Timely two day medical course helps ensure trauma room success

By Tracey Richardson

It was early evening in May this year — a weeknight — at the tiny Lion’s Head Hospital on the Bruce Peninsula. The day had been warm, 20 degrees, with a heat wave right around the corner, but still too early in the season for the waves of tourists gliding up and down Highway 6, heading to the national park or Tobermory and the Chi-cheemaun ferry.

There was nothing to suggest it would be an atypical shift in the emergency department for the one nurse and the RPN on duty, while the doctor, Dr. Jonathan Thomas, slipped home to eat dinner with his family. Nothing except for the unending sirens suddenly piercing the air.


RN Dana Fries wondered if something was up, but it wasn’t until an ambulance roared up to the back doors that she sprang into action. And quickly realized that what she had on her hands was no broken ankle or chest pain complaint.

On the stretcher was an adult male patient in critical condition after an ATV crash. Fries knew immediately she’d need all the resources at her disposal — her RPN, Margaret Thompson, the doctor, and the on-call X-Ray technician. ORNGE too, and whatever help she could get from the paramedics and even the police. All would be pressed into action.

Without the ability to intubate, without a CT scan or MRI, with no other doctors to call upon and the regional hospital – Grey Bruce Health Services Owen Sound Hospital – more than 65 kilometres away, Fries and Thomas were limited. What wasn’t limited was their determination that night to save a life.

With the patient hemorrhaging blood and his breathing compromised, Thomas and Fries got to work on the basics — circulation, airway, breathing. A laryngeal mask airway, two separate chest tubes, blood transfusions. Even then, the patient was barely hanging on as ORNGE rushed to the scene and police officers tag teamed to Grey Bruce Health Services Wiarton Hospital to retrieve blood for the patient.

“A lot of mistakes happen when you try to do more than that early on,” Thomas said of their treatment plan that night. “You’ve really got to stick to the fundamentals.”

Following that standardized approach helped them to “stay organized, to compartmentalize,” he said, “especially when we don’t have a giant team or different parts of the team attending to different parts of the case.”

And if they’d had a large team at their disposal? Thomas insists the same protocols would have been followed for stabilizing the patient. “If this had been at a Level 1 Trauma Centre like Sunnybrook, the treatment would have been no different. Again, you stick to the basics.”

They knew the patient had catastrophic injuries, even though at the time it wasn’t known how bad. “Basically, any one of his injuries could have and should have killed him,” said Thomas. The patient, who is still recovering, had suffered a ruptured spleen, a ruptured diaphragm, lacerated liver, lacerated aorta, a perforated bowel, and his stomach was in his chest wall.

When Thomas and his team later discovered the extent of the man’s injuries, and better yet, his positive prognosis, “to be honest, it was pride at that point.”

For Fries, a nurse for 18 years, “it’s one of those things where all your education paid off, the training and everything. Makes you proud of your career choice.  And proud of our little facility, proud of our physicians, our team.”

Thomas likes to call it “frontier medicine. We’re just used to not having the same resources as elsewhere, so we just take care of it. It may not be a perfect solution, but we’ll come up with a solution that’s workable.”

Both health care professionals credit teamwork as the key to success in such a small emergency department. The Lion’s Head Hospital is a four-bed facility with a 24-hour ED, one of the six hospitals under the Grey Bruce Health Services umbrella, and one of the smallest in Ontario.

“In a situation like (the one in May), we need the team,” Thomas said. “If I was on the hook as the sole leader who’s making (all) the choices, that (patient) would have died, for sure.”

It’s the isolation of the hospital that promotes that much needed teamwork, Thomas says, because “it promotes self-reliance, and that drives the necessary teamwork.”

A timely two-day rural emergency medicine course on the Bruce Peninsula just two months before May’s incident also played a critical role in the successful outcome, Fries and Thomas said. The CARE Course (Comprehensive Approaches To Rural Emergencies) is designed for small rural hospitals where generalists (family physicians), nurses and paramedics tend to medical emergencies without the support of a large, specially trained team.  “It was excellent and it certainly did help us in this scenario,” Fries said.

 

The course originated in British Columbia and offers healthcare providers working in isolated areas opportunities to hone their emergency response skills in simulated emergency situations.  It was the first time the course had been offered in Ontario, and dozens of nurses, doctors, and EMS on the Bruce Peninsula participated.  The course is being piloted as part of a rural medicine initiative of the Ontario College of Family Physicians’ Collaborative Mentoring Networks.

Thomas called May’s incident “a once-in-ten-years case for us.” But it’s one he and the team were better prepared for than at any other time, he said. “I feel to a certain extent that we’ve been preparing for that case for years. We’ve been slowly, slowly learning little bits and pieces here. …We’re more prepared now than we were five years ago.”

Tracey Richardson works in communications at Lion’s Head Hospital.