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Paper text:
in the spring of 2003 , toronto found itself in the midst of a worldwide outbreak of sars .
a total of 375 probable and suspect cases of sars ( as defined using world health organization criteria ) were reported in ontario , of which 44 died .
the vast majority of these cases were contracted in hospital by patients , visitors , and health care workers .
this unexpected outbreak pushed toronto 's health care system to its limits and presented many challenges to the delivery of critical care .
years of cost constraints and a lack of critical care nurses had resulted in bed reductions and high occupancy rates in icus throughout ontario .
this made it difficult to find beds for the influx of critically ill patients with sars .
furthermore , with the high rate of transmission of sars to health care workers ; fear , staff quarantine , sars development , and emotional stress further limited the supply of critical care staff . compounding this problem ,
as sars transmission occurred , entire critical care units began to close for quarantine periods .
for example , 73 icu beds were closed during various phases of the sars outbreak , representing 38% of the tertiary care university medical / surgical icu beds ( some of which housed important regional programs such as trauma ) and 33% of the community icu beds in toronto . such closures limited beds for all critically ill patients .
in addition to the difficulty of bed access , sars necessitated several changes to the delivery of critical care , especially with regard to infection control measures .
such changes needed to be rapidly and widely disseminated , as well as taught to frontline workers .
we quickly learned that communication strategies both within the critical care community and between the critical care group and others ( such as hospital administrators , government , and public health officials ) were key weapons in the fight against sars .
the purpose of this report is to describe the unique communication strategies that we undertook in the critical care community during the sars outbreak .
we hope that this information will help others to deal with similar events in the future . following an insurmountable number of e - mails and telephone calls , it was recognized that the toronto critical care community would benefit from regular teleconferences for several reasons .
because sars was a new illness , a great deal was gained by providing a forum for the exchange of clinical information and advice .
many health care providers felt isolated during the outbreak because regular hospital rounds and meetings were cancelled .
furthermore , with infection control regulations limiting interhospital patient transfers , individuals had to manage cases that they might not usually have managed .
finally , regular communication would allow coordinated data collection for the purposes of better understanding the critical care aspects of the illness . as a result ,
thrice weekly teleconference calls involving critical care clinicians , and invited representatives from public health , infection control , infectious diseases , government , and hospital administration were held .
participants were identified by searching individual e - mail contact lists , personal communication , and announcements to hospital administrators through the ontario hospital association . during the calls clinical information and therapeutic challenges were discussed .
in addition , we were able to dispel rumors , clarify media reports , synthesize the barrage of faxes and government directives , answer questions , and support those feeling isolated .
the discussions generated new ideas about how to deal with this previously unknown illness , and identified leaders to focus on specific tasks .
a team of individuals was asked to work with infection control colleagues to develop guidelines for icu practices considered to be high risk for sars transmission ( i.e. cardiac resuscitation , intubation , bronchoscopy , noninvasive ventilation , suctioning , high flow oxygen therapy , and high frequency ventilation ) .
this group rapidly agreed on several recommendations , ensured the recommendations received government approval and mandates , disseminated the information on a broadly advertised website , developed instructional videos , and provided remote and local training .
another important task was to identify , both within and outside toronto , a workforce capable of working in the icu in the event of a staffing shortage .
finally , leaders from the icu community were appointed to deal directly with the ministry of health to bring forward ( in one voice ) critical care issues and to assist in finding system wide solutions to critical care challenges .
other communication initiatives included a group of tertiary care intensivists making themselves available to provide 24-hour on - call clinical support and advice to any critical care provider .
in addition , software specific to sars was developed for handheld computers and made available for broad distribution free of charge .
finally , on a more personal level , icu leaders needed to communicate regularly with critical care staff in quarantine and those who were admitted to hospital with sars .
at many institutions ongoing emotional support was provided to all levels of icu staff through regular meetings and psychologic intervention .
several lessons emerged from our experience , the most important of which is the need for preparedness . we were not prepared for sars , or did we have a system - wide critical care communication strategy in place . ideally , centers should have leadership and communication systems prepared to allow for the rapid expansion and modification of critical care services in the event of a disease outbreak . fortunately
, sars appears to have disappeared , at least temporarily , from toronto and the rest of the world .
while we remain vigilant for a return of sars there are ongoing communication initiatives within the toronto critical care community .
efforts related to debriefing are also ongoing . additional emotional and counseling support is being offered to those who are left with psychologic sequelae .
finally , research initiatives continue in an effort to learn more about the events that occurred . in summary ,
other critical care communities should consider their communication strategies in advance of similar events . despite the dramatic impact of sars on our community ,
it was inspiring to witness the incredible spirit of cooperation that occurred at the local , national , and international levels .
the sars outbreak in 2003 pushed toronto 's health care system to its limits . 
 staffing shortages , transmission of sars within the icu , and the influx of critically ill sars patients were some unique challenges to the delivery of critical care . 
 communication strategies were a key component in the critical care response to sars . 
 regular teleconference calls , web - based training and education , and the rapid coordination of research studies were some of the initiatives developed within the toronto critical care community during the sars outbreak . 
 other critical care communities should consider their communication strategies in advance of similar events .