What to know:

  • St. Michael’s Hospital hosted expert colleagues from Veterans Affairs Canada and McMaster University to stage a large-scale wildfire tabletop exercise (TTX) focused on the often-overlooked mental health and psychosocial impacts of disaster. 
  • The two-day exercise brought together participants from Unity Health Toronto, the Government of Canada, Canadian Forces Health Services, McMaster University and other partners to determine how the health system can better respond to and mitigate these impacts. 
  • The scenario emphasized that disasters affect communities differently, highlighting the need for tailored approaches and strong coordination across health care providers, first responders, the military and community organizations.
  • The exercise is part of ongoing efforts at St. Michael’s to strengthen preparedness for complex emergencies, applying lessons from a wildfire scenario to improve responses to a wide range of future disasters, including geopolitical crises. 

The first update came quickly: there was a fire in Ashwood Forest. Conditions worsened as the wind shifted. The surrounding communities were at risk as uncertainty and concern grew among participants.

In a meeting room at St. Michael’s Hospital, psychiatrists, psychologists, paramedics, trauma surgeons, public health specialists and spiritual care practitioners examined briefings and timelines. There were no sirens, no smoke in the air, but the intensity was palpable.

Participants from Unity Health Toronto, the Government of Canada, Canadian Armed Forces Health Services, McMaster University and other participants were gathered for a large-scale disaster tabletop exercise (TTX), designed not only to simulate the physical destruction of a wildfire, but also to examine something often overlooked: the profound mental health and psychosocial consequences that unfold during and after a disaster, and how the health system can mitigate them.

Event organizers like Dr. Alexandra Heber, a retired lieutenant-colonel and chief psychiatrist at Veterans Affairs Canada, and Dr. Julie Maggi, a staff psychiatrist and researcher in Mental Health and Addiction Services at St. Michael’s, say that emergency response planning must go beyond immediate survival to include the mental health and psychosocial consequences of disaster, as well as community recovery.

“I hope that people develop an understanding of the complexity and importance of providing psychosocial support in a disaster,” says Maggi. “We know that there are significant mental health impacts, and interventions employed as the disaster unfolds can mitigate the psychosocial impacts of the disaster.”

Increased rates of post-traumatic stress disorder, substance use disorders and intimate partner violence are among the less visible and talked about consequences of disasters. 

The exercise reflects ongoing efforts by St. Michael’s Hospital to strengthen preparedness for complex emergencies. As an American College of Surgeons Level 1 verified trauma centre with experience in planning for both civilian and military disaster management, the hospital adopts an all-hazards approach, taking lessons learned from exercises like a wildfire scenario and applying them to a wide range of other large-scale emergencies.

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As the scenario unfolded, the room was divided into four fictional communities. At one table was Hearthvale, a tight-knit rural community where generations live and work side-by-side and where outside intervention is not always welcome. At another table was Blackridge, a diverse industrial resource city shaped by energy extraction, workforce mobility and rapid growth. Across the room, an urban centre known as Stillwater Bay prepared for an influx of evacuees. 

The government and media were represented at yet another table, where participants discussed tactics for communicating with the impacted communities, aiming to balance transparency with the risk of causing panic. 

The exercise highlighted a few common themes in emergency preparedness, the first being that each community has different needs, and system partners – whether it’s health care providers, on-the-ground first responders, government officials, or beyond – can’t operate in silos. 

This was evident at the Hearthvale table, where the community’s cultural norms and reluctance to accept outside help created challenges, not only for immediate response measures, but for long-term follow up and care. Conventional emergency communication strategies like alerts and public messaging were not always effective. 

Leadership in a crisis can be another challenge. Leaders are responsible for connecting people, reinforcing trust and guiding communities toward recovery. That responsibility often comes with stress, uncertainty and emotional strain. Supporting communities also means recognizing the demands placed on leaders and health care providers and ensuring they are equipped and supported to sustain that role over time.

“We often focus on the physical aspects of managing fires, ensuring we don’t have loss of life,” says Dr. Margaret McKinnon, a professor and associate chair in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, and one of the event organizers. “But we are far behind in our understanding of the psychosocial aspects of response.”

She describes disaster as having “circles of impact,” affecting not just those directly harmed, but families, responders and entire communities. Participants emphasized that reducing those challenges depends on clear communication and early psychosocial support, particularly psychological first aid delivered by people closest to those affected. 

Rather than relying solely on specialists, they stressed the need to equip frontline workers and community members with practical tools they can use right away, helping people cope in the moment, increasing resilience of the community and reducing longer-term mental health impacts.

With support from the Public Health Agency of Canada, McMaster University developed CanEmerge, an online platform providing mental health and well-being supports, during emergencies and disasters.

For Heber, the goal of the exercise was not just to simulate disaster, but to reshape how people think about response and ensure that learnings are being passed on. 

“As disasters occur in our community, country and around the world, it’s important to have people who want to work in this area and pass their knowledge on to others,” says Heber.

Dr. Andrew Beckett, medical director of the Trauma Program at St. Michael’s and a lieutenant-colonel in the Canadian Armed Forces, says lessons learned from a wildfire scenario can inform planning for other large-scale emergencies and the under-explored mental health impacts. The goal should be for our health system and its partners to develop a shared plan for response.

By Hannah Nickle

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