Inter- and Intra-Health Authority Relocation Working Group

The “Inter- and Intra-Health Authority Relocation (IIHAR) Toolkit” (IIHAR) initiative represents a ground-breaking advancement in enhancing the resilience and responsiveness of health services during climate-related emergencies. This innovative toolkit, designed in response to the severe challenges posed by the 2021 wildfire season, focuses on the efficient, risk-based, patient-centred, and culturally-safe relocation of residents from long-term care, assisted living, and independent living  facilities.

The IIHAR toolkit emerged from a collaborative effort involving Health Emergency Management BC, regional health authorities, the First Nations Health Authority, and the Ministry of Health’s Emergency Management Branch. The toolkit includes 21 tools and resources designed to standardize and enhance evacuation processes, addressing all aspects of emergency evacuations such as activation, coordination, evacuation preparedness, transportation, and reception. The toolkit’s development was driven by the necessity to improve emergency management and disaster preparedness in health care systems, particularly in the context of the increasing frequency and severity of climate-related disasters. The IIHAR toolkit is grounded in a patient-centred, culturally-safe, and risk-based approach, ensuring that the unique needs and well-being of patients, clients and residents are prioritized while acknowledging and respecting their diverse cultural backgrounds.

The implementation of the IIHAR toolkit during the 2023 wildfire season demonstrated its profound impact on the quality of care in emergency situations. The toolkit helped with the safe evacuation of approximately 850 residents from various health care facilities, ensuring continuity of care and minimizing harm. Key to its success was the clear definition of roles and responsibilities, improved management and sharing of information, and effective communication among all stakeholders.

A significant feature of the toolkit is its emphasis on cultural safety and patient-centred care, particularly for Indigenous communities. During the evacuation of patients from the Northwest Territories in 2023, Indigenous Health Liaison Teams were activated to provide culturally-safe support. Indigenous Patient Navigators welcomed evacuees, and medicine bundles prepared in ceremony were provided, ensuring a culturally respectful and supportive environment. This culturally sensitive approach significantly mitigated the trauma associated with evacuation, especially for Indigenous patients with historical traumas linked to forced relocations. Beverly Lightfoot, the coordinator for the Indigenous Health Liaison Team, highlighted the positive impact, saying, “Having Indigenous representation and cultural safety embedded in evacuations is vital for our community’s well-being. It acknowledges our unique experiences and helps mitigate trauma.”

The IIHAR toolkit also introduced innovative practices such as “STOP CHECKS” during transportation phases to reassess the necessity and safety of continued movement, thereby integrating and maintaining patient-centred care principles even under emergency conditions. Furthermore, the creation of a “Family Support Line” during evacuations addressed the need for effective communication with families, enhancing the overall care experience. Health care providers involved in the evacuations have praised the toolkit for its clarity and comprehensiveness. One health care worker shared, “The IIHAR toolkit provided a clear roadmap for us during the evacuations. The detailed checklists and decision-making frameworks were invaluable in ensuring we could deliver the best care under challenging circumstances.”

The IIHAR toolkit represents a significant advancement in emergency preparedness and response within the health care system. By fostering collaboration, ensuring cultural safety, and prioritizing patient-centred care, the toolkit has substantially improved the quality of care during evacuations, setting a new standard for emergency management in health care. Its successful implementation and ongoing refinement highlight the importance of continuous improvement and the potential for this initiative to serve as a model for other regions facing similar challenges.