Transferring Trauma Knowledge: Lessons From the Front Lines of Care
Two University of Toronto doctors are taking the lessons they’ve learned working on the front lines of a major trauma care centre to help teach medical professionals who may send patients to hospital by helicopter.
“Trauma happens everywhere, and we know it is most appropriately treated in a major trauma centre. Unfortunately, most places in Ontario don’t have one,” says Dr. Joel Lockwood, a 5th year resident in the Department of Medicine’s Division of Emergency Medicine. “If a person is in a motor vehicle accident at Queen and Yonge Streets in Toronto, their care might be a lot different than if it happened four hours north of Sudbury.”
The sooner a person receives care after they are critically injured, the better their chances of survival will be. That’s why emergency medicine practitioners call the first sixty minutes following a trauma the “golden hour.”
Ontario has major trauma centres in Toronto, Thunder Bay, Sudbury, Ottawa, Hamilton, London, Kingston and Windsor — but about 15 per cent of the province’s population lives more than an hour away from any of them.
In a recent commentary in the Canadian Journal of Emergency Medicine called Improving Air Medical Transport of the Trauma Patient from the Ground, Lockwood and his co-author Dr. Alun Ackery suggest strategies they say will help get patients to major trauma centres faster.
Lockwood and Ackery recommend using clear, calm, jargon-free communication for trauma patient transfers. The doctors also say that physicians need to control any bleeding and prepare patients for continued resuscitation during transfer. They also recommend physicians act quickly to get patients to the major trauma centre rather than trying to diagnose problems they can’t treat locally.
“Don’t try and figure the problem out,” says Ackery, an emergency physician and trauma team leader at St. Michael’s Hospital. He points to CT scans as an example. “Physicians who send us patients sometimes do a scan to be helpful. They might identify a problem, but may not be equipped to fix it. The scan has to be repeated, which delays treatments and means the patient gets another dose of radiation.”
In their article, Lockwood and Ackery also present an itemized “to do” list — similar to the standardized checklists used in the aviation industry — to help make sure doctors take the proper steps before putting a patient on a helicopter.
“In a crisis, having checklists prepared in advance can be a big help,” says Ackery. “If you take a step-by-step approach, you’re going to miss fewer things.”
Severe injuries from incidents like car crashes, gunshot wounds, or stabbings, kill more Canadians under the age of 45 than any other cause of death. In Ontario alone, about 5000 people require trauma care each year. The authors hope their advice will help improve the chances of survival for patients in places that don’t have a trauma centre.
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(Photo: Ornge Agusta Westland AW 139 C-GYNN by russavia via flickr)
