A young woman who lost half her blood in a terrifying car crash, and lived. A man with a fractured skull from a simple fall on his stairs. A crack team of nurses, surgeons and specialists on call 24/7. Welcome to the daily drama of the region’s trauma HQ.
It was late on a Thursday afternoon in early December last year. Santanna and her mother-in-law had just finished installing a set of holiday flower arrangements at a client’s house in King Township, near Nobleton, Ont. The pair planned to fit in one more client visit before Santanna met her husband Dan for a dinner date.
As they turned out of the driveway, their truck collided with another car. Though both vehicles were badly damaged, no one was seriously injured. While Santanna waited for the police to turn up, Santanna’s husband and her father-in-law arrived.
About 40 minutes later, without warning, another car cleared the corner, slid on the ice and spun. It was followed by a black truck that swerved to avoid the car. It too struck the ice, hit Santanna and tossed her through the air. The truck then ran over her and dragged Santanna about four metres before it came to rest, with her buried in the snow under its rear wheels.
“The last thing I remember is being underneath the truck and having Dan dig me out. He was crying and freaking out. I said, ‘I love you, and ‘goodbye’,” recalls Santanna. “I didn’t think I was going to make it.”
Santanna owes her survival to a set of coincidences, some quick thinking by an off-duty emergency physician and a first-rate trauma team at Sunnybrook.
The crash took place not far from the home of a pair of Sunnybrook doctors. Dr. Valerie Krym was outside, cleaning snow off the steps of their house when her husband telephoned. He is the Medical Director at ORNGE, the transport medical service provider for the province of Ontario, and was on duty in ORNGE’s Communication Centre that evening. He’d heard about the crash and called home to check on his wife.
By now it was dark. The ORNGE helicopter did not land at the scene because these landings are not safe to do at night, and there wasn’t a nearby helipad or airport available. A land ambulance was dispatched and already en route to the scene.
Dr. Krym, an emergency physician at Sunnybrook, walked to the end of her long driveway. The crash scene was a kilometre away and Dr. Krym’s car was in the shop, but because there were so many emergency vehicles on the scene she decided to walk there.
When Dr. Krym arrived, she saw that Santanna was critically injured—her pelvis and lower legs were crushed and one of the major blood vessels in one of her legs had opened up. Her blood pressure was very low. Sunnybrook was not the closest hospital, but “I knew it was her only chance of survival. She needed a trauma centre,” recalls Dr. Krym. “While we were speeding down the 401, I told the driver to notify Sunnybrook’s trauma team and tell them to be ready and waiting for us in the trauma room for our arrival.”
Santanna’s injuries were so severe, the health care team didn’t think she would live. “The injuries were clearly horrific and life threatening. She’d lost more than half her blood,” says Dr. Doreen Yee, the trauma team leader who directed Santanna’s care that night.
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Sunnybrook’s Tory Regional Trauma Centre provides care for patients suffering from a wide range of traumatic injury from motor vehicle collisions, stabbings and gunshot wounds, cycling and other recreational activities, and falls in the GTA and south central Ontario.
When Sunnybrook receives notice that a trauma is en route, it activates an internal network that draws the on-call trauma team composed of anaesthesiologists, orthopaedic surgeons, general surgeons, neurosurgeons, respiratory therapists and nurses to the trauma centre.
On a Monday afternoon in late February, Heather Mazurenko, a registered nurse, picks up the receiver of the red phone on the nurses’ desk in the emergency department. “How far out are they?” she asks the dispatcher. A screen mounted on a nearby wall has begun to flash. An older man has fallen down the stairs at his home and hit his head. EMS has scored the injury a level 2 out of 5 on the Canadian Triage and Acuity Scale, where 1 is the most severe.
“It’s coded as a trauma, so they’ll come to the nearest trauma centre, which is us. We’ll treat it as such until we know what’s going on,” says Ms. Mazurenko, taking off her glasses. It’s just after 5 p.m. and nearly 10 hours into her shift. As the scheduled Clinical Care Leader, Ms. Mazurenko’s role is to manage the movement of patients through the hospital’s emergency department and its health care staff. “I need to know where everyone is and what beds are available. I run around all day—I’m the rabbit. That’s why I have lunch at 7 p.m.,” she says. When the ambulance is on its way to Sunnybrook she pages the trauma surgical team. Most traumas will reel in seven staff; a major trauma will draw in closer to 10.
At 5:40 p.m. four paramedics wheel the patient stretcher into the trauma room, a large open space with four trauma bays. Metal storage racks stacked with blue boxes stocked with syringes, gloves and other medical supplies line one wall. A low fridge tucked against the opposite wall holds blood. A Kodak Direct View DR 95000 system X-ray machine is suspended from the ceiling.
The man is intubated, hooked up to an intravenous line, sedated and attached to a portable monitor that measures his heart rate, blood pressure and blood oxygen levels. Dr. Paul Engels, the on-call trauma team leader, leans over the table and rubs his knuckles into the centre of the man’s chest.
At the scene of the crash, the man had scored an 11 on the Glasgow Coma Scale, which assesses a patient’s eye, verbal and motor responses following a head injury. The pain response was a good sign, but the patient’s score had dropped to a five, and considered severe. “Pupils are 2, and reactive bilaterally,” says Dr. Engels.
Dr. Sebastian Tomescu, the on-call orthopaedic resident, runs his hands along the man’s legs and flexes his knees and rotates each hip, checking for broken and dislocated bones. He moves quickly, finding no injuries.
The team of seven rolls the man onto his side so that Dr. Tomescu can check his spine. Amidst the chatter, the beeps and the pings, there are the sounds of the patient’s flannel shirt ripping and metal hitting the floor as his belt and pants are dropped. Discarded packaging and medical tape accumulate around the stretcher. A kidney-shaped tray holds the patient’s dentures. They remove the neck brace, staple shut the laceration over the man’s right ear, and roll him back. “Let’s do a chest and a pelvis X-ray,” says Dr. Engels. It’s 5:59 p.m.
Less than 10 minutes later, the room is noticeably calmer and quieter. The trauma team continues to check the patient’s vitals noting the numbers in his chart, and tidy up the tubes and wires that connect him to the IV bags and machines, before he is wheeled a short distance down the hall to the trauma centre’s dedicated CT scanning room.
Ten staff lift the man from the stretcher to the narrow CT table to scan for bleeds and breaks. Dr. Martin Shoichet, a radiologist, spreads his elbows wide and leans on the desk peering at the computer screen in front of him. He spots a crescent-shaped sliver of blood between the brain and the skull. “There’s also a rib fracture, and probably a small hemothorax [blood in the chest cavity], maybe two,” says Dr. Shoichet. Dr. Engels picks up the phone and books an operating room.
Ginny Cosby, a registered nurse on the trauma team, pops into the room to speak to Dr. Engels. “I’ve told the family he’s critical and that you’ll come to see them. I put them in the family room. They’re a little anxious,” she says.
A minute later, Ms. Mazurenko leans into the room, phone tucked under her ear. “I’ve got an OR,” she says. The trauma team stops the scan and moves the patient onto the elevator to take him up to an operating room. It’s 6:51 p.m.
Back at the nursing station in the Emergency Department, staff dressed in jackets and carrying coffee begin streaming in and study a large white board to find their assignment for the night. There are two minutes left in Ms. Mazurenko’s shift and she has yet to eat her lunch. The red phone rings. She picks it up. “Tell me, what’s on the ticket?” she asks.
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Santanna’s heart stopped while she was in the CT scanner. “When people’s hearts stop because of blood loss, it is not easy to get them back,” says Dr. Yee. The team did CPR and gave Santanna epinephrine to keep her alive and rush her up to the OR. “I had an excellent trauma team that night, we were a well-oiled machine,” she says. “Dr. Krym made a good decision to bring Santanna to Sunnybrook and not waste time going to one of the smaller hospitals that might not have had the resources to help her,” says Dr. Yee.
Santanna’s pelvis was crushed. The doctors amputated her left leg above the knee and performed a through-the-knee amputation on her right leg. But she is alive. Three months after the accident, Santanna remains in a rehabilitation hospital receiving occupational and physical therapy daily. “My goal is to get my prosthetic legs, so I can get back on my horses. I miss my animals so much,” she says. Santanna’s other goal is to have a helipad built in the Nobleton region so that other trauma victims don’t face the same risks she did. “If it wasn’t for Dr. Krym, I wouldn’t be here,” says Santanna.
Published in the Globe and Mail as a special informational supplement on Sunnybrook.
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