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m wmmmum plo the tribune wednesday september 13 1989 r trauma centre beats odds on life kate gilderdale correspondent of all the seasons summer is surely the most carefree a time when you can ease up on your responsibilities and have some fun for some unlucky people however its the beginning of a lifelong nightmare as they become yet another statistic in the growing list of healthy in dividuals involved in seriousand often avoidable accidents on the roads at the lake or diving into a backyard pool some of these people will be killed many more will spend the rest of their lives in a wheelchair trying to rebuild their shattered dreams to combat this increasing pro blem staff at sunnybrook medical centre in north york are making a concerted effort to educate people not only on prevention but on how to react when such accidents occur and what to expect if they themselves are personally involved while prevention is the major priority a quick and appropriate reaction when accidents do occur is vital the longer the injured pa tient has to wait for assistance the smaller the chance of a full or partial recovery to that end sunnybrook is one of five metroarea hospitals which participate in the in tegrated trauma program a 24houraday sevendayaweek emergency service to which on tario physicians can refer badly injured patients the program has been in operation since july of this year a call to the central itp number connects doctors to the triage centre located at sun nybrook medical centre where trained staff determine where the patient should be sent in ad dition to sunnybrook torontos hospital for sick children st michaels hospital toronto general and the wellesley hospital participate in the program m r t t m 1 a paramedic unstraps the patient as medical staff at sunnybrook medical centre wait this scene was set up by the hospital for the media to illustrate what happens when there is a trauma case alastair dempster is assistant coordinator of itp he defines a trauma injury as sufficient to be a threat to your good health usually involving more than one body system for instance a chest injury with damage to the lungs and heart sunnybrooks own trauma unit has been in operation since june 1976 and has handled over 3500 patients including 452 in 198889 with annual admissions increas ing at a steady rate patients are brought in from all over the pro vince 25 per cent from within the vicinity of the hospital 10 per cent from other metro hospitals and 65 per cent from outside metro which includes a substan tial number from york and durham regions with time a critical factor the air ambulance plays a vital role in transporting patients from outlying areas or from areas where land access is difficult says air paramedic rob theriault we do about 1200 calls a year out of buttonville airport fiftyfour per cent are trauma patients just over half the accidents involve drinking and driving buttonville is one of five such bases in ontario and each air am bulance helicopter carries all the equipment you would find in photos by rick madonik the air ambulance bandage 1 prepares to land at sunnybrook medical centre paramedics and medical staff at the hospital went through the motions for local media recently to reveal how an emergency trauma case is treated an emergency department but in smaller quantities explains theriault the helicopter will be airborne about four minutes after the team receives a call from the dispatcher notes theriault each carries two paramedics two pilots and a maximum of two patients the first ambulance on the scene is responsible for do ing a rapid assessment to deter mine which patients are more critical and who can wait for a lit tle while in an accident involving speeds of 100 kmh he observes there are three collisions the first in volves the vehicle travelling at 100 kilometres an hour which hits a telephone pole the passengers are also travelling at 100 kilometres they come to an abrupt stop against the steering wheel the third collision in volves internal organs that also continue to travel 100 kilometres an hour until they come to an abrupt stop against the rib cage patients without seat belts sustain significant injuries he emphasizes you can tear blood vessels bruising the heart and brain drinking not only causes accidents but can affect judg ment after the event he says citing the case of two young men who were involved in a single car accident both had been drinking and one was badly injured his buddy left him for several hours before returning when the guy who was left behind decided to move out to get help for himself he severed his spinal cord if help had arrived soon and the patient had stayed where he was he might have recovered fully instead he was paralyzed sunnybrooks acting director of emergency services dr barry mclellan describes the process of treatment for trauma patients as being like a chain with in dividual links its a team ap proach all the way one important link is the system of resuscitation at the first hospital a patient goes to we find that patients receive ex cellent care at the primary hospitals he adds when pa tients arrive at the trauma cen tre theyre placed in the care of a team which includes four physi cians three support nurses an x- ray technician and an attendant for blood work depending on the injuries the patient is then taken for a catscan and either undergoes surgery or is placed in intensive care for special monitoring from there he or she is moved to the appropriate nursing unit specializing in trauma care until being discharged to the home the primary hospital a rehabilita tion unit or longterm care the critical care unit on the seventh floor is for patients who are unable to breathe on their own many of whom are on life support systems the ratio of nurses to patients is one to one and about half are trauma pa tients explains registered nurse lynn riley a critical listing means you dont know if the pa tient will survive or not the neurosurgical intensive care unit is mainly for spinal cord injuries and patients there dont require breathing ap paratus says nursing director elma dinglasson they have some degree of head or spinal cord injury or they have had surgery that involves the head neck or spine each nurse has two patients in her care and its still regarded as a critical care unit diving accidents are the third most common cause of spinal cord injuries and ontario has the second highest number of such incidents in the world after australia victims are usually young 60 per cent are 15 to 30 male 75 per cent and 50 per cent of the accidents are alcohol related willy macleod 34 became part of these grim statistics after diving into a friends pool in midaugust i was diving into the same pool id dived into 300 times before it was a shallow dive into a shallow pool he states i remember from the time i was floating face down in the pool i couldnt turn over i saw kids feet all around me i was taking the mock patient breathes with a manual respirator x 1