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Colonel, trauma physician and military mentor Dr. Homer Tien

©Tim Fraser, 2012

Lt. Trevor Greene doesn't know Dr. Homer Tien.

He knows Dr. Tien was at the Kandahar Base Hospital on March 4, 2006. He knows Dr. Tien prepped the trauma team when word spread that Trevor, on his first tour in Afghanistan, was en route to the base with a severe head injury. And he knows Dr. Tien stabilized him and stopped the bleeding.

Trevor doesn't know Dr. Tien, but he knows he saved his life.

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A soldier’s story

It was Trevor's 50th day in Afghanistan. A Taliban-influenced teenager attacked him with an axe, leaving a three-inch gash in his brain. In the Kandahar Base Hospital, Col. (then Major) Homer Tien, a Sunnybrook trauma surgeon who was also on his first tour in Afghanistan, received word a casualty was on the way. It was a surgical priority, though details were unclear.

When Trevor, bleeding profusely, arrived with combat medics, it was clear he had a significant injury to his head. "In the trauma bay, the priority was to secure an airway, and so he was intubated and resuscitated, as he had bled quite a bit and was in shock," Dr. Tien recalls. "We then took him to the operating room to stop the bleeding from the injury. We did this, and bandaged up his head. His vitals stabilized, but his level of consciousness was still low."

Dr. Tien and the team decided it best to have Trevor airlifted to Germany, where American neurosurgeons would assess him. There, he underwent surgery, and was later transported home to British Columbia, where he began his long road to recovery.

Of course, Trevor doesn't remember the attack. With his wife, Debbie, he's been retracing the events of that day. He learned it was Dr. Tien in charge of the trauma team that day in the hospital.

"He kept me alive," Trevor says.

A doctor's story

Dr. Tien says he didn't join the Canadian military because of any grand ambition. "Embarrassingly enough, 20 years ago, I joined to pay for medical school," he says. At first, there was adventure, like parachuting and diving. But what really drew him in was the leadership training the military provided. "As a medical student, you don't really get formal leadership training," he says. "It's intriguing to be in a position as, say, a 25-year-old – which I was in Yugoslavia – and a medical platoon commander. I was the captain in charge of 40 medics. That, in itself, is quite the life experience for me. It wasn't just about how to treat a sprained ankle."

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Now, two decades and many tours later, the colonel is the national practice leader in trauma for the Canadian Forces and medical director of Sunnybrook's Tory Regional Trauma Centre. He was also recently a script advisor for the Global TV drama series Combat Hospital.

Leadership training has continued to serve him well. As national practice leader, he advises the Surgeon General of the Canadian Forces on issues surrounding trauma care, such as which trauma protocol should be used in a given situation or care for critically injured patients. As a result, Dr. Tien has witnessed – and brought about – many changes in combat care. He recently spearheaded a supplement in the Canadian Journal of Surgery, examining "Lessons learned from the Afghan war." His research focuses on establishing and validating the guidelines soldiers use in caring for trauma patients on the battlefield as well as improving hospital-based care. "We are trying to always improve how we care for injured soldiers before they get to the hospital, because, if they are going to die, most die before they get to hospital," he says.

Bleeding is probably the leading preventable cause of death for the military, Dr. Tien says. While traditional civilian trauma medicine has not advocated tourniquet use, Dr. Tien's research has helped validate the use of tourniquets for the Canadian Forces. "It's most people's opinion that tourniquets on the battlefield have saved many lives," he says.

Other research is focused on bleeding control once at the hospital. Dr. Tien has been working with Sunnybrook surgeon and researcher Dr. Sandro Rizoli to come up with different ways to diagnose clotting problems more quickly. "One of the things we know is that as both a reaction to the initial trauma and a consequence of the initial resuscitation, patients' blood becomes thinner and so they are not able to clot as well," Dr. Tien says. "If they are already bleeding and they aren't able to clot properly, it becomes a big problem to stop the ongoing bleeding." Dr. Rizoli, with Dr. Tien, has conducted the world's first randomized controlled trial looking at a novel way of treating this clotting disorder, called coagulopathy, in bleeding trauma patients.

In December 2011, Dr. Tien was honoured with the Order of Military Merit, awarded by the Governor General of Canada to Canadian Forces members who have demonstrated outstanding dedication and devotion beyond the call of duty. Now in his role as medical director of trauma at Sunnybrook, Dr. Tien helps prepare his brothers- and sisters-in-arms who want to follow in his footsteps.

A recruit's story

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Andrew Beckett dropped out of high school. At 18, he joined the army as a medical assistant, or combat medic. When he was 22, Andrew went to Yugoslavia on his first rotation. "That's where the idea got planted," says Dr. Beckett, now 42. "I started making plans to go back to school. The army offered to sponsor my surgical training and then bring me back in as one of their surgeons," he recalls. "So, I took that opportunity, and with the help of Dr. Homer Tien, I did my trauma fellowship at Sunnybrook, and here I am today."

Sunnybrook has trained three Canadian Forces surgeons in the past few years as well as Canadian Forces family physicians and nurses. "It was an amazing clinical experience with lots of really interesting cases," Dr. Beckett says. "Seeing up to 11 trauma cases a day really prepared me for Afghanistan."

In late 2011, Dr. Beckett completed his second tour there, this time as a member of Operation Attention, in which Canadian troops advise Afghan physicians and surgeons on providing better health care for their soldiers and the soldiers' dependants. Each day, he'd leave the NATO compound, armed with a pistol for his own protection, and head to the National Afghan Army base hospital. "We wouldn't take over operative procedures; we are just advising them on how to get better results for their patients," Dr. Beckett says. "It's quite different from Kandahar, where we were supporting our own coalitions' combat operations. In Kandahar, we'd be providing first-world care in the middle of a battlefield."

Dr. Beckett credits Sunnybrook research for changes he's seen in combat care. "I think definitely some of the research we've done at Sunnybrook has made a positive impact on the way casualties are treated in the field," he says. For instance, both Drs. Beckett and Tien were involved in a trial that examined the placement of needles decompressing trapped air around collapsed lungs. The study resulted in guidelines about needle placement and new protocols adopted by both the Canadian and United States' militaries.

Dr. Beckett recently returned to Sunnybrook to begin a fellowship in critical care. "Homer Tien has been a real role model for me in terms of doing research about your clinical practice as well as writing about it – record and report what we are doing," Dr. Beckett says.

Trevor's story

Last year, Trevor married his wife Debbie, who has stood by his side with their daughter Grace, 6, throughout this ordeal. The pair has written a book titled March 4 about the day Trevor was attacked, and about his remarkable recovery. They've also started a charitable foundation that will help women in conflict zones get access to education and teacher training. "We need a generation to grow up at peace," Trevor says.

Dr. Tien says it's stories like Trevor's that keep him in uniform. "For me, the story of his ongoing recovery is inspirational, and I greatly admire his courage for deploying in the first place," Dr. Tien says. "More importantly, though, I admire the courage and tenacity he has displayed in overcoming the adversity resulting from his injuries. It reminds me why I still serve in uniform, to support our fighting front-line troops."

Trevor says Dr. Tien and other military doctors perform miracles each day. "They put themselves at personal danger to save our soldiers' lives," Trevor says. "They would die if it weren't for people like Dr. Tien." Trevor and Debbie look forward to the day they can thank Dr. Tien face-to-face. For now, they express their gratitude from across the country about the day that will forever link them. Says Trevor: "On behalf of all wounded soldiers and their families, I would like to thank him for his dedication and devotion to duty."

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