Quality management case studies in health service emergencies: SARS and wildland-urban interface fires

The province of British Columbia, Canada, experienced 2 major health emergency situations during 2003: severe acute respiratory syndrome (SARS) in early 2003 and wildland-urban interface fires during the summer of 2003. The interface fires occurred within the boundaries of the Interior Health Authority, 1 of 5 health authorities responsible for the delivery of health services in their respective areas of the province. The British Columbia Center for Disease Control (BCCDC) managed the SARS crisis in the province. Both organizations subsequently conducted quality management reviews of their handling of these emergency situations. This article reports on the quality management review of health services delivery during the interface fires and explores the role of physicians during regional emergencies. A similar report was published in the Spring 2004 edition of Quality Management in Health Care on the way SARS was managed at the BCCDC. This article also compares managing a foreseeable emergency situation, such as a wildland-urban interface fire, with managing the unknown, which describes the situation during the initial stages of SARS. The realities confronting the unknown, and the need to manage the situation such that learning and discovery environments are allowed to come into being and evolve rapidly, are discussed.