Pamela Meyer, patient care manager of the CICU, says, “The staff in the CICU are very enthusiastic and committed to this research initiative. It is giving us an opportunity to share our knowledge and expertise with others, as well as make a difference in the recovery and outcomes of these patients’ lives.“
“One of the reasons I knew I wanted to be a part of the PACT research project was a case we had a while ago in the CICU,” says Sandra. “A young woman who had had an out-of-hospital arrest came in, and because of the cooling techniques we implemented she survived and had a good outcome. Later she came back to the unit with her children to say thank you. It showed me just how powerful and necessary this research is. I really believe in this work, and it is extremely validating to see everyone work together to make it happen.” •
THE EMERGENCY MANAGER
THE ER ON WHEELS
For Patrick Auger, SARS was not only a crisis, but also the impetus to make a major career change. As a critical care flight paramedic, Patrick was already immersed in health care. But when the province got hit with the severe acute respiratory syndrome crisis in 2003, “it was a huge learning curve,” he says. “SARS really identified that we needed a group of specially trained experts who could work in situations never encountered before.”
In 2006, Patrick earned his Masters in Emergency Management and later took on a new role: Incident Commander with Ontario’s Emergency Medical Assistance Team (EMAT), which is operated by Sunnybrook and the Sunnybrook Centre for Pre-Hospital Medicine. Referred to by many as a “hospital on wheels,” EMAT is a first-of-its-kind mobile medical field unit that can be deployed anywhere in Ontario. Since EMAT’s inception post-SARS, Patrick has been involved in four deployments – including an e-coli evacuation, two fires and the G8 Summit – and 12 training exercises.
EMAT has been able to recruit a group of experts in their respective fields.
Patrick’s role in this multidisciplinary, 150-member team could arguably be the most challenging: making sure everything runs smoothly. Patrick says the devil is always in the details. “We have fuel systems, oxygen systems, ventilation and telecommunications. We’ve deployed full-scale training exercises in minus-25-degree weather, so you have to make sure all the doctors have warm coats. The little things add up to a lot.” Thanks to Patrick’s expertise, EMAT can set up a 56-bed unit that provides a staging and triage base within 24 hours anywhere in the province with road access.
EMAT’s latest deployment in July included a 20-hour drive to Thunder Bay to assist with evacuees from fire-threatened communities in northwestern Ontario. “You get that phone call and you have to get things moving,” he says. Sixteen-hour work days are normal during deployment, fed largely by adrenaline and the desire to do good work. "While these situations don’t happen very often, we are there when they do and can make a tremendous difference. It’s all very satisfying.” •
THE BUG BUSTER
A GUT CHECK FOR C. DIFFICILE
Infection from C. difficile is one of the most common found in hospitals and long-term care homes. Most often, the bowel-damaging bacteria grow in patients who have taken antibiotics.
“The vast majority of patients with C. difficile have had some antibiotic exposure in the weeks leading up to their infection,” says Dr. Nick Daneman (above), an infectious diseases physician at Sunnybrook and scientist in clinical epidemiology at Sunnybrook Research Institute. “Any discussion around antibiotic-resistant organisms has two problems we need to deal with–transmission of these bacteria between patients or health care workers, and overuse or inappropriate use of antibiotics in hospitals.”
There are an estimated 220,000 cases of hospital-acquired infections in Canada each year. When a person takes an antibiotic, a natural selection process is launched, through which non-drug-resistant bacteria are killed off, leaving drug-resistant bacteria to multiply and emerge as the dominant strain inside the body.
“Organisms adapt to survive and we’re giving them pressure from the antibiotics to pick up new ways to overcome these treatments,” says Dr. Daneman, who is also the physician lead of Sunnybrook’s antimicrobial stewardship program, initiated two years ago in the hospital’s intensive care units (ICUs). The program involves collaboration between the hospital’s pharmacists and critical care staff to monitor antibiotic prescriptions in ICUs to reduce their use. Over one year, the ICUs saw a 21 per cent decrease in broad-spectrum antibiotic use, which was associated with a 30 per cent decline in C. difficile infections.