Trauma patients benefiting from Toronto Trauma Telemedicine program

Seconds matter when you’re a trauma patient. Thanks to a partnership among St. Michael’s Hospital, Sunnybrook Health Sciences Centre, the Ontario Telemedicine Network, Criticall Ontario and five referring hospitals, patients who wouldn’t usually have immediate access to Level 1 trauma centre care are receiving it via the Toronto Trauma Telemedicine program.

The program, the first of its kind in Canada, began as a pilot project at St. Michael’s Hospital in 2010. Several trauma physicians initially were on call Monday to Friday, 8 a.m. to 5 p.m., for the five referring hospitals — Peterborough Regional Health Centre, South Muskoka Memorial Hospital, Huntsville District Memorial Hospital, Humber River Regional Hospital (both the Finch Street and Church Street sites) and The Scarborough Hospital.

The program was expanded to 24 hours a day, seven days a week, in October 2011 when Sunnybrook trauma physicians came on board. Since then the team has received a couple of consultations per month and expects that to climb to a couple per week this summer.

The goals are to provide expert advice and guidance remotely from Level 1 trauma centre physicians to regional physicians who aren’t as experienced at dealing with trauma patients on a daily basis and to expedite transport of a patient from a regional facility to a trauma centre where they can receive more specialized care.

At St. Michael’s, videoconferencing equipment has been set up in the Emergency Department’s trauma room and on the home computers of four physicians thanks to the Ontario Telemedicine Network. The video equipment can zoom in and out so that physicians can see the whole patient as well as the site of the trauma. No longer are specialists required to be at the bedside to diagnose a patient’s injuries. The team is available to consult on all penetrating trauma and any unstable blunt trauma to patients over 16 years of age.

“This program is a great example of how collaboration within the health-care system can change the way a trauma patient receives immediate treatment,” says Dr. Christopher Hicks, an emergency physician and trauma team leader at St. Michael’s. “Having the ability to see a trauma patient’s injuries via the video equipment in the Emergency or from our home computers, means a trauma specialist can make a crucial diagnosis in real time at any time of the day, versus having the patient wait for test results and a delayed diagnosis.”

When trauma patients are diagnosed immediately they can be transferred to a trauma centre sooner. The team is also available to assist with guiding lifesaving critical interventions.

Researchers at St. Michael’s Hospital have published several papers in peer-reviewed journals about the value of taking critically injured patients directly to a trauma centre, even if another hospital emergency department is closer.

A paper in the June isseue of the Journal of Trauma and Acute Care Surgery reported that people who are seriously injured in a car accident are more than 30 per cent more likely to survive at least 48 hours if they are taken directly to a trauma centre than those who are taken first to a non-trauma centre.

However, fewer than half of people seriously injured in car accidents in Ontario are taken directly from the scene to a trauma centre. In addition, only half of those taken to the nearest hospital are later transferred to a trauma centre after being assessed and stabilized, the paper reported.

Ten physicians from St. Michael’s and Sunnybrook are involved in the trauma telemedicine initiative. The program was made possible through provincial innovation funds from the Ministry of Health and Long-Term Care.

“Having access to trauma specialists at St. Michael’s and Sunnybrook is invaluable,” said Dr. John Ashbourne, an emergency physician and lead for the tele-trauma program at Peterborough Regional Health Centre. “Recently, we received a very unstable patient with a stab wound to the chest and abdomen. Consulting with the team at St. Michael’s meant that we could stabilize the patient sooner, coordinate our care and treatment, and transfer this patient to the specialized trauma centre smoothly and effectively.”

The program is testing a mobile app called Vidyo Mobile that will allow physicians to consult via their ipad from wherever they may be.