Tiffany Jefkins already had a portable CPR mask, on her keychain and ready to go, when she watched a van mow down pedestrians on a busy Toronto thoroughfare.
Prior to the attack, Jefkins had spent much of her life professionally trained in first aid, CPR and resuscitation sciences. She first learned crucial life-saving skills as a teenage lifeguard, working at a community pool steps away from Mel Lastman Square, the scene of the tragedy.
She went on to be a respiratory therapist at Toronto General Hospital and worked for a CPR training organization. In February 2018, Jefkins was accepted to a graduate studies program in health services research at the University of Toronto.
But before she could pursue her research interests at the school — the role of bystanders in emergencies — she would experience the scenario first-hand as one of the first to respond to the deadliest vehicle-based attack in Canadian history.
“It's a complete coincidence that this happened in that timeframe,” she said. With all her years of training Jefkins said she was as “prepared as she could ever be” after being faced with a mass casualty scenario.
But that doesn’t mean the nature of the incident felt familiar to her. “In some ways I was also on auto-pilot. I wasn't thinking about what I was doing, I was just doing it,” she said.
Moments before a 25-year-old man erratically drove a white rental van down Yonge Street on April 23, 2018, killing ten and injuring 16 others, Jefkins was having lunch with her friend.
As a new mom on maternity leave, Jefkins took her 10-month old daughter to Mel Lastman Square with a friend and her young daughter. It was the first time after a long, cold Toronto winter that they felt they could take the girls outside.
Jefkins said they had just finished eating when they heard a crashing noise, followed by screams.
“I turned just in time to see the van mount the sidewalk, and strike four pedestrians and then veer back onto Yonge Street, and then continue down the road,” she said.
Instinctively, she immediately buckled her daughter into her stroller and ask her friend to watch her, before she ran towards the scene. She grabbed her keys with the CPR mask attached.
She found two victims next to each other, and one bystander tending to the wounds of the male victim.
“There was blood everywhere. He was doing his best to try to hold pressure,” she said. Jefkins turned her attention to the female victim and began to start CPR. She couldn’t use her portable mask, because her hands were shaking too much.
She says she screamed out to a crowd of about 40 people, asking if anyone else knew CPR. Nobody responded initially and all were watching her try to help the victim.
One man stepped forward, and Jefkins instructed him on how to do CPR. She spent the next minute moving from victim to victim, teaching bystanders what to do, and coming back around to check on the first victim she saw.
“I've been teaching CPR for quite some time, so it was really common for me to move from group to group, training individuals,'' she said. She continues, “In that regard, it felt very familiar. But obviously it was totally unfamiliar territory to me because this was real life, everybody's in shock, bystanders, victims and people who were watching, and myself.”
Security guards brought out defibrillators and she and other bystanders were able to use those on the victims. Police, EMS and fire personnel all began to arrive and the situation started to become more under control, amid the disaster, she said.
“It was total chaos in the square because some people were screaming, there were quite a few people on their cell phones describing I could only assume the scene to 9-1-1,” she said. After EMS arrived, Jefkins said she just wanted to get back to her daughter.
She returned home after organizing a first attempt in saving four victims. But trying to save lives on the street and sidewalk that day didn’t leave her mind.
It’s changed her life forever.
Bystanders need support too
Jefkins experienced symptoms many bystanders feel following a traumatic incident. She had trouble sleeping, kept replaying the day’s events in her mind and was “constantly on edge.”
“I was left to fend for myself. I kind of had that feeling, that nobody really understood unless they were there that day and encountered it as well,” she said. Therapy and a strong support network ensured she got the help she needed after the attack.
Having access to that kind of support isn’t available for all of those impacted by events like these, who might not have the means, she said. Professional support allowed her to heal and be able to speak so candidly about her experience, she said.
The months following the attack injected a deeper sense of purpose and need for her field of studies. What was a passion for Jefkins, now had a larger force working behind it: her own personal role as an active bystander who tried to save lives.
Jefkins research involves “lay-rescuers,” active bystanders who work to aid victims at the scene of an incident.
“Now that I've been in that situation I realize how critical it is, and how important it is to do research in the field that will support hopeful program development and changes in public policy surrounding how lay-rescuers are supported,” she said.
Jefkins recently did a TEDx University of Toronto talk on her research field and its intersection with her experience during the van attack.
Bystanders actively involved in an emergency situation do not always have access to the same support systems that EMS or police might, she said. She wants that to change.
Many ‘still in the depths of despair’
One year after the attack, she says these support systems must be in place if we want to train more civilians in CPR or first aid, they go hand-in-hand.
For those who want to find a way to help— she encourages Torontonians to seek out CPR and first aid training.
Those who were impacted by the attack may be at different stages in terms of healing, and may not be ready to discuss the events, or their grief, publicly, she said.
But talking to people you trust is the best way to move forward, she said.
“Being open about it, whether with a professional or those you are close with, that's probably the most important thing,” she said.
Understanding the complex emotions and needs of those impacted by the attack requires the attention of multiple organizations and institutions, said Bobbie McMurrich, associate executive director at Victims Services Toronto.
Victims Services aims to provide immediate response to those in need, who have been impacted by crime or any kind of sudden tragedy. The organization has close ties with the Toronto Police Service, and were in touch with all the families directly impacted by the attack soon after it happened.
They also sought out as many witnesses and first responders as they could, with many calling on their own volition, said McMurrich. Often, their work with individuals following an event will last for months.
What many underestimate about the impact of traumatic events is that most victims are not immediately ready to go to therapy, said McMurrich.
“[Therapy] doesn't come into play until several months later for most people. Because the first few months are really focused on making sure that basic needs are being satisfied,” she said. “So when you think of having your life just ripped away from you, and being left with really nothing…. you cannot address the higher needs yet.”
Victims Services is still involved with some of the families impacted, but many returned home as they are from overseas, she said.
“At this point a year later, families who have lost family members are really still in the depths of despair and grief,” she said. “Not everybody wants [therapy].”
Coming up to the one-year anniversary of the attack, Victims Services is examining how to better prepare for large-scale critical incidents and how to coordinate as smoothly as possible with other organizations, like the police.
Events planned to commemorate the anniversary, organized by the City of Toronto and the We Love Willowdale community organization, are expected to draw crowds.
The city is also planning to consult with survivors and families during the year to discuss a permanent memorial and the needs of those impacted.
Learning from how other cities have supported victims and pursued memorials was part of the city’s process over the last year, said Patrick Tobin, director of arts and culture services at the city.
WATCH: 2018 Memorial for Van Attack Victims
Tobin, who leads a team that’s launching consultations about the memorial with the families, says they consulted with Boston officials who worked on memorials after the 2013 Boston bombing.
He said they were advised by Boston not to push victims into making quick decisions about memorials.
“We need to allow time for reflection and healing. The marathon bombing was in 2013. They just introduced monuments five years later,” he said, adding that their memorial will come sooner than that. But they were told to let victims focus on healing first, and continue to consult with them.
Rallying around victims and their families is something average Torontonians, who don’t play a role in city planning, have aimed to do as well.
What happened to #TorontoStrong?
Funds from the city’s #TorontoStrong initiative, where $4 million in donations from around the world, were distributed among those impacted at the end of last year.
That file has been closed at the city, with the funding portfolio moved to the Toronto Foundation, an organization that helps to strategize philanthropic initiatives.
Currently the Foundation is working on what’s next for raising funds for victims and for helping to ensure multiple organizations in Toronto know how to work together, in case of another traumatic incident.
They will be figuring out what that looks like this year, said Julia Howell, vice-president of community engagement at the Foundation.
“We'd never done anything like this before, we spend a lot of time trying to understand how you do this well,” she said. They’ve established the Barbara Hall Resilience fund which is meant to be the next step in supporting victims.
The interest from Torontonians to continue to help those impacted by the attack hasn’t gone away, she said, mirroring the city’s initiatives.
“I think just by people saying publicly that they care and keeping the story alive, that is probably somewhat a source a comfort for the victims,” she said.
Like Tiffany Jefkins, some of those who were impacted were willing to speak out fairly early.
“But for others that's not the case and it may never be the case,” said Howell. “Everyone needs to respect that.”