Innovation Sunnybrook Magazine – Fall 2016

Cutting-edge innovations fuel Canada’s largest trauma centre

Members of Sunnybrook's trauma team

On a beautiful spring afternoon in 2010, Trent University student Steve Lanys-Morris left his rural home and drove into Peterborough, Ont., to pick up a pal for a night of beer and wings. In response to a text, Steve picked up his phone and typed “I’m on my w–.”

He never completed the word. A car ahead of him had stopped to turn left. Steve swerved into oncoming traffic, colliding head-on with another vehicle.

Paramedics concluded the 28-year-old had suffered a severe brain injury, and that one of his thighbones was broken in two places. With his life on the line, Steve was airlifted to Sunnybrook’s Tory Regional Trauma Centre.

The trauma centre, now celebrating its 40th anniversary, was Canada’s first regional trauma centre and it remains the country’s largest. The centre’s expert team cares for over 1,600 injured patients annually, many of whom are at risk of losing life or limb, usually from a motor vehicle collision, shooting, stabbing, severe fall or industrial incident.

While patients with injuries like Steve’s are a rarity at many hospitals, they’re a daily reality at Sunnybrook. Tory Regional Trauma Centre’s success at saving lives place it amongst the top 10 per cent of all North American trauma centres, according to a recent report by the American College of Surgeons.

Sunnybrook’s trauma team saves 94 per cent of the most severely injured patients who come through the centre’s doors. They can do so because they harness the latest advancements in trauma care, some of which have been spurred by their own cutting-edge research.

This state-of-the-art care was there for Steve when it mattered most. Comatose and bleeding, he was rushed to the trauma bay and treated by a multidisciplinary team of surgeons, anesthesiologists, nurses, respiratory therapists, imaging specialists, blood bank technologists and others.

They stabilized him over the course of nearly three hours by getting the bleeding from his leg under control and treating his life-threatening brain swelling.

Steve had won the opening round of his long fight to return to his daily life. He went on to spend the next 52 days in the Intensive Care Unit. Next came in-patient rehab, and then more from home.

Steve is still living with the residual effects of his permanent brain injury, which has prevented him from pursuing his career path, but he feels fortunate to be alive. “The trauma centre saved my life. I owe so much to them,” he says.

A history of innovation

The advent of computed tomography (CT) imaging – a technology that was crucial to Steve’s care – is one of the major ways trauma care has improved since the Tory Regional Trauma Centre opened four decades ago. CT imaging can visualize nearly all parts of the body, and it is particularly well-suited for rapid evaluation of brain injuries and internal bleeding.

With the introduction of this technology, Sunnybrook developed protocols for its optimal use to assess injuries and come up with effective treatment strategies. A recent addition to the team – dedicated emergency and trauma radiologists who conduct CT imaging – is yet another Sunnybrook innovation.

Advancement in blood transfusion science is another area where trauma care has improved in recent decades, thanks in part to contributions by Sunnybrook. For instance, the hospital’s Massive Hemorrhage Protocol is a comprehensive, multidisciplinary protocol that has been used as a model for hospitals worldwide.

Sunnybrook’s trauma team saves 94 per cent of the most severely injured patients who come through the centre’s doors

Developed by Dr. Jeannie Callum, Sunnybrook’s director of transfusion medicine and tissue banks, and Dr. Barto Nascimento, a trauma specialist, the protocol stipulates how and when blood products – for instance, red cells, platelets, plasma – should be transfused in cases of massive bleeding. It also speaks to the use of medications to stop bleeding, and advises on various factors that can impact bleeding such as maintaining normal body temperature, using blood warmers for all blood products and frequent tests of clotting factors.

Dr. Callum’s team reviews every resuscitation involving massive transfusion. Their goal is improving the protocol and saving lives, while carefully and efficiently using scarce blood products. Many patients who survive the early hours and days of a trauma can die later because of a blood clot in the legs or lungs. This is because immediately after trauma, the blood clotting system goes into high gear to stop injury-related bleeding. This process can also lead to abnormal blood clots. Sunnybrook’s Dr. Bill Geerts has led research to enhance prevention and treatment of such clots.

Dr. Geerts, director of the hospital’s Thromboembolism Program, leads a team that assesses every trauma patient for this risk, often prescribing low doses of clot-preventing drugs. His team has dramatically reduced deaths and is considered a world leader in this aspect of trauma care.

Sunnybrook’s chief of surgery, Dr. Avery Nathens, says the Tory Regional Trauma Centre’s innovative care wouldn’t be possible without its talented staff. “We’ve brought in the right people, all of whom are here because of their commitment to the injured patient,” he says.

Sharon Ramagnano is one of those people. She was brought on this year as manager of trauma services and will lead quality improvement and strategic project work in order to make processes better and foster more alignment across all clinical areas that are involved with trauma patient care. She is also focused on patient and family education to both prevent trauma and support those going through the continuum of trauma care.

“We are very proud of the work we do saving lives,” says Dr. Nathens. “We also realize the importance of improving the quality of life of our trauma survivors. This focus – bringing together the experience of our surgical teams, rehabilitation medicine specialists and mental health physicians – to get patients back on their feet to the lives they’ve had before injury – will be our next advancement.”

An important innovation on the horizon is the construction of Sunnybrook’s first hybrid operating room (OR). At twice the size of a standard OR, the hybrid OR will bring advanced imaging and surgical equipment into the same room. This will, for instance, enable one surgeon to operate to stop abdominal bleeding, while another surgeon operates on the brain.

“A hybrid OR means we will never have to compromise in our approach,” says Dr. Nathens, adding that the facility, which will be built with the assistance of donors, is evidence of Sunnybrook’s commitment to inventing the future of trauma care.

For trauma patients like Steve, it’s all quite remarkable. “There’s so much work that goes into saving one person,” he says. “I think it’s just amazing.”

A P.A.R.T.Y. with a message

Steve Lanys-Morris cannot change the past and return to life before his crash. But he can try to prevent youth from taking unnecessary risks, including texting and driving − the fastest growing cause of traumatic injury in young people.

As a speaker with Sunnybrook’s Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) Program, Steve shares with students how risky behaviour can lead to life-changing injuries.

“Showing the consequences from risk-taking behaviour, like texting and driving, is what the P.A.R.T.Y. Program has been doing for the past 30 years,” says Joanne Banfield, manager of the RBC First Office for Injury Prevention at Sunnybrook, which runs a range of risk-reduction programs, including P.A.R.T.Y. “We know that when young people see the reality and impact of a traumatic injury, it inspires change in behaviour and attitude.”

P.A.R.T.Y. participants, usually students aged 15 years and older, come to Sunnybrook and visit the trauma bay, critical care unit and other key treatment facilities and hear from doctors, paramedics and police. They then hear from injury survivors, like Steve. “It’s reality-based, and it resonates with students,” says Banfield.

Giving back is also a key part of rehabilitation for Steve and other former trauma patients who may struggle to accept what can be lifelong injuries. It’s satisfying, Steve says, to help prevent incidents similar to his.

Studies that observed P.A.R.T.Y. participants over a 10-year period show they have a lower rate of injuries, collisions and driving offences, including drinking and driving, than young people who did not attend the program. Based on the success of P.A.R.T.Y., Sunnybrook has licensed the program to 150 centres in seven countries.

Photography by Tim Fraser

About the author

Diane Peters