Critically-injured patients who arrive at Sunnybrook Health Sciences Centre's trauma unit benefit from lessons learned in military combat.
Dr. Homer Tien is one of the trauma surgeons bringing the most up-to-date lifesaving measures to both military and civilian patients. He is the medical director of the Tory Regional Trauma Centre at Sunnybrook and a colonel in the Canadian military. He has treated soldiers in war zones in former Yugoslavia, the Golan Heights, Southeast Asia, and Afghanistan.
"There are many synergies between working in the military and working in trauma care at Sunnybrook. In going over to war zones, civilian trauma helps train us. And there are different things you can bring back from war," says Dr. Tien.
Trauma protocols are similar whether a patient has been in a car crash and is arriving by helicopter to Sunnybrook's state-of-the-art trauma centre, or has been shot in the abdomen and is carried in a military vehicle to the hospital at Kandahar airfield. The first order of business, says Dr. Tien, is usually to find out where the bleeding is coming from, stop it, and transfuse the patient with new blood.
"There are similarities in the things that kill people, the two main ones being bleeding to death and catastrophic brain injury. We try to treat those very, very quickly and then deal with broken bones and soft tissue injuries afterwards."
In Afghanistan, Canadian surgeons learned lessons they brought back to civilian trauma care. One is that in cases of catastrophic bleeding, when a patient is receiving a blood transfusion, it is better to give more plasma than previously thought, as this improves survival. Another is that tourniquets – which had gone out of favour in medical circles – in fact save lives, especially if applied before shock sets in. "In war, we found that if someone's leg was blown off and you didn't apply a tourniquet, they would bleed to death. In civilian trauma, we are using tourniquets more and more for severe injuries to the extremities," says Dr. Tien.
The synergy between Sunnybrook and the military extends to research as well. "The Canadian and U.S. military have repeatedly turned to Sunnybrook to help conduct research into how to stop and control bleeding," says Dr. Tien. The knowledge is applied to saving lives, both military and civilian.
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