There are some cases that stick with you when you’re a police officer.

For Constable Paul Breeze, it was the horrific collision last summer involving a young woman who was in the passenger seat of an SUV. Unconscious, she was rushed to the Tory Regional Trauma Centre at Sunnybrook and Constable Breeze was there to share important details with the team.

Paramedics were able to identify the woman quickly, allowing Constable Breeze to contact her family right away and then bring in Victim Services Toronto, a community-based agency that works with the Toronto Police Service (TPS) to provide free, immediate response and support for families of victims in crisis situations.

Discharged from Sunnybrook in December, the young woman is now well on her way to recovery. Constable Breeze, who works in the Traffic Services division of the TPS, recalls how well the two teams worked together that day, something that he and Sunnybrook have been working on to make their collaboration even better.

“So many things went right that day,” he recalls. “Everyone worked together perfectly.”A former combat medic with the British Armed Forces, Constable Breeze is familiar with Emergency Department (ED) and trauma bay terminology and procedures – vital experience that has made him the division’s go-to guy for crisis scenarios.

He has been working with Sharon Ramagnano, manager of Trauma Services at Sunnybrook, on an orientation program that shares his trauma knowledge and know-how with police officers, so they will know what to do and how to behave in a trauma setting.

“Often, younger officers have never been in a hospital trauma unit before. They don’t know who’s who and what their role is, and it can be overwhelming,” Ramagnano points out. “The program guides them to the right people in the trauma unit.”

Called “A Police Officer’s Guide to the Trauma Room,” the program offers an in-class session with videos featuring trauma protocol and procedure. It clarifies the role of the police, hospital policies and appropriate conduct in the trauma area.

The program was a collaboration between Constable Breeze and Ramagnano, alongside Agnes Ryzynski, manager of simulation and curriculum development at Sunnybrook’s Canadian Simulation Centre and was based on trauma bay experiences and case studies. Last September it was presented for the first time at the Toronto Police College.

“[For the videos], we filmed scenarios the right way and then the wrong way, showing, [for example], a police officer standing too close to the patient care area and not getting names right for paperwork,” says Ramagnano.

Educating police on trauma bay policies has had a side benefit of enlightening the hospital’s trauma team, too. When an abbreviated version of the police presentation was shared with Sunnybrook, team members gained a better understanding of why visiting police officers are in the Emergency Department’s trauma unit and what they might need from hospital staff.

“The videos showed missed opportunities for evidence,” says Ramagnano, “such as staff throwing out an article of clothing that may seem insignificant to them but has importance to the police investigation.”

The program has helped both sides understand the role each plays in the care of the patient and in support of the patient’s family, resulting in improved communication and collaboration between police and the trauma team.

The program has been so successful that Sunnybrook received a community award from Toronto Police Traffic Services.

“It’s an award for community partners working together with us, and recognizes the teamwork that went into the development of this program, between Traffic Services, the Trauma Centre and the Simulation Centre. We felt it was important to recognize these efforts,” says Constable Breeze.

“Now that we’ve started delivering this [program to the TPS], officers are trained on what to expect – and the trauma team staff knows what we need to do our job,” says Constable Breeze. “It benefits all concerned.”

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Alexis Danford was only 25 weeks pregnant when she went into labour. Born at Sunnybrook almost 15 weeks early and weighing less than two pounds, her daughter Reylene faced a range of serious health problems, including life-threatening breathing, heart, brain and eye issues.

Fortunately for the new mom and baby, the Neonatal Intensive Care Unit (NICU) at Sunnybrook’s Women & Babies Program was running an initiative that brings in breastfeeding peer counsellors to help and encourage families like hers. Breast milk is especially critical in the care of premature infants, as it promotes healing, growth and development and decreases the risk of life-threatening infections and conditions. Yet, mothers of preterm and critically ill infants face unique barriers and challenges to breast-feeding.

The NICU Peer Counsellor Program aims to increase the percentage of premature infants who are exclusively breastfed on the day of discharge. The program is part of a study through Sunnybrook’s Breastfeeding Centre of Excellence: it opened last year as the first of its kind in Canada. The program’s goal is to promote the exclusivity and infants, with a particular focus on “micro-premature” (born before 26 weeks) infants. The study found that bringing peer counsellors – moms who are themselves graduates of the NICU – into the unit increases breastfeeding rates in new moms who are having trouble breastfeeding.

“Having a peer counsellor to help support me with my breastfeeding experience was integral to achieving my feeding goals,” says Alexis, 25. “I had to pump every two hours for the first three months of Rey’s life. I was getting my supply up for when we were ready to start trying at the breast. During this time I was often exhausted and sometimes felt overwhelmed, but my counsellor would make a point to recognize my efforts and motivated me to keep going. I’m grateful to have had such strong support.

“I’m grateful to have had such strong support,” says Alexis Danford (above), of having a peer counsellor during her daughter Reylene’s time in the NICU. (Photography by Tim Fraser)

“Three days after my daughter was born, still in shock and terrified, I met Ophelia Kwakye in Sunnybrook’s NICU Family Room. She introduced herself to me immediately and invited me to join her and the rest of the NICU moms for the weekly Mom Lunch,” adds Alexis, a freelance multimedia producer from Barrie, Ont. “From that day forward, she made every effort to encourage, support and help me in any way possible. She was someone who truly understood what we were going through and assured us that there was a beautiful and joyful end in sight.”

Kwakye gave birth to her own son 15 weeks early. He stayed at Sunnybrook for almost four months, battling infections and pneumonia, and requiring three blood transfusions. Kwakye credits NICU Parent Support Specialist Kate Robson with getting her through the trying time.

It was Robson who later approached Kwakye to see if she would be interested in becoming a peer counsellor herself. It’s a part-time job for Kwakye, who now spends her days working with moms in the NICU.

“I go in the unit, room to room, and talk to moms about how to pump every two to three hours and how to maintain your milk supply,” says Kwakye. “I also encourage them about what happens around here and how to take care of themselves. I ask them about what they’re doing and share how they can do better.”

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“We truly are blessed and grateful for all that the entire amazing team in the Sunnybrook NICU did for our family.”

– Alexis Danford

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When it comes to preterm babies, and micropreemies especially, breastfeeding is truly life-saving, says Jo Watson, chair of the Breastfeeding Centre of Excellence and operations director of the Women & Babies Program.

Breast milk promotes healing, growth and development, and decreases the risk of life-threatening necrotizing enterocolitis (a condition that affects the intestines), infections and time spent in hospital. It also improves motor outcomes, cognitive skills and neurobehavioural development.

“When a baby is born premature, the composition of the milk actually changes from the characteristics that a full-term baby would receive,” says Watson. “It’s higher in fat, because what that baby needs is a higher fat content to support the final growth of the brain that would have happened in the uterus. Breastfeeding also reduces the risk of sudden infant death syndrome, and premature babies are at higher risk for it.”

Watson developed the program after seeing similar initiatives elsewhere with successful outcomes. “The opportunity came up to apply for funding through the Government of Ontario and the support of the Best Start Resource Centre at Health Nexus to have an improvement project specifically focused on supporting breastfeeding in populations that had lower breastfeeding rates,” explains Watson. “I knew this model had worked in other centres, so we thought that we would introduce peer counsellors into the NICU and see if we could improve breastfeeding outcomes.”

Mothers of complex or critically ill pre-term infants encounter  a variety of unique breastfeeding barriers and challenges that can make it difficult to initiate and sustain breastfeeding. Many have to pump their milk up to 10 times a day for many weeks before the baby can be at the breast, Watson says. “Not only are you pumping around the clock, but you also have a sick baby in an intensive care unit. A lot of women have to travel a long way to get here and get home. They may have other kids at home. There are all kinds of challenges. It’s hard to maintain that routine for weeks and weeks,” she says.

According to Watson, the national average for babies receiving only breast milk on the day of discharge from an NICU is 40 per cent. “Our rate was already at 70 per cent, so we were doing really well in comparison with the rest of the country, but we thought we could do better, and we knew there were still opportunities,” she says.

Former NICU mom Ophelia Kwakye is now a peer counsellor, advising new moms on breastfeeding their preemies. (Photography by Doug Nicholson)

While rates for breastfeeding exclusivity at Sunnybrook for 2013 indicated that preterm infants are less likely to be exclusively breastfed at discharge than their full-term counterparts (68.3 and 76 per cent, respectively), thanks to the peer counselling program at Sunnybrook, that rate has increased to 75 per cent.

“I fiercely believe that Ophelia was an integral part of not just surviving the NICU, but [also] flourishing in it,” says Alexis. “The empathy, insight and information she was able to provide as a graduate mother herself were intrinsic and incomparable.”

Now almost five months old, Reylene is doing phenomenally well, says her mother – thanks, she adds, to Sunnybrook’s Peer Counsellor Program and the centre’s exemplary practices.

“Considering we had prepared for the worst, to now be home with a beautiful, healthy baby girl is both astonishing and humbling,” says Alexis. “We truly are blessed and grateful for all that the entire amazing team in the Sunnybrook NICU did for our family.”

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Sunnybrook is part of an elite global team working with new image-guided radiation technology that raises the stakes in fighting the most hard-to-treat cancers

Soon, a revolutionary, six-tonne piece of machinery will be lowered through the roof of Sunnybrook’s Odette Cancer Centre and into a specially constructed radiation treatment bunker. It will be a huge undertaking – the equipment is so massive the roof is the only way in.

But the effort will be more than worth it. Bringing the new hardware, known as an MR-Linac, on stream will be a major leap forward in the treatment of cancer. The equipment will save more lives by precisely targeting even the most elusive tumours with high-powered radiation.

The MR-Linac is the world’s first machine to fuse a radiation delivery system (known as a linear accelerator) with a magnetic resonance imaging (MRI) machine. The Odette Cancer Centre will be the first Canadian site to have the technology. Sunnybrook is part of a seven-member international consortium hand-picked for their expertise by Elekta and Philips – the MR-Linac’s manufacturers – to refine, test and use the machine to treat patients.

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The MR-Linac Dream Team
Sunnybrook is one of the founding members of the consortium that also includes:

• Christie NHS Foundation Trust (Manchester, U.K.)
• University Medical Center Utrecht (Utrecht, Netherlands)
• University of Texas MD Anderson Cancer Center (Houston, U.S.)
• Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (Amsterdam, Netherlands)
• Froedtert & Medical College of Wisconsin Cancer Center (Milwaukee, U.S.)
• The Institute of Cancer Research/ Royal Marsden NHS Foundation Trust (London, U.K.)

[/mks_pullquote]The MR-Linac carries out high-definition imaging of tumours in real-time during radiation therapy. This will allow Odette Cancer Centre specialists to target tumours with extraordinary precision – even as a tumour moves inside the body – and to quickly see the radiation’s effect on the tumour.

With the technology, doctors will be able to more effectively treat a host of cancers that were previously hard to tackle. “It’s very exciting for pancreatic cancer, esophageal cancer and other cancers where we have been limited in the way we can treat them with radiation because the tumours actually move,” says Dr. Arjun Sahgal, head of the Odette Cancer Centre’s Cancer Ablation Therapy Program.

“It’s also exciting for brain cancer, where real-time understanding of tumour change would help spare healthy tissue from radiation,” Dr. Sahgal says, adding that the MR-Linac may also allow some breast cancer patients to avoid surgery. The MR-Linac’s more detailed real-time images of tumours and surrounding tissue mean doctors will be able to more precisely target the cancer and fine-tune the amount of radiation delivered. As they monitor how tumours are responding to radiation, they can adjust treatments as they go, potentially resulting in fewer treatment sessions and side effects.

“The MR-Linac will help us better understand the mechanisms of tumour response during actual treatment, in a sense making a tumour visible in a way that has not been possible before,” says Dr. Gregory Czarnota, head of radiation oncology at the Odette Cancer Centre and an international research leader in brain and spine cancer.

As part of the global consortium testing and refining the MR-Linac, Sunnybrook will work with the other members to prepare the machine for the first human clinical trials. “It’s a global consortium of medical physicists, research scientists, radiation oncologists, partnering together all across the world with the common goal of advancing the entire field of MRI-guided radiation,” says Dr. Sahgal.

Sunnybrook is developing the machine’s applications for brain cancer. “We are the lead site for the consortium to develop applications of the MR-Linac for glioblastoma, the most common malignant brain tumour in adults,” says Dr. Sahgal. “We have a protocol that’s looking at advanced imaging for primary cancers of the brain as a first step, and we’re going to have a clinical trial that’s geared toward adapting the radiation dose using the MR-Linac each day as we treat primary brain tumours.”

Dr. Calvin Law, chief of the Odette Cancer Program, says Sunnybrook’s “responsibility as an academic centre is not only to deliver the standard of care, but also to always ask the question: ‘How can we improve the system?’ We have already been making the most out of the technology we have. This next level will combine existing innovation with a new way of doing things and allow patients to have treatments faster, better and with resulting gains in quality of life.”

After the MR-Linac is installed, there will be testing and further treatment protocol development. The team hopes to be treating patients by 2017.

“It’s a paradigm shift. It’s not just a new machine for radiation therapy; it’s more than that,” says Dr. Brian Keller, a Sunnybrook medical physicist and physics lead for the MR-Linac project. “It has very good imaging so we can hone in on where the tumour is, and because we can do that, we can deliver a higher dose, using fewer treatments, and perhaps eliminate surgery that some patients would need in the future.”

There’s great anticipation as a cancer treatment of the future arrives – and, with it, new hopes for patients at Sunnybrook and beyond.

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How the MR-Linac Works

• Radiation Beam: Because the MR-Linac uses real-time imaging, doctors can direct the radiation beam at tumours with unprecedented precision, even as the tumour moves or changes as it is damaged by the radiation.
• Treatment bed: As with standard MRI machines, the MR-Linac patients lie on a bed that moves into the imaging/treatment chamber.
• Magnetic field: The MR-Linac’s developers overcame a major engineering hurdle by creating a machine that can simultaneously visualize tumours with high-resolution magnetic resonance imaging and treat them with radiation

Illustration by Tonia Cowan

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