can instantly be interrupted by the proper authorities and the message sent. Whatever else is going on in every broadcast medium — cable, radio, television, you name it — can be interrupted without anybody having to make a phone call or get permission: ``Right, folks, here is the nature of the problem and here is what we need you to do.'' In that way, you can reach a very large number of people at almost any time of day.

Is there such a system in place now in Toronto that would give you instant access to the 20, or however many it is, radio stations, television stations and cable systems that exist, and if not, is it being contemplated, to your knowledge?

Dr. Basrur: We certainly do not have that capability now, and I cannot tell you whether it is even being discussed at a provincial or federal level insofar as it applies to Toronto. We do have many media outlets here — print, radio, TV. That being said, it is a huge challenge to communicate in a city with so much media density because there is so much going on all the time.

Right now, if we have an emergency we need to make known to the public, the mass media is our best and only way of doing that, and we rely on them to get their TV trucks to wherever we are holding the press conference and then on the news cycle to actually get it out, unless they interrupt their regular programming.

I will just note that getting information out to the general public is extremely important and something that should be considered. Another is rapid communication with others who have a need to know, and I will give you the example of community physicians. We believe that we have — and I say, ``believe'' pointedly — 8,000 doctors in the city of Toronto. One-third of them has neither e-mail nor fax communication capability with Toronto Public Health, so for 30 per cent of 8,000 physicians we have to rely on snail mail or Canada Post or what have you to get information out, and that does not make any sense either. We do not have the communication infrastructure, whether it be pressing a button to interrupt TV programming, or even just to say this is the latest update, please make sure that you do not let this kind of patient into your office, or if you do, this is the kind of treatment they need.

Senator Banks: However, you do not surely suggest that we ought to subsidize doctors' offices by buying computers, or should we? If we do that for the 2,400 who do not have it, what about the good guys who already do?

Dr. Basrur: I realize that that is one good reason for not having addressed the issue. However, in an event like this, we were severely hampered by our lack of ability to communicate, and there may be more or less draconian ways of making an it expectation, whether as a condition of licensure or of being able to bill OHIP for reimbursement. Somehow or other, there ought to be a duty on the part of health providers to be able to communicate with one another, perhaps with some reasonable amount of financial assistance to at least subsidize that function, because it is in the public interest.

Senator Banks: To move briefly to another subject, and this will be my last question, Chair, you mentioned the Urban Search and Rescue. We were given some assurances last week that this is all in training, is all working very well and Vancouver, we are told, is up and running and meets the UN international standard for HUSR, Heavy Urban Search and Rescue.

I think Calgary is getting close to that. Can you tell us where Toronto is with respect to Heavy Urban Search and Rescue, since obviously, if there is going to be Heavy Urban Search and Rescue, Toronto is where it ought to be?

Dr. Basrur: I will have to defer to my municipal colleagues, who will be following my presentation. I can only speak for the health side.

Senator Atkins: Doctor, thank you for your presentation this morning. Just one point, we were told the other day that Top Off III was in the planning stages. I believe they were to have something by 2005. I do not know whether you are aware of that.

The Chairman: Let the record note the witness shrugged.

Dr. Basrur: Let the record show the witness checked with her staff and we are not aware of this. Frankly, it speaks to the degree of participation in these national or international exercises. I realize there is a lot of protocol and a lot of logistical problems in saying we will participate as a country, and that it is easier said than done by a long mile.

However, if the international degree of co-operation in such an exercise is limited to people in Ottawa, or at best, people in Ottawa and Queen's Park, it still does not get to the front-line bottom end, if you want to call it that, of the response.

Senator Atkins: I have some questions based on your presentation, just for information. Are there any new cases of SARS at the moment?

Dr. Basrur: Not that we are aware of. International health surveillance is underway. However, I think there is still a lot of work to do in even finding agreement on how to define a case.

Senator Atkins: Your numbers are very striking. How many cases of post-traumatic stress disorder have you identified?

Dr. Basrur: We have not tried to do an internal survey of the extent to which that has occurred. It is anecdotal information, but to the extent that I have had a few stories come to my attention, I think it is a legitimate observation.

It probably does bear some study of who and how, and with what resources, because it is a complex and sensitive matter to get into, as you can imagine, and once you do, what will you offer them, having labelled them a problem of some sort? However, leaving it alone does not fix it either.

Senator Atkins: You talked about service agreements. Do you mean union agreements?

Dr. Basrur: Well, that is one example. In the event, we were able to secure an agreement with our unions about the inclusion of workers from other health units at the Toronto worksite to perform work that would normally be done by union members, if we could find enough of them. They were members of a different local in their home employment establishment and had to pay union dues, and we agreed that they would when they came to work for us.

It is possible, and ideal, to figure everything out in advance, from how you compensate people in the middle of an emergency, who gets danger pay, if you give that, and who does not, all those sorts of things. However, it is not just labour management, it is also employer-to-employer.

Currently, the medical officers of health in the central-east area of Ontario are collaborating to develop a shared service agreement in emergency preparedness and response. One of our difficulties is that we are so big in relation to the others that they cannot conceive of saying, ``Well, we will send you a nurse.'' First of all, it is a drop in the bucket for us and it might be their only nurse, so it is a little tricky to work out those sorts of details, but it is necessary. Ideally, the province would be able to sort this out for us and develop a template agreement that we could all tailor to our specific circumstances, rather than us re-creating the wheel at the local level. However, if that is what it takes, we will do it.

Senator Atkins: Are you saying that as a result of the SARS emergency, a whole lot of activity has been triggered in these areas?

Dr. Basrur: Absolutely, yes, and that is a good thing.

Senator Atkins: Yes.

Dr. Basrur: It is a good thing if it is done before the next one hits us.

Senator Atkins: I want to read you part of a summary at the conclusion of your letter of January 29, 2002, and maybe you can comment on it. It is quite insightful. You say:

Nonetheless, jurisdictional sensitivities are a heavy obstacle to the proactive sharing of information and resources, even in the current environment of heightened political will among the major players to work co- operatively. The needs of local first responders, as well as the knowledge and expertise that is resident among them, must receive stronger recognition, and measures to ensure their direct participation in future federal planning activities must be developed.

Dr. Basrur: Still true.

Senator Atkins: It is all still true?

Dr. Basrur: Yes. I do not assume that these problems will be resolved overnight; they have accumulated over many decades. However, I do not see measurable progress occurring to dismantle some of these barriers.

Senator Atkins: That is the point I want to make. This was 2002. That is two years ago.

Dr. Basrur: Yes.

Senator Atkins: You have not seen any significant movement?

Dr. Basrur: I may need to confer with my staff, but Dr. Henry, for example, was mentioning that she had been approached by representatives from OCIPEP and two different units within Health Canada, all trying to put together a training program focused on the same audience, which was front-line health care workers. There were three different entities at the federal level trying to do the same thing, and we heard from OCIPEP that it was not necessary to include public health representatives, even though we are front-line health care workers and have a direct interface with both hospitals and EMS. It seemed to me, therefore, that something was still broken on both fronts.

The Chairman: Would you like to bring your colleague to the table, Dr. Basrur?

Dr. Basrur: Perhaps, yes. Dr. Henry was saying that occurred last January\February 2003, so a year after that letter.

The Chairman: Dr. Henry, could you identify yourself for the committee, please?

Dr. Bonnie Henry, Associate Medical Officer of Health, City of Toronto: I am one of the associate medical officers of health with Toronto Public Health, and I work in the Emergency Services Unit.

Senator Atkins: One final question. You mentioned transfers, and I think you said there was $60 billion for health?

Dr. Basrur: Again, I am going by the information contained in the Naylor report, but I think it was $60 billion over eight years. Maybe there was money that was announced twice in there.

Senator Atkins: Is that the CHST program?

Dr. Basrur: Correct, of which $20 billion was not earmarked, and therefore could be potentially allocated to support local public health efforts.

Senator Atkins: It is almost a constitutional question, getting back to what Senator Banks was talking about, because once the money is transferred, the provinces want to preserve the right to make their own decisions on this.

Dr. Basrur: Well, all I will say to the Chair and members of the committee is there may be more than one way of looking at this, and there is the typical way, which is federal\provincial, with everything subsidiary to the province — their jurisdiction to do or not do, to be active or neglectful as they see fit.

A law professor at the University of Toronto, Professor Sujit Choudhry, produced a report in the context of this committee's work that took a look at what opportunities might exist for the federal government legally to provide stronger support to public health at a local level, using both the peace, order and good government provisions and the criminal law powers that are clearly a federal responsibility.

Yes, you can look at it one way and say it is their job, it is their problem and I do not want to arm wrestle with the provinces, or you could say that this is something of national importance, let's find a way. I would encourage the committee to get a copy of that report, and I can provide it to the clerk if need be.

The Chairman: If you would, please, and the spelling of the name.

Dr. Basrur: I will provide that to the committee clerk, Ms. Reynolds.

The Chairman: Thank you.

Senator Meighen: Welcome, Dr. Basrur. I think I am the only resident of Toronto among my colleagues, so you are familiar to me, at least from the television, and I can only commend you and congratulate you on the incredible job you and your colleagues did during that outbreak, when it was very apparent that we were so ill-prepared to deal with it in many ways.

As you say, luck sometimes does play a role, and fortunately, we had more good luck than bad luck and we survived, and you certainly deserve the lion's share of the credit for keeping things within reasonable bounds.

I did want to know whether, to your knowledge, the Naylor report is the only one that has been commissioned? My understanding is there are some other reports in the works.

Dr. Basrur: Yes, the report of the National Advisory Committee on SARS and Public Health, chaired by Dr. Naylor, is the only federal report that has been commissioned and the only one published to date.

There are two investigations underway at the provincial level in Ontario. One is an independent commission under Mr. Justice Archie Campbell, under the provisions of both the Health Protection and Promotion Act and the Public Inquiries Act. That is an independent review, as you can imagine, which will report in, I believe, September 2004.

In addition, the province has set up a provincial counterpart to the national advisory committee, a provincial advisory committee on infectious diseases, under Dr. David Walker, Dean of Medicine at Queen's University. I am an ex-officio member of that panel, and they will be issuing a progress report in November and a final report in February, subject to the agreement of the new Minister of Health.

Senator Meighen: Senator Banks was talking with you about communication with the public. Are you aware whether there exists in Toronto or anywhere else — I am not — a so-called ``reverse'' 911 system, whereby, let us say, if a noxious gas is escaping from a plant and you wanted to contact all the people in the area to tell them what preventive action to take, you could dial 911 in reverse and get through to all those houses?

Dr. Basrur: I probably should defer to my municipal colleagues, who will be appearing afterwards. I will just note that we looked into it in the context of our West Nile virus contingency planning earlier this year, because we anticipated that it might be necessary, on the basis of mosquito surveillance or what have you, to flag an area of high health risk and advise those residents to wear more repellent, et cetera. My understanding is that we had to purchase the service and it was only accessible to Bell subscribers.

Senator Meighen: The acronym OCIPEP, the Office of Critical Infrastructure Protection and Emergency Preparedness, has been bandied about somewhat. Do you work closely on a personal level with the regional director of OCIPEP?

Dr. Basrur: The short answer is no. I do know Mr. Wayne Brocklehurst, who is with the Toronto office. We have had very limited dealings with them because again, in this chain of command, we talk to the provinces; only the provinces talk to the federal officials, and we are not allowed to do so, unless it is ``under the table.''

Senator Meighen: I wanted to ask whether you had any comments on the effectiveness of the airport screening system at Pearson. To be provocative, would I be wrong in saying that that system, and any other that may have been in place, has not, for better or worse, caught one single person suffering from SARS?

Dr. Basrur: You would be absolutely correct. Again, not to beat the drum, but it is my drum.

Senator Meighen: Beat away.

Dr. Basrur: The Naylor committee report does deal with this. The report itself is pretty hefty. The executive summary is an easier read; it is 11 pages, and on the last page there are some statistics that I will note for the record here. As of August 27, an estimated 6.5 million screening transactions had occurred at Canadian airports for the detection and prevention of SARS transmission; roughly 9,100 of those 6.5 million passengers were referred for further assessment; none of them had SARS.

There are pilot thermal scanners, which do surface temperature checks, in Toronto and Vancouver, and neither of those, nor the facilities that have been put in place in other international ports of call, have been effective in detecting SARS for a whole variety of reasons. The efficiency is minimal.

Senator Meighen: In your view, is it because of inherent inefficiencies in the checking system, or does it lead to the conclusion that we are wasting our time doing that?

Dr. Basrur: It is a combination of factors. First of all, my understanding of the rationale for screening incoming people is that we want to prevent the export of cases. I am not much of a mathematician, but I do not know why you stop the inflow to prevent the outflow; however, that was one of the rationales for instituting airport screening.

The second issue is that it relies on the customs agents, as you are aware, and in personally going through the airport a number of times recently, I have never been asked for the form; sometimes I have had it and they have never looked at it; sometimes I have hidden it and they have never asked for it. I go past the scanner just to check if they are awake; they usually are.

However, if I am incubating the disease and do not yet have a fever, they will not detect it. It registers surface temperature, not core temperature, which is really the issue of concern. You may have a fever for some other reason, you may have a sunburn, may have been drinking a lot of alcohol on the plane and you are flush and set off a scanner. There is a problem with both sensitivity and specificity of the screening tool, over and above the difficult logic that I find in this. Dr. Henry would like to make a comment as well, if that is acceptable.

Dr. Henry: Two issues about the screening at the airports and quarantine: One, in February/March this year, Health Canada made the decision to remove all of the quarantine officers; this is a federal function. All of the quarantine officers were removed from Toronto and the responsibility was given to customs officials, who had not yet been trained. That proved to be a difficulty for us during the outbreak, needless to say.

The Chairman: Could you give us the dates again? There were how many quarantine officers here, they were removed by Health Canada at what date and how many do you have now?

Dr. Henry: We had none on-site at Pearson International Airport when the outbreak started in March.

The Chairman: And they were taken away from Toronto when?

Dr. Henry: It was in the January to March period.

The Chairman: And the reason for this was?

Dr. Henry: My understanding from Dr. St. John, who is in charge of that aspect, was because it was an inefficient system. They were not sure who had actually been designated as quarantine officers and they had not been used for a long time.

The Chairman: You say that there was no training of customs officers to assume that duty?

Dr. Henry: The training was to have started in the near future. The customs officers were expressing concerns about taking on that responsibility.

The Chairman: You are telling the committee that the quarantine officers were removed before trained replacements were provided?

Dr. Henry: That is my understanding. The replacement was a 1-800 number in Ottawa, where somebody was on call 24 hours a day to answer the questions of the customs agents on the ground if they had a medical concern.

Senator Forrestall: Your brief and your presentation have been an excellent recap for us, but why did you not once mention SARS in your slide summaries?

Dr. Basrur: It is on the title page, and that was the only reason. It is implied on every page.

Senator Forrestall: That is fine.

The Chairman: Dr. St. John, to whom you just referred, testified before this committee that there were 1,600 caches of medical supplies across the country designed to be of assistance to first responders in the event of medical emergencies and crises. Senator Forrestall and I have had occasion to inquire in some locations about these, and we would like to know from you, doctor, what shape these supplies are in. Obviously, if there are 1,600 of them, Toronto must have some. What sort of equipment is there? Were you involved in deciding what was needed? Are the locations convenient for you to get to? Is the equipment packed in a way that you can access it easily? Does it complement other equipment that you have? Would you suggest any other additions to that equipment that would make your job more effective and useful?

Dr. Basrur: I will provide my own perspective and then defer to Dr. Henry for a more practical illustration.

I feel that this is another illustration of the schism between emergency responses from the bottom up, and the fact that if you need any help, you call all these numbers in the chain of command, and eventually you get to the person who controls the stockpile. Then there is a trickle-down of something helpful.

It would be ideal if there were far more local involvement. If we are really on the front lines, then we are at the front, not the bottom, of emergency preparedness and we should know exactly where the caches are, what the inventory is, how they are organized, what they do not have, what state they are in, et cetera.

I remember discussing this matter with Dr. Jim Young, who I believe will be a witness before the committee this afternoon. He had arranged with Dr. St. John to go on a tour of one of their depots. Unfortunately, I was unable to attend, and I suppose that was my opportunity to inform myself, which seems a little ad hoc.

When Minister Rock was the Minister of Health, he commissioned a National Advisory Committee on Chemical, Biological, Radio-nuclear Safety, Security and Research chaired by Dr. Donald Low, from Mount Sinai Hospital in Toronto. I am a member. We had a presentation from the Health Canada Centre for Emergency Preparedness and Response, which controls this stockpile. I asked questions — and I made the same comments there that I have just made to you — and did not feel that I got satisfactory answers in terms of a complete disclosure of where they keep these, what is in there and whether we would be welcome to assist in the planning and organizing; it was a federal responsibility, and something of a national secret, to be honest with you.

Now, that said, I know Dr. Henry has worked with her federal counterparts on certain events such as World Youth Day, which was a massive undertaking, and that the stockpile was used in that context. Dr. Henry?

Dr. Henry: We did have agreement prior to World Youth Day — it took a long time — from the federal government to use some of the national emergency stockpile to try out one of their new portable clinics. Both portable clinics are located in Ottawa. The nearest stockpile to us was in Cambridge, which is two hours away.

The Chairman: There are 1,600 in Canada, and the closest one to Toronto is two hours away?

Dr. Henry: That is my understanding, unless they have changed the locations. Most of it was old 1950s, post-Second World War equipment, things like cots. It was basic medical equipment that you would need to set up a centre to look after people. That is not the drug stockpile, although some of the drugs, Cipro, for example, are stored with the manufacturers, who happen to be mostly in Mississauga.

One of the biggest problems is that the stockpile is only equipment, et cetera, so you have to find the staff yourself. When the SARS outbreak started, we opened a ward at the old TB hospital, West Park, and requested from the federal government some equipment from the stockpile to help put beds, et cetera, in the wards. They only had cots. The hospital itself managed to find beds and the needed equipment. The one thing that they did send down from Ottawa was a portable chest X-ray machine, which we did use.

Therefore, it has limited utility for us. We are not privy to most of what is in it. Our experience, from use in the past, is that most of the equipment is quite old, needs upgrading, and one of the biggest problems is it does not come with the support that we need.

If we are in an emergency situation and everybody is overwhelmed, we need people as well as equipment.

The Chairman: A recurring theme, Dr. Basrur, is lack of surge capacity. We have heard about it elsewhere. Can you comment on it in the context of your experience in Toronto? Your colleague has talked about there being equipment but not people. First of all, is there surge capacity in the public health system, and if so, could you describe it to us; and if not, could you suggest what might be appropriate?

Dr. Basrur: As Dr. Henry mentioned, surge capacity involves, first, the inanimate things, facilities and equipment, and then the people to actually deliver the services, because programs and services in the health sector are people- driven.

SARS was an infectious disease outbreak, but in a similar fashion, if we had a smallpox-related terrorist event or pandemic influenza — name your biological hazard — we would be short in both areas. We have a desperate shortage of proper infection control facilities in our acute care settings. We have emergency rooms that were not planned to take into account the spread of infectious diseases. They did take revenue generation into account when planning new hospital wings and so forth, so the Second Cups, the McDonald's and whatnot have their place, but not necessarily the room with negative pressure ventilation, not just in emergency but also in ICU, intensive care unit.

There was a time during the SARS outbreak when we were at our limit in terms of access to ventilation equipment for people who needed assisted breathing and we could not care for them. We were literally at the limit of the equipment that was available, and that was for a fairly mild, focused event, relatively speaking.

The second thing, of course, is the staffing. Dr. Henry mentioned opening up West Park. The hospital found the beds. The limiting factor was staff to work there — not beds or rooms in the building itself. Clearly, we need the facilities, the equipment and the people.

We operate at our baseline capacity, which is our maximum capacity. Hospital occupancy rates are at 95 per cent on a regular basis, even without an infectious disease emergency.

The Chairman: I will come back to you in a moment to ask for your views on how to solve the surge capacity issue, particularly the people aspect.

Senator Meighen: I want to ask Dr. Henry to elaborate a little on the bottom line: Who has the key to these so-called ``stockpiles''? You alluded to negotiations on whether the door should be opened or not. Who negotiated? How long did it take?

Dr. Henry: The key is with the Centre for Emergency Preparedness and Response in Health Canada. The case that we were talking about, of World Youth Day, was not an emergency. It was what we called a ``planned emergency,'' an event that was to take place where we had concerns about specific issues, including infectious disease. There was reluctance on the part of the federal government, understandably perhaps, to use the emergency stockpile for an event where an emergency might occur.

Senator Meighen: I am not sure I understand that one. Who says, ``This is an emergency and we will open the door''? Is that OCIPEP?

Dr. Henry: Well, they could. Emergencies have to be declared, according to our system, by the elected officials of the jurisdiction in which they occur.

Senator Meighen: Who would that be in the case of SARS?

Dr. Henry: In the case of SARS, it was the province. If the state of emergency was declared, then, potentially, it could be set up.

Dr. Basrur: On an unequivocal basis, the stockpile would be accessible if the local jurisdiction asks the provincial Solicitor General, who then asks the federal one, who then asks Health Canada, and then it comes back.

Senator Meighen: To the person with the key.

Dr. Basrur: If you are anticipating the need for something and have not therefore declared an emergency, it confounds me as to why this should be a subject of negotiation, when in fact it was an opportunity for us to test our capacity. You never know when you might have an actual emergency when you are bringing in a million extra people.

Senator Meighen: In your professional opinion, what is the likelihood of a return of SARS?

Dr. Basrur: You can ask for my opinion, Dr. Henry's opinion and Dr. Low's opinion, and get three different answers.

Senator Meighen: Is it a realistic apprehension?

Dr. Basrur: It is an absolutely realistic concern, whether it is SARS or some mutated variant of it. If it could mutate once to infect humans, it can mutate again, in my opinion. To imagine that we have absolutely cleared it from the worldwide landscape, I think is a stretch.

I know Dr. Low feels that it is gone and will not come back, so it may be a matter of professional speculation at this point. However, whether it is SARS or the next influenza virus that mutates enough to escape control by our vaccine, we have to be ready for it.

Senator Forrestall: And we are not?

Dr. Basrur: No.

The Chairman: Dr. Basrur, do you have advice for this committee, or views that you could express, on how to address the surge issue, particularly in relation to staff? Your colleague has talked about the need for extra supplies of equipment and drugs, but they are not much use if you do not have trained people.

You are operating at a 95 per cent capacity in the normal circumstance in the hospital system here in Toronto, if I understood you correctly. What solution would you like to see to deal with surge problems?

Dr. Basrur: This is a long-term solution. It is not something that will be easily reversed overnight. However, there needs to be a national strategy on health human resources, and that is actually something under discussion. Whether it will lead to a concrete resolution in the foreseeable time frame is another question, but there are two federal-provincial- territorial working groups looking at health human resources planning. That is something to build on, for what it is worth.

It needs to involve everything, including the recruitment and funding of additional placements for people in public health fields, whether that be community medicine, epidemiology, hospital epidemiology or infection control, et cetera. There need to be stronger training programs and training standards established at the national level that are then applied in a provincial and local context, so that the rising tide can raise all the boats, so to speak.

There needs to be stronger accreditation of health care institutions so that the current staff are more aware of and adept at infection control and disease surveillance, and also occupational health matters where they have a bearing on infectious disease control.

We will definitely need to accelerate the licensure of health professionals who have immigrated to Canada with credentials from another country, and who, with some modicum of training, could get an accelerated licence here, because we clearly have shortages and underemployed professionals, and it seems to me that the two ought to be able to join up somehow before we build up our institutions in the longer term. Those are a couple of suggestions.

The Chairman: If Quebec or Manitoba had had physicians available, could they have come to assist you?

Dr. Basrur: We did have physicians come from other provinces who were granted a temporary licence by the College of Physicians and Surgeons of Ontario under the supervision of one of our doctors. We worked out a temporary arrangement to facilitate that during the event.

There were still issues of insurance and so on that needed to be overcome.

The Chairman: They came without any malpractice protection and that sort of thing?

Dr. Basrur: Malpractice protection is national. For the other kinds of practitioners, nurses for example, it was a prohibition on exchange of staff, in many instances.

The Chairman: How about Buffalo? That is closer than Montreal.

Dr. Basrur: Again, Dr. Henry can probably speak to the detail better than I, but we did have some physicians come from the States to assist us. Some of them were from the Centers for Disease Control itself and came to do an investigation of hospital transmission, for example, and others came to assist with infectious disease surveillance and control for individual hospitals.

One of the problems was that they ran the risk of being put in quarantine when they went back to their home institutions, and if they saw patients or did research, they were at risk of being cut off from their source of livelihood, so it was an absolute prohibition on them coming in the first place.

That is not necessarily under our control; it is one of those realities that you know you cannot count on people who are not under your own control.

The Chairman: Senator Meighen raised the possibility of SARS coming back. Let us assume for the moment that Dr. Low, a well-respected individual, is not correct. How well prepared is Toronto to deal with SARS if it reappears here? Could you comment on your isolation capacity and the quarantine capacity, and perhaps differentiate those for the committee?

Dr. Basrur: The bottom line is we are not yet ready. I will not say we never will be, but it is definitely a work-in- progress with a capital ``W.'' Quarantine is for healthy people; isolation is for sick people. People who were exposed, contacts of a case, but not yet sick, were put in quarantine. They were placed at home as the most feasible place in which to quarantine them, as compared with using motels and having all the guests leave. That would have been another option potentially, although then you have to staff the motel.

Isolation is for sick people. I will tell you that there has been no major capital program that I am aware of in Toronto hospitals to deal with a shortage of negative pressure rooms or the lack of equipment and staff and so forth. These are major undertakings, and work is underway through the panel that I mentioned earlier.

If you ask me now, are we that much further ahead than we were a year ago? I would say no. We probably will have more people vaccinated against influenza this year than last year because of awareness, and a lot of people are washing their hands, but in terms of the physical infrastructure, it is a longer road.

Insofar as public health is concerned, we did get provincial funding for additional staff to deal with hospital-based surveillance for SARS-like illnesses. Unfortunately, there is a lot of difficulty in setting the standards on what these staff should do, provincially and federally, so we are having to take all these draft forms, establish a city standard as best we can and just work in a voluntary fashion with our hospitals to try to persuade or cajole them to do what we think is reasonable from a public health perspective.

However, please note the funding is guaranteed until the end of March, and then it will revert to a 50/50 cost-shared basis between the province and the local municipality, which is the basis for public health funding.

Here we have a situation where it is in the provincial interest, and, I would hazard a guess, the federal interest, to make sure that we have disease surveillance, and we will put 50 per cent of the tab on the property tax base when there is no more room there to manoeuvre. That does not make sense to me.

The Chairman: I have been advised that one of your meetings today is a budget meeting.

Dr. Basrur: Right after this one.

The Chairman: Do you anticipate that the city will be supportive of further funding for public health in light of the experience over the past year?

Dr. Basrur: I expect that the city will not be prepared to pay a dime for it because they will see it as yet another underfunded mandate, and that will leave us and the public, frankly, as the meat in the sandwich. We see the work that needs to be done; the public expects government to somehow figure out these issues; there are enough bright lights in government that they ought to be able to figure it out. At the same time, there will be a throwing of the hot potato from one level of government to the other, and meanwhile the clock will keep ticking and eventually we will have the next emergency.

The Chairman: The last area I wanted to touch on was your experience and your department's experience with Health Canada and OCIPEP. You have touched briefly on the Office of Critical Infrastructure Protection and Emergency Preparedness, and correct me if I am wrong, but my understanding is that this is not an organization that you deal with on a regular basis.

Could you elaborate on that, and on Health Canada and what sort of service they are providing to the citizens of Toronto? Are they here? Is their presence felt? Do you seek out federal assistance in a tangible way here?

Dr. Basrur: Not in my opinion, not with OCIPEP. It may be that is because their relationship is primarily with the province. However, if the JEPP funding is an example of how they could provide material assistance to us, it has fallen short of our expectations, and certainly short of our needs.

We are the biggest health unit in the country and yet Dr. Henry has only a small unit, and even that sets us apart from the vast majority of the rest. We have three-year funding and then, as I say, we get alternate funding or we put it yet again on the property tax base, and frankly, I cannot imagine doing without at least a couple of staff dedicated to emergency preparedness in a city this size.

Senator Banks: Is the funding during those three years sufficient?

Dr. Basrur: It is modest, and therefore sufficient between events. During an event, I think you get whatever you can and run. Frankly, it would be nice to know pre-event what the funding arrangements are, so that we know what expenses we can incur during an event and not be told afterwards, ``Well, that was not eligible. You should have known that.'' ``How would we know that?'' ``Well, you did not ask.'' ``Well, okay. I am asking now for the next time.''

Dr. Henry: May I make a comment on OCIPEP? I do have a relationship with the regional representative, who does his best. However, my feeling is that that person has little to say when matters go up to Ottawa, and we often hear back late. We have problems particularly with the JEPP funding and budget cycles. We do not hear from them until September\October. In our budget cycle, the money has to be spent by November. This year, for example, we heard in September that the money for our chemical, biological, radio-nuclear team would not be forthcoming; we had already spent a large proportion of that, so that becomes yet another pressure on the city.

The Chairman: This is a recurring problem. Do all municipalities in Ontario work to the same fiscal year, and by extension, all the municipalities in the country? You may have no idea, and perhaps I am directing the question to the wrong panel, but we have heard before about budget cycle problems that cause difficulties in dealing with the federal government. You are saying you have that problem here, too?

Dr. Basrur: That is correct, yes. Our fiscal year, from the Toronto municipal perspective, is the calendar year, January to December.

The Chairman: There are people nodding behind you. I think the next panel may help us with this issue.

Dr. Basrur: The provincial one is April to April. This one is November to November.

Senator Banks: So is the federal one. So in this game of chicken, who should blink?

Dr. Basrur: Not me.

The Chairman: That is a good note to end on.

Dr. Basrur, I have to tell you that the Deputy Chair has passed me a note saying, ``We need this doctor in Ottawa in camera.'' I think there is a feeling that perhaps the transcript may not do justice to the testimony.

On behalf of the committee, I would like to thank you and your colleague for appearing before us. You have given us useful information for our deliberations. We are very grateful for the work you have done, not only in protecting the citizens of Toronto but also Canada during the SARS outbreak, and we would like to compliment you and your staff. If you would convey to them that we were all impressed with the work that took place here under very difficult circumstances.

We would also like to thank you for the information you are providing as we go forward with our examination of federal assistance to first responders, and if you could convey those thanks to your staff we would be most grateful.

In a short time, we will continue our study of first responders by hearing from other officials of the City of Toronto. If you have any questions or comments, you may visit our Web site at We post witness testimony as well as confirmed hearing schedules. Otherwise, you may contact the clerk of the committee by calling 1-800-267-7362 for further information and assistance in contacting members of the committee.

It is my pleasure, honourable senators, to welcome our next witnesses to the Senate Standing Committee on National Security and Defence. We will hear testimony from officials about Toronto's ability to respond to natural or man-made emergencies.

Mr. Barry Gutteridge is Commissioner of the Department of Works and Emergency Services for the City of Toronto.

Mr. Gutteridge is responsible for managing 9,300 employees, with an annual budget of over $1.5 billion and an annual capital budget of $600 million.

His responsibilities including fire, emergency medical services, emergency planning, streets, roads and expressways, solid waste management, engineering services, and all water and wastewater operations.

His career has included over 20 years in management positions in the public sector. He has worked for the City of Toronto for the past eleven and a half years, in the private sector for two years and for the Province of Ontario for a number of years.

Mr. Gutteridge is accompanied today by Chief William Stewart, Fire Chief and General Manager, Toronto Fire Services; Mr. Bruce Farr, EMS Chief and General Manager, Toronto Emergency Medical Services; and Staff Superintendent Emory Gilbert, Operational Support Services, Toronto Police Service.

Also in attendance are Mr. Warren Leonard, Manager of Toronto's Office of Emergency Management, and Mr. William Crowther, Executive Director, Technical Services Division, Works and Emergency Services Department.

I welcome you all to the committee. We are very pleased to have you here.

Mr. Barry Gutteridge, Commissioner, Department of Works and Emergency Services, City of Toronto: Mr. Chairman, we do want to thank you for the opportunity to provide input to your views on frontline response to emergencies. This is a key issue that concerns us all.

You will have received a copy of our July response to your questionnaire and I have tabled an overview of today's presentation in advance. With your concurrence, I will briefly go through that overview. We will be happy to deal with any questions the committee has, either during or after the presentation. You will certainly see some echoes in the commentary of some things you have heard from our Chief Medical Officer of Health.

First of all, I do not think we need remind anybody that Toronto has a population of about 2.5 million, which is about a quarter of the provincial population. Our daytime population, however, is about a million more than that because of people coming to work in the city. Therefore, in terms of emergency management, we are concerned with a fairly large population base.

We certainly have had some experience in dealing with fairly significant emergencies over the last few years: The aftermath of 9/11 in terms of what happened in Toronto and elsewhere in Canada; the planning and contingency for Y2K, which fortunately was a non-event; SARS, which you have heard about recently; and, more recently, the blackout. One of the things we have learned from that is that in addition to dealing with an additional population of 1 million in Toronto during the day, we also have to deal with commuters trying to leave the city and get back to their home communities when these emergencies occur.

We have also dealt with a number of major fires, chemical spills and, a few years ago, a loss of telecommunications during a fire at Bell. The fire itself was not the major emergency. The emergency turned out to be the loss of telecommunication capability, including cell phones, in a major section of the city, and the impact on emergency response and so on.

We clearly also have some experience, in planning for major events such as the Papal visit and the Rolling Stones concert, in trying to prevent incidents from occurring and being ready. The staff here can give you much more detail on any of those areas, should you wish it.

Just to briefly touch on our approach to emergency management — this is one of the issues you raised — if you will refer to the handout, I will walk you through very quickly. We have a small emergency management office of about six people within my department. We have pulled together emergency planning staff from the other services, including fire, emergency medical service, police and others, into one location, and they all work closely together. That has been one of the benefits of amalgamation.

The purpose and mandate of the Office of Emergency Management is to assist us in risk identification, mitigation, preparedness, response and recovery. Its legal authority comes under the municipal code and the provincial Emergency Management Act.

As part of that approach to emergency preparedness, management and planning, we have quite a large Emergency Management Committee and two subsets of that, what we call a control group and a support group.

The control group is comprised of key decision-makers in case of emergency. The mayor has the authority to declare an emergency under the bylaw and under the legislation. That group includes, as you might expect, me, the Chief Administrative Officer, Emergency Medical Services, the Office of Emergency Management, Toronto Police Service, Public Health, and representatives from community and neighbourhood services and our economic development, culture and tourism services.

Then there is quite a large support group within that committee. We have tended to be very inclusive in terms of the other agencies that we have invited to participate. I will not go through the whole list, but as you can see, we have involved the various utilities, including Toronto Hydro and others; the Insurance Board of Canada, St. John's Ambulance — which is one of our helpmates in emergencies and day-to-day activities — the school boards in terms of the implications for their activities; the Toronto District Health Council; and representatives from the Ontario Hospital Association. TTC are also part of that, because each has to have emergency plans that fit into our more comprehensive framework.

We have an Emergency Operations Centre, a central facility that has been upgraded since Toronto's amalgamation in 1998. To date, we have spent about $750,000 in setting up and upgrading that facility. It has backups at other locations and is in a building with high security and earthquake protection. We discovered the need for backup power, for example, during the blackout, when we were running on standby generators.

It is also important to realize that within Toronto's emergency operations mechanism, there is the central Emergency Operations Centre, but most of the other services have their own emergency operations centres that, during an emergency and depending on what it is, act as links into those services. For example, TTC has its own emergency operations function that is activated if there is an incident involving them. We have a health coordination centre under EMS when there is a health care emergency. It is an integrated linkage.

The slide in front of you shows some of the linkages of the Emergency Operations Centre. One of the key links is to the province through their provincial operations centre. In case of emergency, they have a provincial representative at our centre, so there is a direct link intended as part of that framework.

In terms of front-line responders, we operate on the assumption that we may be on our own for up to 72 hours when facing a major emergency, before others can come to our assistance. Our approach is, and would be, to try to exhaust our services before calling on anyone else. We also see our role in working with the province as a major resource, both to the province and to Canada, in case of emergencies, and we want to be treated that way in various processes.

I also wanted to highlight that — and I alluded to it earlier — we have an integrated response beyond the traditional and infrastructure base. Much of the traditional approach to emergency management and planning deals with natural disasters, infrastructure failures, et cetera. We have discovered over the last couple of years that there is a weakness in some of those traditional approaches when dealing with health care emergencies. Typically, in some jurisdictions, health care personnel have not been conceptualized as part of the response team.

In Toronto we have four key responders, including health services, because there is a health component to dealing with things like CBRN and other emergencies.

We have also realized, in dealing with emergencies, that most are multi-dimensional, and that a particular incident may trigger two or three other, ancillary situations that you have to then deal with. Sometimes, these can consume as much or more of your time than the so-called ``major'' emergency. A good example is the fire in a Bell switching location that I referred to previously. The fire and rescue was a major issue, but the secondary emergency with which we had to deal was the failure of the communication system.

Based on our experience, we have been trying to be very practical over the last few years in terms of special initiatives. HUSAR is, as I have mentioned here, the Heavy Urban Search and Rescue program. Toronto's is one of five that we understand are being proposed across Canada. Vancouver has one that I understand is fully operational; Toronto is getting there; there will also be programs in Calgary, Montreal and Halifax. We still need about another 12 to 18 months to become fully operational. It is a multi-year training and equipment program.

As you know, this is a good example of a federal program to create a resource that can be moved anywhere across Canada to assist in emergencies. Agreements are in place on dealing with reimbursement and so on when deployment occurs. It is a very good example of co-operation between the federal government and the local level, with input from the provincial level, in creating a good national resource structure to deal with Heavy Urban Search and Rescue.

For CBRN, the Chemical, Biological, Radiological, Nuclear program, Toronto is one of three response teams in Ontario. Ottawa had the capability first. Then Toronto and Windsor were added. Through agreement with the province, and by design, our team, as well as the other two, can be deployed anywhere in the province, as required. Again, agreements are in place to deal with recovery of deployment costs.

In terms of the roles of the other levels of government, it is no secret that a municipality is a creature of the province. I mentioned the Emergency Management Act. It is new provincial legislation that, for the first time, makes it mandatory to do municipal risk assessment, emergency planning, training and public education. Previously, Toronto had a plan in place, as did most of the other municipalities, but it was permissive; now it is mandatory, and there is a phase-in process occurring.

Clearly, we are dealing with the emergency function in Ontario and the ministries. One thing to realize here is that each of the traditional services has a linkage to a ministry: the EMS to the Ministry of Health; the MOH to her counterpart, the Chief Medical Officer of Health for the province; fire services to the Fire Marshal; and police services to the Solicitor General. There are direct, ongoing program linkages. The intent of the emergency management function at the Ontario level is cross-coordination.

As part of that, the province is supposed to be a resource provider to us. In reality, the level of funding that they have been available to provide has been an ongoing issue. There were announcements in 2001 of about $21.5 million for various programs. Some of those resources have been made available to municipalities, including Toronto, but many of them are provincial resources.

We continue to grapple with the fact that the province has the mandate to seek federal agencies' resources on our behalf in case of emergency. We have to officially call an emergency and ask the province to call on federal agencies for resources. We are not to go directly to the federal level, the way the protocols are presently structured.

In terms of our relationship with federal agencies, as Dr. Basrur and Dr. Bonnie Henry indicated, we do deal with the Regional Director of OCIPEP. It is a very positive relationship, but our perception is that there may be very limited delegation of authority to actually make decisions at that level. Everything seems to have to go back to Ottawa.

We have had a very good relationship in terms of the JEPP grants, and have been especially appreciative of the funding provided in some of the programs like HUSAR. By contrast, the CBRN program is largely being funded through the city, with some input from the province. We seem to be hearing that there is less funding available through the federal mechanism than perhaps we were anticipating. I will come back to this in my further comments.

Under section 4 of my overview, I just touched on, in my role in coordinating emergencies on behalf of the City of Toronto, some of the things I have learned, and we have learned collectively, and provided some food for thought. Most of these issues apply across all jurisdictions, and some you have heard before.

First is the issue of resources: equipment, training and coordination. Coordination is an important part of that that we should not miss. In some cases, coordination costs nothing, but is not always in place the way we would like to see it.

The other issue on funding is the need for sustained funding levels. It is important for something like HUSAR to get funding for the equipment and initial training, as we have, but then there is the ongoing issue of the need to keep the equipment up to date and retrain people. They should not be conceived of as one- or two-year programs, after which funding ends.

We are all dealing at various levels in the public sector with limited surge capacity. In Toronto, we have downsized staff considerably in many areas as a result of amalgamation. We have also added staff in some areas, but we are all faced with the issue of having resources stripped out in terms of any spare capacity. I do not think we are alone in that.

There need to be better processes in place for identifying and sharing inter-jurisdictional operational resources to be ready for an emergency. We all recognize that public sector resources are limited at all levels. The challenge is to make best use of the existing resources. This means knowing where they are in advance, and how to activate their deployment on short notice. A little more work needs to be done in that area.

There are some frameworks and models out there. I mentioned the HUSAR one, which is a good model to follow and could probably be adapted to other programs.

We at the municipal level also have a series of mutual aid agreements with surrounding municipalities that sets out how we would help each other in an emergency, the protocols for calling on each other, and how costs are to be recovered. I suggest some consideration should be given to formalizing a similar approach, through the province, with federal agencies.

The other point is, we are aware that there are stockpiles of various sorts around the country, but there needs to be greater clarity around where they are, what is in them and how they are accessed. We understand the information has to be kept confidential, but it is difficult to plan for access to resources to deal with an emergency without knowing the full gamut of what is out there.

A second lesson we have learned in dealing with emergencies has to do with the issue of media and public communication, getting key messages out through the media about how to deal with the emergency.

For example, during the blackout, the communication from the province dealt with the reality of what happened, with the failure of the grid and how long it would take to restore power, among other things. However, at the municipal level, we were dealing with issues of people in high-rises. In some cases, the pumping of water to upper floors had ceased, or the elevators had ceased to operate. More modern buildings have standby systems, but not all buildings do. We started to prepare a series of public announcements about what people could and should do, which we were pleased to see were distributed across the province. They were intended for a Toronto audience, but were taken up and distributed. That is a good example of the need for that type of information.

What we have discovered, and I do not think this is news to any of you, is that if information is not provided to the media, they start to speculate. In some cases, that is worse than the actual situation.

Another issue that is always a challenge when dealing with emergencies is the need for credible spokespersons. You cannot just use a media representative. The media and public are looking for senior staff; they are looking for the mayor; they are looking for councillors; they are looking for a public-political interface, someone they feel has an authority they can trust in terms of the messages they are given. Therefore, during the blackout, we quite consciously used the mechanism of regular press conferences with the mayor. In a lot of them, we were saying the same thing — we are moving closer. However, one needs to do that.

The challenge of any emergency is that takes away a chunk of your resources. Unless you are very careful, you can get distracted in dealing with that part. The media and public want the key spokespersons. They want to see the police chief, ideally, or the fire chief or whoever. However, those are the very people you need in the backroom dealing with the emergency. We always have to deal with that dynamic.

More can be done nationally, and otherwise, to get people better prepared. Certainly, one of the things we learned in the blackout is that we need to assist the public in coping during an emergency and recovery. We saw people spontaneously helping with traffic control where lights were out, and so on. In a lot of cases, the public wants to help, if someone just tells them what to do in a situation and it can be coordinated.

Last but not least in the issues I have identified, and I think you had some discussion with Dr. Basrur about this, is the matter of roles and coordination. There is plenty of good intent among the jurisdictions. It is not that anyone does not want to make it work. One should realize that issues exist not only between federal, provincial, and municipal levels. There are issues across those levels, across our peer groups, in some cases, in terms of coordination. I do not think it is 1-2-3; it is much more multi-dimensional than that. Bruce Farr can give you more information from the SARS event, where the issue was hospital coordination, and all the dynamics that go with dealing with various hospitals and the ministries across those jurisdictions, as well as with the province. There are more things that could be done to improve this.

One of the questions raised is the way the current structure works. We declare an emergency, access the province, and then get them to access you, is how the information flow and decision-making work in these types of situations, whether it is timely or not.

In the case of Toronto, when we get into an emergency, we collapse our organizational hierarchies. Everybody pitches in. We coordinate through the EMC. People do not get upset about someone who may not be at their level telling them something. We just deal with it. I am not sure that always happens everywhere.

The lack of direct local access to federal agencies is an issue. We are aware of and work with the regional director. The provincial access protocols, however, tend to be enforced somewhat rigidly, even from a planning standpoint. A better design is needed, with provincial involvement. We are not trying to suggest that there should not be provincial involvement, but protocols for access and information flow should be improved, and more ability to work collectively is needed.

In the wake of 9/11, I did call some meetings and received great co-operation from the three levels. I discovered there was a lot we did not know about what each other was doing, but there was a lot of resource available. It has not been institutionalized and developed.

You might expect to hear this from a front-line municipality, but as you are dealing with your process, try to get some input from us as front-liners when you are looking at high-level planning and strategy, because clearly, any policy directives from other levels have to be activated locally. We feel we have very strong expertise in that and would like to provide input into any of those initiatives. I do appreciate the opportunity to provide our comments today and I would like to open it up for any questions you have for any of us.

The Chairman: Thank you very much, Mr. Gutteridge. That was a very helpful presentation.

Senator Forrestall: Could I take you back to square one? I have listened to what you said, and in one extended sentence, you spoke to the core of what I am very concerned about.

You talked about an ad hoc arrangement in which you told the old story of emergency measures. The fire chief tells the emergency measures fellow to go away. ``I am busy, I have a fire to put out. Talk to me when it is over.'' Who drives your bus when an emergency occurs? Who is in charge? Who is number one? I know there is the first fellow on the scene, but who is the boss? Who is the bus driver? You need every discipline at your fingertips, smooth coordination, effective implementation of planning and everything else that looks so good on paper. What is that office? Who is that person?

Mr. Gutteridge: I will answer the question in terms of dealing with an emergency at a level that requires activation of the Emergency Operations Centre. In dealing with day-to-day emergencies, any of the three first responders here can explain to you our process for incident management — dealing with a major fire, and so on.

That group is called together. The mayor or deputy mayor is present as the senior political representative.

Senator Forrestall: How long do they have to get together?

Mr. Gutteridge: The intent is to get there as soon as possible. The Emergency Operations Centre is not downtown; it is remote from city hall. While others are gathering, through the police services, the call-out is made to bring people there. My emergency management office staff are located in the same building, so they start gathering information and get some of the logistics running while waiting for people to arrive.

The usual process is I chair the Emergency Management Committee. I am the one who calls the shots and organizes the coordination. We also have a process for when we need to draw on and use the resources of all the players around the table. In any real emergency — and we have done exercises as well — it is a very active process of getting input, making collective decisions and moving on.

In dealing with issues of public communication, the mayor or deputy mayor has the final say. It is clear that the TTC, fire and other services know what their authority is within their jurisdictions. They know what decisions they can make.

For the EMC, one of the major challenges is finding out the correct information. Part of the first session is spent trying to get input from various sources. It is interesting how divergent the information you get can be when it first comes in. It is also important, as part of that process, to identify the lead responder to the emergency.

In the blackout it was Ontario Hydro, but we had a representative from Toronto Hydro at the table to give us information.

Then we would start a roundtable discussion of what we thought the issues were likely to be, what resources were required or likely to be required, and begin putting plans in place to deal with them.

Senator Forrestall: I am trying to get at the process that we have come to refer to as ``bottom-up'' support. I was prompted to go in this direction when you talked about the 72 hours for external help to get to you. As the legal entity that is Toronto, you have probably slightly less than half of the urban population. There are not too many open fields between here and Hamilton.

What about the bottom-up, trickle-up process? The fire department needs the money, and so does the police department. I have just as big a problem after dark on the streets of Toronto as anybody else.

What about the funding system? Should there be a closer relationship between the large municipalities? You have more people here in Greater Toronto and environs than in five Canadian provinces. I was listening to Dr. Basrur a few minutes ago, and it is a scandalous, unacceptable mess. What do you think about bottom-up funding?

Mr. Gutteridge: I would certainly like to see that work better, and not just in terms of funding, but especially of access to resources when we have an emergency. If we needed helicopters, for example, from National Defence Canada, there are a lot of things that could be done to access those resources more quickly if we had protocols in place in advance.

The way it works now is, we contact the provincial authorities and they act as a clearing house. We tell them what we want, presumably, and then they go looking on our behalf and come back to us with the information. Our recommendation is that it would be better to know all that and have it laid out in advance, so if you need helicopters, here is where you go. Bang, bang, bang. Our experience is you need to make decisions and to move quickly.

On the funding, again, in the blackout and other situations, our bylaw, right or wrong, does not cut across the issues. We deal with the emergency, and with the cost implications later, because you make the best decisions you can at the time, and if resources are required, there is a collective agreement to cover it.

Senator Forrestall: Does worrying about the costs later include worrying about the authority later? Do you go to the source, or do you follow the protocol up the line?

Mr. Gutteridge: Under the emergency bylaw, the mayor and EMC and company — and actually, I too as commissioner — have the power to make financial expenditures in an emergency situation. I do not need to go to council for authority as I normally would. I have to report to them afterward, but I have the authority to purchase what is needed and we have the authority to go out and do what is necessary.

For example, during the SARS emergency, when it was necessary to purchase medical equipment and so on, Toronto EMS was the main clearing house. Bruce Farr will give you more information, but I had sole authority to source that. We recovered the funding later from the province, but those authorities are in place in an emergency situation. We make the decision and worry about it later. We report publicly on what we have done and where the money has gone.

Senator Forrestall: Would it be useful if you could say to someone sitting at the table in your bunker: ``For goodness' sake, get on the telephone to the Minister of National Defence and tell him we need 10 helicopters — not Sea Kings — and we need them immediately''?

To me, this business of jurisdiction and protecting your turf during an emergency is a problem. Would it be helpful if you could do that?

Mr. Gutteridge: I agree. That is one of the things we would like to be able to do. The province could be involved in getting protocols in place in advance, but when the emergency occurs, we would notify them and then go straight to our federal contact. That would be the ideal. As you know, when you have to go through another level you lose time, and you may lose clarity in terms of the way the message gets through.

For example, during the ice storm a few years ago, Toronto was not impacted but we were trying to be ready to provide resources. We can help, but how do we get our resources out to those who need them — it could be someone in Eastern Ontario, wherever — and what is the process for us to marshal and deploy our resources and so on.

There needs to be some ability to make those decisions faster and move on. Rightly or wrongly, at the municipal level we tend to cut through, make the decisions and move on, to the extent we can within our jurisdictions, and worry about the niceties later. I do not think anyone is worrying about hierarchy or protocol in an emergency; everybody pitches in, we do it and worry about the sensitivity and the money later.

Senator Forrestall: We had the diversion of two El Al flights just last week, after a threat on the ground. This is a perfect example. Down the road, it tends to be necessary, not just useful, to have a protocol in place beforehand to clear the way for immediate federal aid without having to go through the province. It is absolutely necessary?

Mr. Gutteridge: I think so, senator. Our experience with 9/11 was that, although Toronto was not directly impacted — except by flights being diverted into Pearson, and then how to accommodate people — dealing with our own population was another issue, in terms of the reaction, the traffic congestion and being able to respond more directly as a municipality to what was a national-level issue in that case.

Senator Forrestall: I wish you well and that you receive everything you need to continue to bring pressure to bear on the province to pre-organize these lines of communication. In other words, eventually, somebody in the Department of National Defence, Treasury Board or the Department of Health gets a call saying, ``Hey, if so and so calls you, please respond directly, and we will be in your debt if you do everything you possibly can immediately for them, because they have a problem.''

Mr. Gutteridge: That is exactly the process we would like to see, Senator Forrestall.

Senator Forrestall: Put in place beforehand.

Mr. Gutteridge: Yes. Absolutely.

Senator Forrestall: Then you do not ruffle feathers. He has asked for permission to do this. This is an expedient way to do it.

Mr. Gutteridge: It is pre-cleared, basically.

Senator Forrestall: It is clear in your own mind. Who knows when someone is hunting or fishing? You need the Halifax Rifles. There is absolutely no question about that. I recommend it when I see my friends floundering, doing their best.

The Chairman: Let the record show that is the 67th time that this committee has mentioned the Halifax Rifles.

Senator Forrestall: It will not be the last, either. It is euphemistic in the sense that somebody has to bring order out of this chaos, or bring the army in to do it for you. Good luck with it.

Mr. Gutteridge: Thank you.

Senator Banks: Gentlemen, as we have often heard and said, the first responsibility of the state is the protection of its citizens. We are hearing, in our meetings across the country and in Ottawa, that that is harder to achieve than all of us would like. Unless we grasp some machinery or create some, I do not have a lot of hope, to tell you the truth, because in my previous life, I was frustrated for 10 years in trying to bring about the things we are discussing in a completely different area. I was trying to get different jurisdictions in different orders of government to get together just to make it easier to deal with some forms.

We did not succeed in the nine years that I worked at it. It has not succeeded yet and that was 10 years ago, so I understand what the impediments are.

There is a natural state of tension in our country, and in many other countries, between the need on the one hand for national standards, national coordination and rapid national involvement, and on the other hand, the ``do not tread on my business,'' with which you will be familiar, between your agencies, let alone among the different orders of government.

It seems to me that we have the model wrong. Dr. Basrur referred to it this morning very well. The one model that we keep talking about is top-down or bottom-up, this vertical model. However, that is not what happens in the case of an emergency. It is a horizontal model. You people, and your counterparts elsewhere, are there first.

It seems to me, therefore, that the structure with which we have to deal is, in this one instance — not, I think, in any other area of human endeavour or in government — on the wrong plane. That is not a question; it is a statement.

If you were the king, Mr. Gutteridge, how would you get around that? You are familiar, as are we, with the urgent necessity for the different orders of government to be involved on some prioritized basis that everybody understands. This country is not a unitary state. Our country works precisely because our Constitution is very clear on the division of responsibilities between the federal government on the one hand, the provincial governments on the other hand, and municipal governments on the third hand.

You know what those tensions are. If you were the king, how would you fix it tomorrow afternoon?

Mr. Gutteridge: I have a few suggestions to offer you.

First, my perception at the provincial and federal levels is that there needs to be some clear authority given to the staff who are involved in emergency management planning to make decisions without having to go through a long process. I indicated earlier that there is goodwill. The JEPP grant process is an example of where we cut through all that a year or so ago. I got very impatient with it because we have to send applications to the province, which has to review them. They make changes and send them back to us. You know the loop. Up, up, up to the federal government; so with the concurrence of the province and the federal representative, I said: ``Lock all the people who are reviewing them in a room. We will bring in our forms. You tell us jointly whatever changes you want to make. I will get them back to you, the same or the next day, with any changes that the province and the federal government want.''

We did that and all the grants went through quickly; money was received and spent; things worked. It was a case of getting past the notion of what the process has to be and focusing on what the goal is supposed to be, which everybody agreed was to get the money allocated for and spent on these necessary things.

Senator Banks: That is fine in the case of something that is up and coming and that you can foresee. However, if somebody flies a plane into a building, you do not have a day to work it out.

Mr. Gutteridge: That is right.

Senator Banks: There is no day — meeting, shmeeting. Someone has to do something now. Is there a way around that?

Mr. Gutteridge: There needs to be a way to make levels disappear in an emergency. For example, we at the responding level say, ``Here is what we need,'' and it is provided directly to us. We must get past that ``I am provincial; you are municipal; you are federal.'' We are all in this together. How can we collectively solve this? How can I bring my expertise and resources to the table? Then we can worry about the niceties later.

The current processes are not structured that way. You need a means, in an emergency, whereby that process can be collapsed and people can work together. However, the staff involved need to feel they have some authority in those situations; that in the aftermath, they will not be crucified when they go back to their home roost.

At the municipal level generally, with few exceptions, council is very supportive, in retrospect, of what has been done and understands that during an emergency, there is a necessity to stand outside the usual political power/staff power structures and just deal with it. I would certainly like to see a process where those things disappear.

We have a provincial representative in our centre who says, ``What is it you need? What can we do? Okay, you have it. Bang.'' However, we can deal directly with the federal government, if that is where we need to go to get the resources. We can make direct calls to people who have the resources, get them, and worry about the process later.

Some of that can be facilitated in advance; you are quite right. In an emergency, one does what one needs to do. That is when one needs a collective attitude, an approach that people do not make a fuss about. You mentioned the inter-jurisdictional issue. The three service providers can comment on this, but in an emergency, we do not make a fuss about whether it is a police, fire or EMS issue. We just deal with it. If people are slightly off their turf, we worry about it later, but it is not worth spending time on. One has to deal with the immediacy of the situation.

A lot of the structures we have in place do not recognize that we do not always have the luxury of time. They seem to be structured for an emergency that you can see coming two weeks beforehand, so you get together and have meaningful discussions about what you do, plan and find resources.

That all collapses, as you know, when you are dealing with something that is right in your face, and it is always unanticipated. One uses the plans and methods one has. Structured plans are helpful, but you need people who can lead on the ground, who can make decisions, who can improvise based on the information available, the knowledge of their staff and so on.

It is good to have structures, but one also needs a trained and capable staff that can respond in those situations. Certainly in Toronto, with our front-liners, we do.

The Chairman: I have the impression Staff Superintendent Emory Gilbert has something he would like to add.

Staff Superintendent Emory Gilbert, Operational Support Services, Toronto Police Service: I can only endorse what Mr. Gutteridge is leading up to.

If there is an incident, something within the normal realm of our work, and we need something from another level of government, we would probably get it on the basis of a phone call to people we know, so a piece of the puzzle is already there.

Senator Banks: And it would happen?

Mr. Gilbert: It would happen. They would make a decision because it is clearly within their defined realm of responsibility: ``Certainly I can send you a truck. I can send you 50 people.'' It will come to you.

With this structured kind of process, we are dealing with a fixed mindset that has not changed over time, that is, ``When you call us about this big, ugly emergency, we must go into this regime that we use, and that is beyond our level.''

The other aspect is that the other two levels of government — and I say this with the greatest respect for what they do across the province and the nation — do not operationalize their responsibilities in the large municipalities. There is no real federal presence here in Toronto prepared to sit in the room with us and work through our crisis management problem.

Therefore, they are not part of the solution; they have become part of the problem because they are far away and not engaged with the issues. There has to be a different way of doing business.

We can write all the procedure we like, but two gentlemen from Oklahoma City gave us a key lesson in Toronto a couple of years ago. They handled the Oklahoma bombing and currently work for the FBI. They basically said, ``It is not the plans that get you through the problem; it is the people who know how to work together.'' If you do not have this synergy of people who are engaged in various areas of responsibility working closely together, knowing they can pick up the phone and get a definitive answer, it will not work. On some level, we do that on a daily basis in Toronto. It happens almost fluidly among all our agencies. When we start reaching into other levels of government, it is a little more difficult. Across municipalities it is extremely fluid.

I can get things from of Peel Region, York and Durham on the basis of a phone call. My chief can do the same. There are structures and mentalities and processes that are the basis for this, but we have to break down some of the existing ``bad habits of time.'' It is a mental attitude that has to change.

Senator Banks: Can you get things from the province in the same way, with a phone call?

Mr. Gilbert: To a certain degree, yes, and it depends on whom we phone.

Senator Meighen: On that issue of how you get things and whether it becomes a bureaucratic maze — and I do not ask this question facetiously — a few years ago when we had two or three successive snowstorms, the Mayor of Toronto called in the army, much to the amusement of the entire rest of the country. In the mechanical sense, how did that happen? Was it an official emergency? Did he phone the Minister of National Defence and say, ``Can you give me some soldiers to shovel snow?'' How did it work?

Mr. Gutteridge: I should answer that because I was personally involved in the situation.

Snow clearing is one of my responsibilities. The mayor went directly to the minister, in that case, bypassing the province, and with the predictable reaction. It was his decision, politically, to do that. I think he was looking at what usually happens in Buffalo and places like that. They call in the National Guard to help.

Senator Meighen: Therefore procedures go by the wayside. If you know the appropriate minister and you need the minister's facilities or equipment, going back to Supt. Gilbert's remark, you can pick up the phone?

Mr. Gutteridge: He can, yes, and that happened to be because the mayor clearly knew the minister personally.

Senator Forrestall: The former mayor himself?

Mr. Gutteridge: It was on the basis of a personal relationship. That is a reflection of Supt. Gilbert's comment, that the interpersonal relationships are important as well. Right or wrong, that is the way that worked.

Senator Meighen: Therefore we should forget about plans and make sure we just interact?

Mr. Gutteridge: I think we need both, and that you are being somewhat facetious.

Senator Meighen: I am being facetious.

Mr. Gutteridge: Supt. Gilbert's comments are accurate. In an emergency you have to know each other. If you have an ongoing relationship, you know whom to contact and how to work with them. That face-to-face aspect is important and is missing in the current process.

The Chairman: If I may, I also noticed that Chief Stewart would like the floor for a moment, and, Staff Superintendent, I would like to challenge your comment, if only to have you explain it better to the committee.

You talked about face-to-face communications and the value of being able to talk to somebody you know; that things work a lot better when you have already created the relationship. However, you work for an organization that moves people around a lot. The normal career progression is that people work here for a while; they work there for a while. The same is true with almost all of the organizations we see before us. It is certainly true of the military and federal government officials. No sooner does one develop a good relationship than one discovers the person has been promoted, retired or transferred laterally, so one is continually recreating these relationships that you have described as being so important.

The timing of emergencies, however, does not necessarily mesh with the career plans or paths of individuals. How do you rationalize the two? We all understand your point that if you have taken the time and trouble to personally get to know a colleague in Peel, then you can work things out quickly. However, if that friend of yours has just been promoted or has retired, what do you have in its place?

Mr. Gilbert: Lots of friends. I do not mean to be facetious. Let me explain how it happens. I know the gentlemen at the table here very well from a working point of view, but I also know 10 other people in their branches. It is not dependent on one individual. I have a very large branch within the organization, 1,200 people in varying ranges and positions. They connect with and match with both my counterparts sitting here and in other branches.

I will tell you what has happened over time. Back in the 1990s, the police service lost a lot of people through downsizing. On a Friday afternoon we had many years of human experience in policing. On Monday morning, we did not, and it was a major hiccup. All other agencies, services and businesses went through major change.

We used to be able to call an officer at CFB Downsview and get assistance from the military on virtually anything. There was an immediate answer and they could supply anything, even a helicopter. I do not mind repeating the story of an armed robbery, where we had to get police officers outfitted and credentialed as military personnel in order to deal with a hostage taking. We had that accomplished in four hours and no one had to worry about phoning Ottawa.

Those were the kinds of things that happened many years ago, but those relationships were interrupted and that has harmed us at some levels. At other levels, things have moved along because people have moved along.

The people in my junior ranks are connected to many of the individuals in the same positions in the other organizations; so it does work. It is an inexact process. It is not scientific and does rely upon people. It comes together frequently because of the bond that is created when we, the OPP and the RCMP work together in policing matters.

The faces change; the personalities are often still there and the work goes on. The new challenge is to establish a new working relationship one on one, but can my chief phone? Can I phone? Can my staff sergeant phone? Yes.

Chief William Stewart, Fire Chief and General Manager, Toronto Fire Services, City of Toronto: I have just a brief comment with respect to the NBC School at Camp Borden, which is the military establishment for nuclear, biological and chemical warfare. We have a close relationship with the school, and I agree with your comment, senator, about staff moving around.

Post 9/11, I was in close contact with the captain and the major at the school and requested assistance from them should the need arise. Unfortunately, they said to me verbally, and then later in writing, that it would not be available to us at the federal level; that the NBC training was for the Canadian Armed Forces only, not for civilian staff. This response prompted us to create the CBRN attributes of the City of Toronto.

Senator Banks: Superintendent, you are saying that notwithstanding the impediments, rules and procedures, it works because people know each other.

However, would it not better if you did not have to do end runs, punch through walls and say, ``Never mind the regulations, I am going to phone the person because I know him''? Would it not be better if the system accommodated that and you were not bending the rules, you were simply doing your job well?

Mr. Gilbert: Quite true. The relationships would be there regardless, but certainly what we call the ability to ``can do'' would be through the regular channels. This other channel, the reliance upon personal contact, is there and is strengthened because it is the only way to get things done. The normal procedure will not work effectively and in a timely way — I emphasize the word ``timely.''

Senator Banks: Well, let me ask the same sort of question of you and Mr. Farr. You said that it works quite well because the people involved, and I think you are talking mostly about agencies at the municipal level, are sitting around and talking about it.

This is the biggest city in the country, and it seems that other people ought to be at that table too, as a matter of course, on a daily, weekly or monthly basis. In every region across the country there is a representative of a federal organization called the Office of Critical Infrastructure Protection and Emergency Preparedness, hereinafter known as OCIPEP.

I am wondering whether you are on a first-name basis with those people. Do they sit down every once in a while to talk with you? Are they among the people to whom you would feel comfortable making one of those phone calls?

Mr. Farr, there are stashes of emergency medical supplies across the country. Do you know where they are? Do you know what they are? Do you know exactly how to get at them quickly, when and if needed?

Mr. Gilbert: It has worked for me in the last two years, as in the example that Dr. Basrur gave you, principally through her associate, Bonnie Henry. I do not know the individual from OCIPEP; I know the name. I have met the individual, but we do not have a working relationship.

Senator Banks: Is that not ridiculous?

Mr. Gilbert: No, because I have found a way to make it work: Bonnie Henry is my contact and the Manager of Emergency Operations for the city is my contact. When I need the answer to a question to OCIPEP about where our money or our application is, I make a phone call to a person I know who knows the person.

Senator Banks: Is that not like saying I have a cousin who has a friend who has a friend who can get me a cheap suit on the Danforth?

Mr. Gilbert: Agreed. I do understand. I am able to get my questions answered, but yes, that is quite true.

Mr. Bruce Farr, Chief and General Manager, Toronto Emergency Medical Services, City of Toronto: I would like to add to the comment of our friend from the police services that the culture that we have developed amongst our agencies here in the city means that our relationships are not dependent on any one individual. Our front-line paramedics, firefighters, police officers and public health workers, everyone throughout the organization, have worked very hard to communicate how important it is to work as a team, and we understand each other's roles. That is critically important.

Yes, senator, I am aware that there is a cache of equipment, 200-bed hospitals and so on, and tractor-trailer units somewhere in the area of Cambridge. I do not know exactly where they are, and like the superintendent, I too make a phone call to my friend from the Emergency Planning Office, or my other friend, Dr. Henry, and ask if we can utilize them. We attempted to do that during the SARS crisis.

When we were planning for the Rolling Stones event — and we had a very short period of time, three to four weeks, to establish the plan and put it into action — of course, our major responsibility in EMS, along with our other emergency services, was to provide emergency medical coverage on the site. When we realized that we had to establish an on-site field hospital, the only way I thought I could do it was to ask for the federally held equipment to be made available to the City of Toronto for that purpose. Everyone agreed that it was a great thing to do. When we finally asked the question through the usual process, some seven days later, we were told, ``No, because we may need it for a real emergency.''

I heard the comments earlier from Senator Kenny about 1,600 caches of equipment across the country. We had great difficulty, at the time, in saying that we would be unable to support the Stones event if we could not set up an on- site hospital, recognizing that it was on a weekday; the impact it would have on our already overcrowded hospitals throughout not only the city, but also the GTA; and, of course, the impact of providing not only emergency medical services, but fire and other emergency services as well.

When we got the answer that we would not be able to have the equipment, my first response was: ``Then we will not to be able to support the concert.'' It took another three days and a lot of help from a lot of people at this table, the emergency planning folks and the province for somebody finally to say: ``Okay, you can borrow 200 beds and some tables to set up your hospital.''

I am very happy to say that about four days before the event, the equipment was delivered to the city. We had to sign for it and put up money in advance to protect it. Commissioner Gutteridge had to put his life on the line, so to speak, in ensuring that everything would be returned appropriately — all of this as we were setting up the site and expecting upwards of 600,000 people to come to our city.

Fortunately, we did get it. We had it set up the day prior to the event starting, which was cutting it a little fine, in my estimation. We did provide care to over 3,000 patients. Fortunately, because we did get this equipment, we only transported 24 people off-site. Everyone else was treated on-site.

Do we need assistance? Absolutely. Do we have surge capacity? No, we do not. To this day, I do not have a detailed list of what would be available to us as emergency medical service providers, in the event that I needed it on short notice.

Senator Banks: To ask a rude question, have you asked?

Mr. Farr: Our medical adviser, in discussion with Dr. St. John, asked for a list of certain materials available in the cache, and we did receive it.

Senator Banks: So you do have some idea?

Mr. Farr: We had some idea at the time of the kind of things we were looking for to establish a field hospital.

Senator Banks: I just want to make sure I understand this, and I am sure some of my other colleagues will want to pursue it. In the end, you got a ``yes,'' after having first got a ``no,'' and the entire process took something like 10 days?

Mr. Farr: Absolutely.

Senator Banks: That hardly qualifies as an emergency response.

The Chairman: Mr. Farr, sometimes senators think they have knowledge a mile wide and about an inch deep, but it would seem that the logical approach to these 1,600 caches would have been to go to local first responders and say, ``What do you think you might need? In what order should it be packed and organized in the containers? Where would you like it contained? Here is how you access it. By the way, if Dr. Basrur's colleague is on holiday and none of you can contact her, here is the direct number to call Ottawa.''

Is that a question you have ever contemplated, and if not, why not? Is it a reasonable question, and if you have not asked it, will you? We feel a little uncomfortable here asking these questions. We are not wandering around trying to create problems. We detect a degree of frustration on your side of the table, but we are also wondering whether you are taking the steps to alleviate or articulate that frustration by saying, ``Okay, we would like to have this information.'' It would be a lot easier for us, in any event, if we could go back and say: ``Look, they have asked for it. They want to know what is in there. They think they should have some say in it, that it should be modern and effective and mesh with the other equipment they have. It may be used not only in Toronto, but in Hamilton and London as well.'' ``Terrific. We hope they do not all have problems at the same time.''

Have you or will you ask these questions?

Mr. Farr: From our perspective, we would be more than happy to work with anyone at any level of government. I know in the past we have had discussions at the provincial level, and there have been indications from the people with whom I deal that they have asked for the federal equipment to be moved to the city and for a smoother process, but to my knowledge, that has not moved ahead at this point.

The Chairman: Am I off base on this? Does anyone else want to respond?

Mr. Gutteridge: Senator, what you have described is an ideal process. We have asked for the information at various times over the past few years. Under the current protocols, the federal government should give the information to the provincial government, to us. I remember one incident after 9/11 when there was some back-and-forth on where the information was and how it would be accessed, but people forgot who was involved and at what level. It is something we have raised, although perhaps not strongly and officially enough.

The other part of your comment deals with how those caches of equipment are planned and what is in them in terms of what would be required in an emergency. That goes back to my last point about talking to the front-line responders about that, rather than someone making assumptions about what should be in there, which may not turn out to be what we would need in an actual emergency at all. When we start getting into where medical supplies and so on are, it is a whole other story.

The Chairman: One of the reasons we sent you that questionnaire — and it was delightfully vague and we do appreciate your much more articulate answers to it — was that we were curious to find out from municipalities themselves what crises they anticipated. What did they think was going to be a problem? What assets did they have to address those crises?

Then we thought it might be appropriate to come up with a list of the existing deficiencies, and once those were determined, allocate them between the federal government and the province and decide who should assist in remedying those deficiencies.

We were doing that as a committee exercise simply to get a better grasp of the nature of the problem. However, it does occur to us that this is perhaps a proper role for OCIPEP to undertake; if, in fact, we are going to have a federally funded agency, it might be a worthwhile exercise. Do you have views on that?

Mr. Gutteridge: Absolutely. I strongly support that approach to getting greater clarity and making sure that what is out there is appropriate and appropriately distributed. As Mr. Farr has indicated, there is also the issue of where the caches are located. We do not feel that they should all be in Toronto, because one may be dealing with an emergency where there is a benefit to having some of them elsewhere.

The first task would be to clarify what is out there and, as you have said, the shortfalls. We are realists about what is likely there, but I suspect there is a lot more available collectively, between the three levels, than we realize. I have a suspicion that when we are dealing with emergencies, we are using a fraction of our real resources. Given that we are all in tight funding situations, it does seem rather foolhardy to be trying to equip various levels, only to find out that the same things may already be available somewhere else.

Part of that, too, is the whole issue of training. If there are things people are not used to or trained to work with, they will not be of great use either. There is the issue of standards, what equipment is available, how it gets used and who is trained to use it, especially with specialized equipment.

The Chairman: Are there contrary or supplementary views at the table on this?

Mr. Gilbert: The issues you are talking about touch on more than just a storehouse of material. They touch on funding. They touch on the need to see the cities, Toronto specifically, in this case, as part and parcel of the solution to the protection of this country.

It is not as though what the other levels of government provide is to be given to Toronto, strictly for Toronto's use, and therefore of value only to Toronto. Much of this country is impacted on a daily basis by virtue of a lot of things that happen here.

On the policing side, there may be less need for us to have a large core of equipment. Our main job is to manage geography and deal with people. We do not need huge volumes of equipment to do that.

We do share. When we work with HUSAR, Toronto police personnel train with and work with fire service personnel. In Toronto we have developed the CBRN model from the HUSAR model. It is a joint team. They all train together. They all share the respective jobs within their spheres of responsibility. It is a bound-together organization.

That group needs incremental funding for the equipment needed to carry on the job. That is not a Toronto job; that is a national job. This is about national safety, in the way you are looking at it, and the cities, large, medium and small, are a grassroots part of that solution.

For us it is a funding situation dealing with mitigation on intelligence matters. The money the federal government produced for policing and dealing with joint intelligence did not filter down to the Toronto Police Service.

The Chairman: You do not have access to SABER, Staff Superintendent?

Mr. Gilbert: I am not familiar with SABER. We have connections and we have people working in it, but we have no funding for the incremental work to go with it.

The Chairman: SABER is a vehicle for CSIS to provide intelligence to police services across Canada, and you are telling me Toronto does not receive that?

Mr. Gilbert: I am not saying we do not receive it. I am not familiar with it. We sit on a variety of working groups in Toronto, working shoulder to shoulder. However, in terms of incremental demand on our people and the equipment and so on that supports them directly, the City of Toronto has nothing.

The Chairman: Would it be possible for you to make inquiries and advise us whether the police service here has access to SABER, and whether you find it a useful way of informing yourselves about national security issues?

Mr. Gilbert: Certainly. I can tell you we are not out of the loop in terms of information. However, we have not been able to increase or enlarge any form of intelligence work within the Toronto Police Service in support of that larger exercise in terms of the resources that are part and parcel of the process.

The Chairman: Could you get back to the committee about SABER in particular?

Mr. Gilbert: Certainly.

Mr. Farr: I wanted to add to the response to your question about the importance of stockpiling, et cetera.

One of the major lessons we learned during the SARS outbreak was the need to acquire sufficient personal protective equipment for all workers — paramedics, firefighters, police, hospital workers and anyone else who was faced with this very serious situation.

EMS and Toronto Public Health, along with hospitals, were involved with SARS probably four or five days ahead of it becoming a serious public matter. The first step we took was to instruct our purchasing people to begin buying as many protective masks as they could find.

There were no significant stockpiles in North America, let alone in Canada, and we ended up buying every available N95 mask. We often think about what would have happened if the lady who got off the plane in Toronto and went to her home in Scarborough had had a friend who got off in Chicago at the same time, and the U.S. had had a similar problem. I suspect that our crisis would have been significantly worse because we would not have been able to find enough of those particular protective devices for our staff to continue.

As it was, we had a number of police, firefighters, paramedics and nurses who were quarantined, even though we did have access fairly quickly to large numbers. That is all part of the planning process. It is all part of the relationship process and the culture of working together to protect our country.

Senator Banks: I have a supplementary question that also finishes what I was talking about with Mr. Farr before.

When we find out that there has been a shortfall of some kind in the Government of Canada, something that has not been looked after, one of the things that we can do by various means, not the least of which are our reports, is to call attention to it and sometimes actually affect public policy.

With respect to the caches, things like 200-bed field hospitals, if we go back and complain in one way or another that you do not have that information at your fingertips, so you know exactly where it is, what button to push and what string to pull, the rug is pulled out from under our feet if the response is, ``Well, nobody asked,'' because it is a two-way street.

I do not know whether you can answer this right now, but have you actually asked OCIPEP what there is within easy access of the GTA with respect to those kinds of stashes? If the answer is no, you have not asked, then we do not have a complaint against the federal government. I would urge that you do ask, and I would hope that you get an answer.

If, on the other hand — Mr. Gutteridge referred to this before — you have a piece of paper that says, ``Here is the date on which we asked this question, and we do not get a reply,'' or, ``we got an unsatisfactory reply,'' then what we can undertake to try to do is entirely different. I will leave that in your minds, not as a question to be answered now.

The Chairman: Following along the lines of OCIPEP roles and lessons learned, we heard from Dr. Basrur that she had to allocate a significant portion of her resources to communication with other municipalities and jurisdictions about what was going on during the course of the crisis. We see now three commissions going forward, ultimately, I presume, to crystallize the lessons learned as a result of the SARS crisis.

Should people come back to Toronto to learn those lessons, or should those lessons be moved to Ottawa so that there is a central place that people can go, and should OCIPEP, or some agency like that, be the repository for future crises of a different nature that may occur?

What is the best way to organize the lessons learned so that everybody does not have to reinvent wheel each time a problem comes up?

Mr. Gutteridge: That is a difficult question to answer. Both at the provincial and the federal level, there is a responsibility to be the central repository or the coordinating point of that information so that we are not reinventing the wheel; we can learn. To the extent that these are national issues, that needs to happen.

SARS did have a national impact, and although it occurred in a particular geographical location, it was a national incident of sorts. There is some wisdom in doing that way.

I do hope that there will be a pulling together of the findings and the information from the various groups. I suspect there will be some similarities in the things that come out, just as I am sure there is some similarity in the presentations you have heard from other jurisdictions; that there are probably a series of common messages that keep coming out of the various processes.

We are more concerned that something is done about them, that some action is taken to fix the various things that require fixing.

For example, perhaps we have not formally requested information about the caches. Certainly we requested the information verbally in meetings, but whether we have formally gone on record as saying, ``Please give us your formal response,'' is something we need to consider.

The Chairman: In triplicate, with a notarized statement. This is the federal government.

Mr. Gutteridge: I am a firm believer in being accountable for our part; that is one of our suggestions in terms of pushing the issue from the bottom up. I support doing that. We are all in this together.

Hopefully, one of the main messages in the various things you have heard from us is that we are all trying to make it work better. In most cases, there is no shortage of goodwill; it is just that for whatever reason, the mindsets and structures are not there. We are all grappling with how we get through that.

Senator Meighen: Mr. Farr, I want to go back to the Rolling Stones concert again, not because I missed it but because I am interested in that procedure.

As I understood it, you said that initially, the request for access to the field hospital was turned down?

Mr. Farr: Yes, sir.

Senator Meighen: Was that request made through the normal channels or Supt. Gilbert's person-to-person channels?

Mr. Farr: Initially, it was through formal channels. We eventually got it by going through the superintendent's process.

Senator Meighen: That is what I was coming to. The formal channels gave a formal turndown?

Mr. Farr: Yes, sir.

Senator Banks: In seven days.

Senator Meighen: In seven days.

Senator Banks: It took that long.

Mr. Farr: Yes, sir.

Senator Meighen: And the informal approach got a positive response?

Mr. Farr: Yes, sir.

Senator Meighen: That certainly is a strong recommendation for Supt. Gilbert's approach.

I hesitate to say this because I cannot believe I heard what I heard: That it was turned down formally on the basis that there might be another emergency and they might need that equipment?

Mr. Farr: Sir, the quote that I received from my senior manager, who was pursuing it on our behalf, was that the government's response was that the equipment was there for use in an emergency, not for an event such as a Rolling Stones concert, and if they provided it to the City of Toronto for that use, then they would have to provide it to Vancouver, or anywhere else in the country, for whatever use they wished.

Senator Meighen: Oh, the horrible precedent problem raises its head, so you do not provide it at all, is the answer.

It comes down, then, to the definition of ``emergency,'' or what qualifies as an emergency. I suppose the authority to define whether or not it is an emergency resides with the provider of the equipment?

Mr. Farr: You are absolutely right. It was all goodwill at that point on our part, and we were pushing the envelope in all of our organizations to make this event happen, to improve everything for the country, the province, and certainly the city that was hard-hit by this crisis. We assumed that everybody would want to jump on that bandwagon, make this happen and move on from there.

The Chairman: Senator Meighen, if I may, this was not an emergency. This was a prophylactic effort to avoid an emergency, which strikes me as a little more logical than waiting for an emergency.

If you had had a thousand people fall sick, they would have given you the equipment right away.

Senator Meighen: After seven days.

Mr. Farr: After a certain number of hours of notification. However, you are right; it was prophylactic. We were trying to prevent the clogging of all of our hospitals.

The Chairman: I would suggest it is not a matter of the definition of an ``emergency,'' it is whether funds were well spent to avoid an emergency.

Senator Meighen: An apprehended state of emergency.

The Chairman: An apprehended emergency — a putative emergency.

Senator Meighen: I will not ask, but perhaps somebody can tell me why it would be so bad if you had to do the same thing for the City of Vancouver or the City of Edmonton, for example. However, that is another matter.

Senator Banks: In fact, might it not be a useful exercise for the City of Vancouver and the City of Toronto to know where it is, how to set it up, find out what the problems are and therefore recommend that we need this instead of that?

The Chairman: Senator Banks, that might involve telling them where it is.

Senator Banks: I forgot.

Senator Atkins: I know we are running out of time, so I have just one question. There are emergencies, and then are emergencies. The blackout must have been a significant experience for you people, quite apart from the fact that you did not know when the power would come back on.

How did it affect your communication systems? I assume that one of the factors that you had to consider was how to deal with the public. The impression I have is that you ended up communicating with the public through press conferences. There is no other mechanism through which you could communicate with the public on the reality of what they were facing?

Mr. Gutteridge: In terms of communication mechanisms, and referring specifically to the blackout, we clearly did use press conferences. We used press releases, which we sent out to the media. We also have something called Access Toronto, which is an inquiry line for the public to get information from the City of Toronto.

We set that up so that people could call that number, which was given out in the press releases. Fortunately, the phone system was working during the emergency, so people could call and get information. We encouraged people not to use our emergency lines, but call Access Toronto for information.

For anybody with power, the city posted information on the Internet at the same time. The interesting thing in that situation is that a lot of people did not have access to the Internet, and unless they had a battery-operated radio, were not necessarily getting the public media.

Also, amateur or ham radio operators have a room in our Emergency Operations Centre. Some of the information we were getting was coming through some of those sources from across North America. It is interesting how some of those information networks work.

Senator Atkins: It did not knock out any of your communication networks?

Mr. Gutteridge: No. I am quite proud of the city's role in getting the information out during the blackout, through public announcements and the various things we were able to do.

We can go through our agencies as well, and we try to use every possible communication vehicle. We do not have a direct radio channel or anything like that over which we can broadcast. We rely on the media, in most cases.

The Chairman: When you say your system worked, it depends very heavily on electronic media. If there were no television or radio broadcasts, because nobody could turn on their television or radio unless they had a transistor, 80 or 90 per cent of your normal communication system would be down.

Mr. Gutteridge: Fortunately, the phone system was working and there were a number of people who had backup capability for the use of radios and so on. However, you are quite right; the major media outlets were temporarily missing, and then we started to get them back on a rolling basis.

Senator Atkins: On the basis of that whole experience, are there any measures that you have implemented in case you ever have another serious problem like a blackout in Toronto?

Mr. Gutteridge: Fortunately, as a result of learning from Y2K, we have a number of locations with backup generator capacities so that we can keep operating the Emergency Operations Centre. One issue we learned about in dealing with the blackout, given the length of the emergency, was water supply. We were able to negotiate with Toronto Hydro that as the power came back on, those areas without water were given priority and continuity.

It is the same issue as you heard discussed with the TTC, about getting the TTC up and running, because you cannot run transit services with intermittent power and have people stuck in tunnels and so on. Those things were negotiated.

I firmly believe that one should learn from every emergency, so we always do a review of how we can respond better in the future.

I do not know if anyone has any other suggestions on alternate means of communication. We have radios; we have backup; we have other mechanisms. You are quite right: When we get that sort of information, how do we get the messages out?

Senator Atkins: From a policing point of view, as this event continued, were there any concerns that you had to address to keep the public from overreacting?

Mr. Stewart: No, as a matter of fact, on that particular day, I was the last person in line. The curious feature was, as I was heading down to headquarters, I happened to notice that everything was out in that section of Toronto. Remember, this is about 4:30 in the afternoon, so the sunlight was still quite good, but the traffic lights were out. I checked with my communication centre, which is a joint facility and was still operating, and they told me that we were not the only ones.

One saw people take things into their own hands right away. They realized there was a problem. They did not realize how extensive it was. No one did right away. Our communication problem was not that we could not talk to the public, but that they could not receive us.

Only a few radio stations were able to function. Virtually all the TV stations were off-line for a time. We could tell people what was happening from in house. We could at least get to our front door to say, ``Here is what is happening.'' It took us a little while to realize that 50 million people across Northeastern North America were affected, but we could have put our news out — 911 was working. Our communication system had a couple of hiccups, but it worked.

We have a linked system among the three agencies. We were able to dispatch. It was not severe weather, which was another advantage. It was the right time of day, the end of the business day, in a lot of cases. People behaved responsibly. Communication difficulties because of cell phone problems, which was the other feature, was a universal issue.

One thing we all should have realized is how absolutely critical electric power and our communications instruments are to us. We have come to rely on them. If we did not have them, we would not be relying on them.

We have become a world of cell phone users, and we have to understand that they can be precarious. Some things are not within our power to change. Essentially, we are well positioned as a city to communicate. The city was not necessarily well positioned to transmit or receive.

Senator Atkins: You were lucky the phone systems worked.

Mr. Stewart: That was only if you had a phone that was hardwired to Bell. Anything that had a transformer, such as a walkabout phone, was not working normally.

Senator Banks: The reverse 911 is a double-edged question. Do you have reverse 911, that is to say, a means by which you can phone people automatically and quickly in a specific area, or the entire GTA, and say, ``Get out of your house''?

Mr. Stewart: All of our police stations in every division across Toronto have a computer-based auto-dial system and backup power. There is a system, for which we have submitted a funding request under JEPP, that would allow us to communicate via a network to every citizen in Toronto. The process that we have currently in place has to be agreed to by the citizens receiving the call. They must sign up with us saying, ``Yes, I do want to receive this voice mail message or these news alerts directly from my police station.'' That is one of the features of the process. The mechanism, the wherewithal, exists today.

We use it presently within the police service to advise neighbourhoods when, for example, a child is missing and we would like the neighbours to be out there looking; or, if they have a crime problem, a disorder problem or a notable event coming up that is community based, to pay attention to their neighbourhood. We will use that system to get the message out, and two things will happen. It will either go to voice mail or people call back to get the information. However, it is unit by unit now. There is technology out there to make it much more universal and we are seeking some federal funding to institute that. We are still waiting for the answer.

Senator Banks: From JEPP?

Mr. Stewart: Yes.

Senator Banks: However, that capability exists now on a neighbourhood basis?

Mr. Stewart: Technology-wise, it is achievable; the equipment is there, but we are seeking funding to do it.

The Chairman: You currently have it?

Mr. Stewart: No.

The Chairman: 52 Division has it in their offices right now?

Mr. Stewart: As a local, stand-alone device, and for those who have agreed to receive it, yes, it is available just in that area.

The Chairman: And how many people in 52 Division have it?

Mr. Stewart: I could not even tell you.

The Chairman: Do you have a ballpark number?

Mr. Stewart: I could not even guess. It varies from division to division, although 52 Division would probably have the fewest because it does not have a large residential population; 32 Division, North York, Etobicoke and Scarborough would probably have more people per area, simply because they are large residential locations.

The Chairman: I thought 52 would have apartment buildings and the population would be much denser.

Mr. Stewart: Not necessarily.

Senator Banks: However, those systems are working now, today? You could do that this afternoon?

Mr. Farr: On a local basis, yes.

Senator Banks: On a neighbourhood basis, station to station?

Mr. Stewart: Yes.

Senator Banks: I live in ``tornado alley,'' and in Alberta there is a warning system that permits emergency personnel to push a button that will immediately interrupt every public broadcaster, every private broadcaster, every television and radio station, every cable channel and broadcast a voice message that might say, ``There is a tornado coming. Go into the basement,'' or whatever message needs to be sent out.

Since it covers every broadcast means, a great many people can be warned of something that is about to be happen.

Is such a system being contemplated in either the GTA or Ontario? It is done in Alberta with both federal and provincial participation. It covers the entire province. It can also be addressed to specific areas of the province. It has worked to very good effect in many circumstances. I am wondering whether you have it, would like to have it or have applied for it.

Mr. Gilbert: Senator, just for clarification, in your example, the person pressing the button works for what particular authority?

Senator Banks: I do not know the answer to that question.

Mr. Gilbert: Does the person pressing the button have the opportunity to speak live on air?

Senator Banks: Yes.

Mr. Gilbert: I was not aware of that.

Senator Banks: I do not know the answer to your first question about who the constituted authority is, whether it is emergency measures or otherwise.

Mr. Gilbert: You go live on air.

Senator Banks: Yes. You get to say what you would like to say. It is not a ticker across the bottom of a TV screen. It interrupts every sound broadcast, whatever else is going on. If it were the middle of the news, it would interrupt the news and you can say what you like. It is live.

Mr. Gutteridge: Senator, in response to your question, we are not aware of any system like that being contemplated in Ontario. Certainly the capacity to do that does not exist at the moment. As I indicated, we rely on the media to get our messages out, generally with good success, but it is not an automatic process such as you have described.

Senator Banks: Given that I have described it correctly, is it something that you think would be advantageous to GTA and to Ontario?

Mr. Gutteridge: Most assuredly. The nearest thing we have to it at the present, within the police service, is our duty desk operation, which operates 7/24, and can broadcast and fax to all media outlets simultaneously, but then we rely on them to get the message out.

Senator Banks: The system that I describe does not. That is the difference. You do not have to call 23 different radio stations to say, ``Would you please put this message on the air?'' It is on the air immediately.

I commend it to your attention. It is operated in Alberta by the CKUA Radio network. It is funded by both the provincial and federal government and is a good idea.

The Chairman: Is there a role for the federal government in developing a best practices file?

Mr. Gutteridge: Yes, there is. We have raised this with the province and they are working on it in their current approach. Given Toronto's size, we at the municipal level typically have resources.

I am thinking also of the smaller communities. When one is asking them to develop an emergency plan, an emergency response, it is useful to find out what others have done and to see what other plans are in place. There is a benefit to having somewhere to get information regarding best practices elsewhere and to learn from the practices of others. We try to do that through our networks and by contact with others in the States. However, I think it would be good to have some mechanism whereby that information can be both coordinated and easily obtained.

The Chairman: What would be your reaction to an audit process, a third-party audit to examine emergency procedures in a community?

Mr. Gutteridge: I think we would be generally supportive. For example, we just went through a nuclear test exercise with the province in which there was a built-in audit process. We had a representative from one of the other municipalities sitting in as an objective observer to give feedback on our reaction to the emergency and how we dealt with it around the table. As long as that is done in the right context, to learn and to improve and not to point fingers, we would see that as worthwhile.

It is often worthwhile to have an objective third-party assessment. In our case, we are confident that we are doing our best, but we are always willing to learn more.

The Chairman: This has been a very instructive morning for us, gentlemen. We appreciate very much you taking the time, not only to come, but also to prepare for this.

This is a learning process for us. We are endeavouring to come to the conclusion of a couple of years' work. In fact, it actually commenced before 9/11, but sometimes we do not move quite as quickly as we would like. Our other reports take precedence.

This is our last public panel on the question of first responders, and we are in the process of drafting a report on this subject. Your comments today have assisted our studies considerably and we are most grateful to you for that. I would like to thank you on behalf of the committee for sharing your expertise and experience with us.

Mr. Gilbert: I wonder if I might just take a moment of the chair's time.

The Chairman: Yes, sir.

Mr. Gilbert: It is extremely gratifying to us, and all Canadians with whom you have interacted over this period, that you have undertaken this arduous task. You have been focused on it for a long time. Your task is large but achievable. I wish to thank you, as a taxpayer, for what you are doing.

The Chairman: Thank you, Staff Superintendent.

The committee adjourned.