Christina Frimpong teaches STOP THE BLEED^® and spoke about her experience and the importance of knowing how to respond in the event of a serious injury.

What sparked your interest in the nursing profession?

I was always drawn to nursing, even as a child. I’m a caring person by nature. My mom was very sick for a time, and I was inspired by the nurses who cared for her.

Why did you decide to become a STOP THE BLEED^® instructor?

I grew up in Toronto Community Housing, and have lost friends to gun violence. I’ve been in situations where I’ve seen someone injured and you’re scared, you don’t know what to do. But if we can help, the person has a better chance of surviving. A mentor of mine encouraged me to take the STOP THE BLEED^® course. After taking it, I was inspired and knew I had skills that I could bring to the table as an instructor.”

Why do you think it’s important to take a course like STOP THE BLEED^®?

STOP THE BLEED^® equips people with knowledge. You don’t have to be a medical expert to learn simple steps that can help save a life. The course provides hands-on experience and it’s not isolated to injuries resulting from violence. Severe bleeding can happen from a kitchen injury or bad fall too. It’s about giving people confidence to help others, or even themselves.

What might surprise people about controlling massive blood loss?

People are surprised by how deep serious wounds are. Also, the amount of pressure that is needed to stem bleeding and how incredibly tight the tourniquet needs to be. People often say “what if I’m hurting them.” The discomfort in the moment is outweighed by the importance of applying pressure and packing the wound.

How have you seen the course impact participants?

Sometimes they’ll share their own experiences, stories and point of view with me or the group. By the end of the session they are often amazed and really thankful to have learned these skills. I’m inspired by their reflections and input. We learn from each other.

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With the days getting warmer and the May long weekend quickly approaching, many of us are getting ready to enjoy some fun activities, like a trip to the cottage, hikes, or the first camping trip of the season. While it’s a great time of year to get outside, it’s also when we see many traumatic injuries take place.

Actively preventing injury is always the main objective, but being ready to respond when an incident occurs is the next best option. It helps to be prepared by carrying a first aid kit with a few essential items. We often think about packing disinfectant and ice packs, but did you know large bleeding incidents (which could be caused by a fall or using home improvement tools, for example) benefit from some specific items. A person can bleed to death in as little as 5 minutes, so it’s important to be equipped with the tools necessary to control critical bleeding before help arrives.

What to pack:

• Gloves. A few pairs of gloves provide a great barrier between you and the individual you’re helping.
• Gauze. A great material to use when applying pressure or packing a bleeding wound.
• Extra clothes or t-shirts. If you run out of gauze, an extra t-shirt or two can be used to pack a bleeding wound or apply pressure.
• A high quality tourniquet, such as the Combat Application Tourniquet (CAT). This is perhaps the most important item to include. A tourniquet can be extremely effective at stopping a life-threatening bleed and can be on for many hours until help arrives. Sunnybrook highly recommends receiving formal training in how to apply a tourniquet before adding one to your first aid kit. You can take training by registering for a STOP THE BLEED® course. A CAT Gen7 Tourniquet can be purchased when registering for our course or during class.
• A permanent marker. This can be used to mark the time of tourniquet application, which is handy if you are in a rural area where it might take longer to get help.
• A whistle. Use this to signal for help and assist first responders in locating you.

Remember, if you’re in rural or remote areas where cell coverage or WIFI is unavailable, emergency calls can only be made through a satellite phone. Check to see if your cell phone has the capability to make a satellite call. Always be sure to tell someone where you’re going and your planned schedule.

Sunnybrook wishes you a safe and happy long weekend!

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Despite this acknowledgement, Canadian Blood Services says blood inventory has declined by 25 per cent in the past two months, with the past few weeks seeing a shortage of O negative and B negative red blood cells.

What’s causing this shortage and why are we having trouble fixing it? Dr. Akash Gupta, a transfusion medicine specialist at Sunnybrook, helps us understand.

Why is the demand for blood so high right now?

Even in regular times, most of our blood collections in Canada are from a small minority of dedicated people. Only about 4 per cent of people go out to donate, despite the fact that one in two people are eligible.

Then with the pandemic, especially at the start of the pandemic, everyone was required to stay home and isolate. So, a lot of the regular donors didn’t come out to donate as often, just out of following the rules and for safety. So that has had an impact. Contrarily now, with limitations being lifted, a lot more people are travelling. But Health Canada has set rules based on COVID, preventing many international travellers from donating.

In short, our donor base is down.

And then as everything opens up from the hospital side, the demand for blood has gone up as we’re doing more surgeries. Plus, trauma season officially started with the May long weekend. So, demand has gone up even further, but the donor base hasn’t gone back to where it was. Thus, we have a deficit.

Does having COVID impact one’s ability to donate blood?

COVID itself is not transmissible by blood. So, there’s no risk to blood products.

Though, if you are symptomatic or actively infected with COVID, then you can’t donate blood. But that’s more for protection of staff and other donors in the clinic so you don’t transmit the disease to them.

Why else might someone be ineligible to donate?

Along with travel, low hemoglobin is the biggest deferral.

A lot of young women are iron deficient to begin with because of their monthly menstrual periods, so low hemoglobin is quite common.

If you have low hemoglobin, then you’ve been identified as having anemia, so it’s probably a good idea to see your family doctor. If you’re anemic, that can be treated. It might be as simple as taking oral iron or maybe IV iron. Then you can boost up your hemoglobin and try again once that’s been rectified.

Even aside from donation, if you’re anemic, you would probably benefit from your hemoglobin being bumped up to the normal range anyway.

What should people know before they donate blood?

Donating is generally pretty painless and pretty quick.

To determine if you’re eligible to donate, now you can do the screening online, so you don’t have to go into the clinic to find out. If you answer yes to any of the high-risk questions, it won’t let you book the appointment, so you don’t have to go in and then be turned away at the clinic itself. And now everything is by appointment because of COVID, so it’s a little more streamlined that way too.

The donation itself is less than 10 minutes. And then you get some nice treats.

Anything you’d like to add?

If people go out to donate, they can save lives.

Blood transfusion is a very common procedure in hospitals; I’m sure most people know someone who’s required a blood transfusion. And it’s often a life-saving process.

So, please go out and donate. That would be very helpful.

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A STOP THE BLEED® participant “packs” a bullet wound with a t-shirt (Durham College).

Thomas Bezruki holds up a package of combat-grade medical gauze and a red t-shirt.

“You would be amazed at how much material it takes to pack a large, deep wound. If you don’t have gauze on hand, even a t-shirt will work,” he tells the group gathered around him, a mix of first responders from the Oshawa area, students and staff from Durham College, and the general public.

A member of the group steps forward to practice packing a deep laceration on a realistic-looking fake limb, complete with simulated blood pouring out of it. She uses almost the entire package of gauze to “pack” the wound and applies direct pressure with her hands before the bleeding finally stops.

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“Anyone who does this training can help save a life.”

– Corey Freedman, Manager, Trauma Services at Sunnybrook

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The demonstration is part of STOP THE BLEED®, a training course developed by the American College of Surgeons that provides civilian bystanders with the skills and tools to stop uncontrolled bleeding in an emergency situation. Instruction is delivered using a combination of presentations and hands-on practice.

Sunnybrook’s Centre for Injury Prevention brought the program to Canada for the first time in 2017, and has since trained thousands of people.

“We show people how to stop life-threatening bleeding following everyday emergencies, natural disasters and mass casualty incidents. Anyone who does this training can help save a life,” says Corey Freedman, Manager of Trauma Services at Sunnybrook and a certified STOP THE BLEED® facilitator.

The facilitators who helped certify over 200 people at Canada’s largest-ever STOP THE BLEED® training event on May 13, 2022.

On May 13, 2022, Sunnybrook partnered with Durham College to hold the largest STOP THE BLEED® training event ever held in Canada, helping 217 people become certified.

The event was held a week before the Victoria Day long weekend, which is often referred to as the unofficial start of trauma season. Trauma hospitals like Sunnybrook traditionally see a significant increase in traumatic injuries over the summer months, making this a key time to offer the training to large groups. Watch of video of the event on Instagram.

Course facilitators included several staff members from Sunnybrook and Bezruki, the Manager of Emergency Management at Durham College and a former Tactical Combat Casualty Care (TCCC) medic in the Canadian military.

Thomas Bezruki demonstrates the proper use of a tourniquet to stop uncontrolled bleeding (Durham College).

Bezruki says Durham College has installed over 30 STOP THE BLEED® kits, which include essential items like tourniquets, gloves and gauze, across its Oshawa and Whitby campuses. He hopes other institutions follow suit by offering the training course and installing the kits, and he encourages individuals to sign up for STOP THE BLEED® training.

“Everyone should know how to stop bleeding after an injury. The more people who know how to control bleeding in someone who is injured, the greater the chances are that person will survive,” he says.

Sunnybrook offers public and private STOP THE BLEED® training opportunities. Learn more and register for an upcoming course at sunnybrook.ca/stopthebleed.

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When the Jennifer Tory Trauma Recovery Clinic opened at Sunnybrook in April 2021, physiotherapist Carly Orava was one of the first people to join the newly-created team.

“I was excited about the creation of this clinic because we’re able to follow and care for trauma patients for up to a year after they are discharged from the hospital. This model gives us a deeper level of insight into our patients’ recovery process that we didn’t necessarily have before,” she says.

Carly says the patients they see are dealing with a variety of issues after an injury, including physical disability, pain, mental health problems and the effects of brain injuries. The new clinic operates in a dedicated space where patients receive care from a range of health professions including physiotherapy, occupational therapy, social work, physiatry, psychology, clinical psychiatry and pain services.

Before the clinic opened, a trauma patient who had been discharged but still required follow-up with multiple care providers would have needed to visit several different areas of the hospital. Patients who live further away from the hospital may have also had trouble accessing care in their home communities.

“Now, we can identify and address gaps in care pathways to make sure no one is falling through the cracks,” says Carly, who has worked with trauma patients at Sunnybrook since 2013, first as a student in the inpatient trauma unit and then at St. John’s Rehab.

The clinic, which is the first of its kind in Canada, has booked close to 1,900 appointments over the past year. Carly says that while there are ebbs and flows, no two days are the same.

“Some days I may only have a few patients scheduled, but then one of the occupational therapists identifies a patient who may benefit from physiotherapy during one of their appointments, so I will drop in to do an assessment. Or, I could be called to the inpatient trauma unit to evaluate a patient and help put together their discharge plan. You definitely have to start your day with an open mind,” she says.

As the team celebrates the successes of the clinic’s first year, they’re already looking ahead to the future.

“We’re still growing and figuring out how best to meet the needs of all our patients,” says Carly.

However, one thing she knows for sure is that the collaborative environment of the clinic has made for a seamless experience for patients.

“Our patients are happy knowing that somebody still cares about their recovery, even when the acute care phase of their journey is complete, and we are happy to be able to provide that to them,” she says.

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From left to right: Michael Lewis, case manager, BRAVE; Illana Perlman, social worker, Tory Trauma Program; and Dr. Avery Nathens, surgeon-in-chief at Sunnybrook.

The repeat experience of injuries resulting from gun- or stabbing-related incidents is often the result of unmet social needs.

“We see it time and again where a patient is treated for a minor gunshot wound and then returns with a more severe injury from another shooting incident,” says Dr. Avery Nathens, medical director of Sunnybrook’s Tory Trauma Program. “We have an opportunity to intervene and prevent the second injury that may end – or significantly change – the patient’s life forever.”

Patients who experience the physical and psychological impact of violence can benefit from a hospital-based violence intervention program and approach that incorporates trauma-informed care with traditional medical care. Such programs are proven effective in reducing risk factors and optimizing the outcomes of young people negatively affected by community violence.

The Tory Trauma Program, under Trauma Services Manager Corey Freedman, launched Breaking the Cycle of Violence with Empathy (BRAVE) in October 2020. BRAVE supports people aged 17 to 30 who have been treated for a gun or stabbing injury by connecting them to a case manager to support them through their recovery for approximately six months.

“BRAVE uses the ‘teachable moment’ approach to intervene early and support the patient’s overall physical, social and psychological needs,” says Brandy Tanenbaum, injury prevention coordinator at Sunnybrook, who designed BRAVE based on models out of San Francisco and other U.S. cities.

With shooting incidents in Toronto doubling since 2014 and Sunnybrook seeing a rise in the number of violent injury patients, Dr. Nathens and Tanenbaum recognized an urgent need for this kind of program. A $100,000 grant from the City of Toronto to run BRAVE as a one-year pilot made it possible.

The BRAVE journey begins with patients still in recovery. They are visited by Michael Lewis, the program’s case manager, who brings extensive experience in community youth violence prevention. He is able to develop a rapport with patients and their families who are often looking for additional support, but do not know how to find it. Lewis continues his work after discharge by visiting patients as they continue their recovery in rehab or at home. In these visits, he learns about the patients’ circumstances.

“I get to know the patients as people and understand what their needs and goals are and begin to develop a case plan to implement over time as they are ready,” Lewis says.

Through conversations, Lewis is able to assess patients’ needs and start connecting them and their family with services. Connections can include victim services, peer support, education counselling, mental health and addiction services and more. Most important is the mentorship Lewis provides to the young patients, without the judgment or bias so often experienced by this patient population.

Support can look different for different patients, says Lewis. He recalls one young man with numerous gunshot wounds who was recovering very slowly and kept losing weight. With BRAVE, the patient was supported throughout his physical and psychological recovery. “Now back home and getting stronger, that young man has plans to study engineering,” Lewis adds.

Lewis says his job is to provide an empathetic ear, help people connect to services and nudge them to move ahead with their lives.

“When you meet people in trauma, you often run into patients who’ve been looking to make a change for a long time.”

The post Breaking a dangerous cycle of violent injury through the new BRAVE program appeared first on Your Health Matters.

One morning each month, Sunnybrook’s trauma team receives an urgent emergency page about an incoming patient. It could be someone with a gunshot wound, a brain injury or a major pelvic fracture. They’ve been rushed to the largest trauma centre in Canada to receive life-saving treatment, and it’s all hands on deck. The team’s leader, surgeons, nurses, residents, respiratory therapists and others race to the trauma bay. But when they arrive, they’re not met with a person in serious distress.

Instead, there’s a high-fidelity mannequin on the stretcher. It looks human; however, it’s actually a prop used for simulation-based training. The mannequin can blink. Its pupils dilate. It is linked to a monitor showing its vital signs. It may even have a head wound to prompt the team that a head bleed may be present.

While simulated learning has been practiced for many years at Sunnybrook, the new “in situ” simulations are conducted in the actual trauma bay of the emergency department, rather than in a lab or SIM centre away from everyday equipment and where real trauma patients are treated.

“The element of surprise is important,” says Dr. Luis da Luz, a surgeon, head trauma team leader and a member of Sunnybrook’s trauma research group.

Although the simulation session is always in the morning, when real trauma cases are less common, no one except the simulation organizers know what to expect when they reach the bay. The lesson takes about 30 minutes and the team gathers immediately afterward to debrief and troubleshoot for another 30 minutes. For instance, during the simulation they might discover that their intraosseous insertion kit (for administering medication and fluids directly into bone marrow) was kept locked in a cabinet away from the trauma bed, creating a two-minute delay.

“Two minutes in a life-threatening situation is too long,” says Dr. da Luz. “We’re able to identify problems and resolve them, so the team is more prepared to act when a real trauma comes. That’s the beauty of the thing.”

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Although motorcycle riding can be a dangerous mode of transportation there are many health benefits often overlooked. For instance, riding a motorcycle strengthens key leg muscles, improves core and neck strength, increases calorie burning, and boosts mood. Reducing the risk and severity of injury is key so that you can enjoy these benefits for years to come.

There are many community and provincial interventions related to motorcycle safety including things like education courses, improved road conditions, and distracted driving legislation. One area that drivers are able to control entirely is riding gear. While only a helmet is required by law for riders and passengers in Ontario, there is much more to consider when riding safely.

ATGATT is the acronym for “All The Gear, All The Time”, which means a full set of motorcycle safety gear should be worn at all times. It’s the foundation for safe riding experiences no matter the road or weather conditions. ATGATT refers to the following equipment, each of which has a great deal of variety to meet rider experience, fashion and comfort:

• Helmet – full face protection is best, must be certified.
• Jacket – leather, textile, Kevlar; with padding for spine and elbows.
• Gloves – designed to protect from weather, while allowing for grip. Should come above the wrist bones for protection.
• Boots – comfortable fit, leather or textile, covers above the ankle for protection.
• Pants – leather, denim and textile, help to protect against road rash and burns

There is a lot to think about when riding a motorcycle, but your equipment shouldn’t be one of them. Buy from a reputable dealer and buy the best equipment you can afford. There are beautiful riding routes in Ontario, and a decent season for enjoying the outdoors. Please take a moment to review ATGATT, get geared up, and make your way to the open roads ahead.

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While you may think of them as a safer, more convenient alternative to a traditional wood fire pit, staff members at Sunnybrook’s Ross Tilley Burn Centre have seen a significant number of incidents involving tabletop fire pits that have resulted in devastating injuries.

“We’ve seen way too many people injured while re-fuelling these fire pits. It’s a problem. People really need to take this seriously, and use caution and good judgement every single time,” says Dr. Marc Jeschke, medical director of Sunnybrook’s Ross Tilley Burn Centre.

Below, two of our experts weigh in on how you can safely enjoy a tabletop fire pit as summer winds down.

1. It’s no safer than a regular fire pit

“People make the mistake of considering it safer than a regular fire pit,” says Dr. Jeschke.

Just because the fire goes on a tabletop, has smaller flames and doesn’t need to be regularly stoked with wood, it doesn’t mean you should lower your guard when using a tabletop fire pit.

Remember to closely supervise kids and pets, too. Since the fire is up off the ground, it’s at roughly their height, making it easy for an errant hand or tail to get caught in the flames.

2. Explosions can happen when re-fuelling

Many tabletop fire pits use highly flammable fuels, like butane and ethanol, so be sure to read the operating instructions on how to re-fuel properly.

“Explosions can happen when you try to re-light the fire, because there can still be fumes or low flames that can ignite during the refuelling process,” says Anne Hayward, a social worker at Sunnybrook’s Ross Tilley Burn Centre.

That can cause the re-fuelling container to ignite almost instantaneously, causing it to explode. The person holding the container may also react by throwing it, inadvertently spraying other people at the firepit with burning fuel.

Don’t re-fuel the fire while smoking cigarettes or marijuana either, because that can also cause the fuel to combust.

3. Plan your exit strategy

Tabletop firepits are often placed close to the home, with people gathered very closely around it.

“If something happens, like a projection of fuel from the fuel source, the pathways are blocked and multiple people can be burned,” says Hayward.

People may also have an altered awareness of risk and a slower response time due to use of alcohol, drugs, medications or mobility issues.

4. Enjoy responsibly

Using alcohol or drugs around any type of fire is always a bad idea.

“Maybe someone’s decision-making ability is impaired by drugs or alcohol, or they didn’t stop to think about the potentially dangerous consequences of a situation,” says Dr. Jeschke.

“Don’t be that person.”

5. If a significant burn happens, call 911

While waiting for help to arrive, don’t put butter, vinegar, oil or lemons on the burn.

“The best initial treatment for all burns is cool running water. Don’t soak the injured area, just let the water run over it,” says Dr. Jeschke.

Share this Facebook post to raise awareness:

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“I was at a training facility with a foam pit learning backflips with the motorbike when it fell with all its weight on top of me. I knew right away something wasn’t right.”

Alex was immediately airlifted to Sunnybrook’s trauma centre, and it was determined that he had a critical injury to his spinal cord, mainly at the C6 vertebra. Surgeons took bone from his hip and pelvis to rebuild the C6 and then fused his C5, C6, and C7 vertabrae using metal brackets to restore some stability to his spine. The damage, however, was too great and Alex was an incomplete quadriplegic, meaning he has varying paralysis from the neck down.

He was a patient on Sunnybrook’s trauma ward for about two weeks and was transferred to Lyndhurst Centre where he stayed as an inpatient for five months to learn how to mobilize with the wheelchair and take care of himself.

Through all of the challenges, Alex has not lost his positive outlook on life. He volunteers for Sunnybrook’s P.A.R.T.Y. Program where he shares his story with teens during the school year. He also speaks with groups in many parts of Ontario, and on behalf of the Rick Hansen Foundation.

“Talking about my injury and my journey helps me a lot in my recovery, and hopefully it helps others too. You can’t take all the risk out of life, but if my story makes someone think twice and prevents an injury then I’ve made a difference.”

Alex also regularly volunteers at Sunnybrook’s Veterans Centre, the largest in Canada. His grandfather is a war veteran, and Alex has a great interest in Canada’s military history, particularly World War I and World War II. “I bring coffee around to the vets, and talk with them. We have some great laughs. It’s something that I really enjoy.”

Alex says, “I want people to know that we all have the ability to dig deeper and overcome great difficulties. A positive attitude, perseverance, communication and support are crucial, but what we find and use within ourselves to build these qualities differs from person to person and can change over time. The important thing is to find that inner strength and discover your own method of empowering it so you can keep moving forward. As Churchill said, ‘If you’re going through hell, keep going.’”

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