As Ontario prepares for another long weekend, and for the tragic car accidents that stain each of them, public health officials warn the trauma care system needs to be better organized to help those patients and others with serious injuries.
Dr. Avery Nathens, the trauma director at St. Michael's Hospital in Toronto, recently commissioned a poll to promote the value of trauma centre care, draw attention to current shortcomings, and help the public understand the resources the province has and how it might better allocate them.
The poll's results, to be released Friday, show that 40 per cent of respondents believe that, within an hour of calling 911, they can access a trauma centre, where care is generally considered to be much more effective for the critically injured.
But there is no certainty that would transpire, Dr. Nathens said, adding that reaching a trauma centre in that "golden hour" might mean the difference between life and death. To literally add insult to injury, 62 per cent of seriously wounded adults in Ontario are taken first to their closest hospital and 69 per cent are never transferred to a trauma centre.
"In Ontario, we have certain ingredients of a system, we have trauma centres, but we really haven't organized everything around those centres to ensure that the right patient gets to the right place at the right time," he said.
According to Dr. Nathens, the answer isn't necessarily building more trauma centres, of which there are 11 in the province. Instead, he said, the way forward involves training staff at smaller community hospitals so that their facilities are better prepared to receive patients and move them quickly to trauma centres as needed.
He also said it's important for doctors and health officials to better use the data that already exist for system improvement.
"We have no understanding of how long it takes to get to trauma care anywhere in the province," he said. "We don't know if centres are doing it well or if centres are doing it poorly and because patients can't make these decisions themselves, the system has to be accountable."
In a 2006 study published in The New England Journal of Medicine, Dr. Nathens and his colleagues show that, when care was provided at a trauma centre, the overall risk of death for a severely injured person was 25 per cent lower than when care was provided at a non-trauma centre.
According to Sunnybrook-Osler's Field Trauma Triage Guidelines, patients should be taken to a trauma centre if they meet any of a series of anatomical or physiological criteria. Anatomical criteria include paraplegia or quadriplegia, and penetrating trauma to the head, neck, trunk, or groin. Physiological criteria include altered level of awareness or consciousness, and abnormalities in heart rate, blood pressure or respiratory rate.
Unless there are mitigating circumstances, EMS should not spend more than 10 minutes on the scene, the document states. Transport time should be less than 30 minutes and, if that is exceeded, the guidelines say the patient should be taken to the nearest hospital despite the severity of their injury.
According to Peter Macintyre, a spokesperson for Toronto EMS, serious traffic accidents happen every long weekend. "People get anxious driving to the cottage, driving somewhere," he said. "They're not paying attention or they're driving too fast or they're impaired."
Sergeant Dave Woodford, a spokesperson for the OPP's highway safety division, said there were nine fatalities on OPP-patrolled highways on Canada Day weekend this year. Five people died in traffic accidents over the August 1, 2010 long weekend and, in total, there were 31 deaths on OPP-patrolled highways over the five long weekends last year.
To prepare for the upcoming long weekend, Sergeant Woodford said the OPP is bringing in more officers to look out for "the big four" – aggressive driving, impaired driving, distracted driving, and seatbelt use.
In its 2011 report, the Ontario Trauma Registry said car accidents, unintentional falls and injuries purposefully inflicted by other people were the leading causes of trauma.
Conducted by Pollara Strategic Insights between March 23 and April 9, the poll was a telephone survey of randomly selected Ontarians. One thousand people participated. To ensure a representative sample of Ontario adults, responses were weighted according to census data. Craig Worden, Polara's public affairs senior vice president, estimated the response rate at 20 per cent. The margin of error was calculated at plus or minus 3.1 per cent.