Car-crash victim Sarah Ginn was given the last rites. Then Sunnybrook’s trauma team set to work.
In real life, trauma care isn’t as sexy as it is portrayed on television. It’s all about pre-planning and readiness. After a car crash or a gun battle, lives are saved when medical personnel perform well-rehearsed procedures, with the best tools and research at their fingertips.
Because it’s about process and touch rather than technology, trauma care is a fundraising underdog, says Dr. Gordon Rubenfeld, chief of trauma, emergency and critical care (TECC) at Sunnybrook Health Sciences Centre. “It is so much cooler to talk about a new robot. But the fact is, providing rapid, coordinated care saves lives in Ontario all the time.”
The Tory Regional Trauma Centre at Sunnybrook is Canada’s first and largest trauma centre, caring for about 1,250 seriously injured patients a year. Many of the people who get put back together there are young: Trauma is the number one cause of death and disability in young adults up to age 44.
“Many people know someone who was involved in a car accident or traumatic event. But a lot of people don’t know what it took to pull them through and get them back to health,” says Dr. Rubenfeld.
What it takes is preparedness – 24/7. Mass casualties such as the Boston bombings bring trauma care into the spotlight but “those are very rare,” says Dr. Rubenfeld. “Car crashes and falls occur every single day. It’s not mass shootings that keep me up at night. It’s a much more common scenario, such as someone crossing the street at dusk wearing dark clothes, and getting hit. That’s how our day starts and ends.”
Common injuries include long bone and pelvic fractures, spinal cord injuries, brain injury, acute lung injuries, lacerations, bruises and bleeding from the spleen or another organ.
Dr. Rubenfeld talks us through what happens when there is a “code” or emergency call, which happens three or four times a day on average. “Everyone’s beeper goes off. We assemble and wait for the patient or patients to arrive at the hospital.” The trauma team consists of a lead physician, as well as experts in trauma surgery, orthopedics, neurosurgery and anesthesiology, imaging, nursing and blood bank coordination.
Sunnybrook has a huge room called a trauma bay that contains all the space and equipment necessary to deal with life-threatening emergencies. “We descend on the patient,” says Dr. Rubenfeld. “Very quickly the team sets up I.V.s, monitors, a blood transfusion, a breathing tube, taking X-rays at the same time. We’re buying time to get them to the operating room.”
Sarah Ginn calls Sunnybrook “the hospital that saved my life.” At age 22, she was airlifted by helicopter to the hospital, unconscious and clinging to life. She had been in a car with her boyfriend and her sister, heading to a cottage in the Kawarthas, when suddenly a man in his late 60s driving an oncoming vehicle lost control of his car and hit them head-on.
Several of Sarah’s injuries were life-threatening: Her lungs had collapsed, her liver was cut in half, and her brain was bleeding.
Doctors in the trauma bay swung into action, cutting open her stomach to reattach her liver, reinflating her lungs, inserting a feeding tube and removing part of the left side of her skull to relieve the pressure. When her mother, Eveline, arrived at the hospital, Sarah’s face and head were so swollen that she couldn’t see her daughter’s eyes, nose or mouth. Sarah had no brain activity in her brain stem. A priest was called and Sarah was read her last rites. She lay in a coma for six weeks.
The need to simultaneously cut open a patient’s skull and abdomen to save their life is an eventuality the trauma team has to be ready for at all times, says Dr. Homer Tien, medical director of the trauma centre. “We need to have everything prepositioned. We can’t scramble ad hoc.”
When Sarah woke up from her coma, she couldn’t talk or move her eyes. About two months after the crash, her parents had still received no recognition from her. One day Eveline said “I love you,” and Sarah moved her mouth in response, silently echoing the words. Her daughter was coming back to life.
Sarah then had to learn everything again: from toilet training to walking, talking, and swallowing. “We started from scratch,” says Eveline. Sarah lived at Sunnybrook for three months.
The Ginns have lost track of the number of surgeries Sarah’s had in the ensuing 10 years – at least 16 – as well as countless hours of speech, cognitive, occupational and physical therapy. She is legally blind, able to see out only of a small area of her upper right eye. Due to brain injury, she’s unable to taste or smell and also has some long-term cognitive and memory loss.
She feels blessed and grateful to be alive. “I know I wouldn’t be here today if it wasn’t for the doctors and nurses at Sunnybrook,” says Sarah. “I love so many of them. When I walk into the hospital I get goose bumps. There is no way of thanking them enough for what they did.”
Sunnybrook also gave her a second gift – an opportunity to talk about her ordeal and help prevent similar crashes. She speaks twice a week for the P.A.R.T.Y Program (Prevent Alcohol and Risk-Related Trauma in Youth), warning high school students of the kinds of traumatic injuries that can occur.
The trauma centre is planning some major initiatives, including:
- Creation of a “trauma centre without walls”, where doctors will have immediate access across disciplines to other specialists, patient data and research.
- A helipad on the hospital’s roof to greatly reduce transfer times.
- An Injury Control Centre to help prevent traumatic injuries. It will bring together traffic engineers, epidemiologists, road designers, car designers, surgeons and government representatives. Doctors at Sunnybrook are very passionate about preventing the injuries and violence that cause trauma, says Dr. Rubenfeld. “Trauma surgeons would really like to work ourselves out of a job.”
- A virtual post-trauma clinic that helps trauma survivors like Sarah and their families deal with the physical, emotional, cognitive and financial challenges of trauma by connecting them with community support.
- A critical care centre to house all critically-ill patients in one state-of-the-art location.
Trauma patients depend not just on the best doctors, but also the best processes, unsexy as they may be. “It’s beyond talent,” says Sarah. “It’s saving lives.”