Trauma

The Montreal Children's Hospital (MCH) of the McGill University Health Centre is a provincially designated Pediatric and Adolescent Trauma Centre, a Neurotrauma Centre of Expertise, and an important player in the provincial trauma network. The hospital is dedicated to its trauma mandate with a well-developed Emergency Trauma Response system, a commitment to making the Pediatric Intensive Care Unit (PICU) accessible, and a variety of innovative inpatient and outpatient programs. Rapid access to expert medical, surgical, nursing, rehabilitation and psychosocial trauma care, state-of-the-art equipment, and a well-developed efficient and innovative trauma care system is paramount to increasing the chances of a positive outcome.

 

 

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About us

MCH Trauma Centre, MUHC

Trauma is a leading cause of death and disability in children and teens. Trauma by its very nature is often sudden, life altering, and can be devastating. Rapid access to expert medical, surgical, nursing, rehabilitation and psychosocial trauma care, state of the art equipment, and a mature, efficient, innovative trauma care system is paramount in increasing the chances of a positive outcome for the patient and family. At the MCH the approach to trauma care is inter-professional and involves the interplay and close collaboration of 30 departments and services. Trauma impacts not only on the patient but their family, friends, and community. Our approach encourages everyone to work together to meet the multi-faceted, complex needs of the children, teens as well as their families. This practice takes place from the patient’s initial arrival in the ER through the critical care phases, early rehabilitation and recovery stages and eventual transfer to an appropriate Rehabilitation Centre, community resource or return home with comprehensive coordinated follow-up.

Every year more than 16,000 children and teens are treated in our Emergency Department for ]raumatic injuries. Annually 300-350 patients sustain moderate to severe injuries, requiring hospitalization and the timely interventions of our many trauma specialists. We take great pride in being a supra-regional provincially designated Tertiary Care Level Trauma Centre and a Neurotrauma Centre of Expertise, and in the 5 inter-professional clinical programs: Neurotrauma; Trauma; Burn Trauma; Mild Traumatic Brain Injury; and Trauma Team Leader. We provide comprehensive, individualized and specialized care. All programs are closely linked to our Trauma Education and Research Program. Additionally our Injury Prevention Program acknowledged for its leadership and knowledge sharing is intricately involved in public awareness, education, and advocacy. Our Trauma Centre enjoys a collaborative professional relationship with the local and national media, and along with being closely affiliated with the Canadian Hospitals Injury Reporting and Prevention Program facilitates the diffusion and provision of timely expertise and alerts.

In addition to our acute care programs we work closely with regional centres and community physicians following thousands of ambulatory patients annually in specialized clinics. The MCH inter-professional Concussion Clinic was cited by the MSSS and INESSS as the model for care in Quebec.

Our Trauma Research Program enables us to develop, evaluate and share our knowledge in numerous initiatives including multi-centre projects, publications in peer reviewed journals, and participation in national and international conferences. Clinical and academic teaching is also an important aspect of our mandate. Many program members hold university appointments and are regularly involved in the education of trainees from a wide variety of healthcare professions, and participate in regional, national and international forums and conferences. A year-round credited Trauma Rounds Educational Series is also available to trauma network partners. Mock traumas, journal clubs, and simulated training offer many opportunities to maintain and further develop expertise. The MCH Trauma Centre has many collaborative partnerships, transfer agreements, and ententes with different stakeholders in the provincial and national Trauma Networks, the RUIS and supra-regional community. Included are: adult trauma centres, regional centres, SAAQ, community physicians, INESSS, other governing bodies, Health Canada, schools, sports associations, and many others. Developing partnerships with community organizations is an excellent way to share expertise. This enables others involved in first line care to be conduits of important information on trauma and injury prevention. It also allows for a better understanding of the needs of the population, and facilitates the development of collaborative ventures.

Although our main priority as a Trauma Centre is clinical care, many of our initiatives enhance our ability to provide: timely expertise, fulfill our global trauma mandate, position us as leaders in the field of pediatric and adolescent trauma, and make us unique.

Mandate

Provide comprehensive, patient and family focused tertiary level interprofessional trauma care for all types and severities of trauma. Expertise spans from the acute, sub-acute and through the early rehabilitation phases. This includes excellence in trauma care; clinical and academic teaching; injury prevention and public awareness; education; research; community outreach; networking; and advocating for the needs of Quebec children and adolescents at a local, regional, provincial and Canada wide level.

Mission

  • To provide excellent trauma care
  • To maintain a high level of expertise
  • To ensure rapid accessibility for all patients to the MCH Trauma services
  • To assist patients and their families in understanding the impact of the injury and the expected course
  • To assist children and teens in achieving their maximum functional potential during the early stages of recovery
  • To provide coordinated patient-focused care in conjunction with other institutions in the healthcare consortium in order to assure timely continuum of care
  • To provide academic teaching and clinical training
  • To be leaders in pediatric and adolescent trauma research
  • To monitor trends and play a leadership role in the development of strategies for targeted injury prevention, public awareness, advocacy and lobbying
  • To be available as an expert community resource and develop strategic alliances with others sharing a common goal in advocating for the needs of the children and teens of Quebec

 History: Montreal Children’s Hospital Trauma Centre

 

 

1989:    

  • Developed 1st inter-professional Pediatric Neurotrauma Program in Quebec and Canada. Included all types and severity of Neurotrauma. Model for future Trauma Programs.

 

1993:   

  •   1st Provincial designation as a Pediatric and Adolescent Trauma Centre (1997, 2001, 2008, 2012).

 

1997:  

  •    Developed comprehensive approach to concussion management.

 

2000:    

  • Re-organized and expanded Trauma mandate to include all types and severities of trauma under one inter-professional program, bringing together the medical, surgical, nursing, rehabilitation, and psychosocial aspects of trauma care.
  • Developed hospital-wide clinical protocols for management of assorted trauma.
  • Developed assorted educational materials for diffusion with community partners.    

 

2001:    

  • MSSS designation Neurotrauma Centre of Expertise.
  • Development of numerous protocols to standardize trauma care.        
  • Teaching of Medical and Allied Health trainees on assorted Trauma topics.
  • Trauma Rounds Educational Series (Inter-professional)

 

2002:    

  • Expanded developed Burn Trauma Program (introduced new Rx, ambulatory shift).                         
  • 1st Trauma Centre in Canada to report rise in concussions in minor Hockey.
  • Diffusion of timely trauma and injury prevention information to media.
  • Implementation of early hip spica for femur#; ambulatory shift.

 

2006:    

  • Expanded Injury Prevention Mandate – Program status.
  • Re-organized & developed Multi-level Emergency Trauma Response System.
  • Implementation of Inter-professional Trauma Activation Quality Review Process.
  • Development of ECMO Program

 

2007:    

  • Certified as a WHO health promoting hospital.
  • Developed MTBI and Return to Sports Program; ambulatory shift.
  • Launched the 1st edition Concussion KiT, educational resources online.                                
  • Expanded Trauma Research mandate, created official Program.

 

2008:    

  • Expanded Concussion Clinic; community out-reach education programs
  • Purchase of transportable mini fluoroscopy machine facilitating close reductions in ER & Clinic

           

2009:    

  • Developed many community outreach projects & partnerships.
  • Developed and launched bilingual MCH Trauma Website (recipient of multiple awards).

 

2010:  

  •    Implementation of FAST in the Emergency Department.

 

2011:    

  • Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) integrated into MCH Trauma System close collaboration with Injury Prevention Program.
  • Further expansion of Trauma Research Program.

 

2012:    

  • Expansion of inter-professional MTBI Program/Concussion clinic. Concussion education
  • Use of the Bier Block for management of upper extremity fractures in Emergency Department. 

2013:    

  • Further expansion of MTBI Program to include vestibular rehabilitation.

 

2014:    

  • Cited by MSSS/INESSS TCC léger management guidelines.
  • Implementation of attending staff Trauma Team Leader (TTL) Program. 

2015:    

  • New site of Trauma Centre
  • Development of Post-Traumatic Headache Management Protocol for community MDs & Emergentologists.                  
  • Development of “Is the Thrill Worth It?” High School Program. 

2016:    

  • On going development and expansion of Trauma Research Program.

2018:    

  • Publication of 3rd edition MCH Concussion KiT 
  • Hosted Trauma Resuscitation in Kids (TRIK) course for  eastern Canada
Our team

Debbie Friedman, BSc pht, M.Mgmt

  • Director, Trauma Programs
  • Director, Canadian Hospitals Injury Prevention and Reporting Program (CHIRPP)
  • Director Trauma Research

Diane Richard, BScN Trauma Coordinator

Erin Mackasey, RN, MSc. Trauma Coordinator

  • Neurotrauma Program
  • Trauma Program
  • Burn Trauma Program

Debbie Schichtman, BScN Trauma Coordinator

  • Mild Traumatic Brain Injury Program
  • Concussion Clinic

Liane Fransblow, BSc. pht, MPH Trauma Coordinator

  • Injury Prevention Program

Lisa Grilli, BSc. pht, MSc Trauma Coordinator

  • Mild Traumatic Brain Injury Program
  • Concussion Clinic
  • Research Program

Carlo Galli, Physiotherapist

  • Concussion Clinic

Christine Beaulieu, Physiotherapist

  • Concussion Clinic

Meghan Straub, Physiotherapist

  • Concussion Clinic

Dr. Isabelle Gagnon, PT PhD Clinician Scientist

  • Research Program

Glenn Keays, MSc CHIRPP Coordinator

  • Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)

ADMINISTRATIVE TEAM:

Amanda Fitzgerald, B.A - APS

Michael Chuipka, B.A - Administrative Technician 

Fatemeh Bahrpeyma - B.Lit - Medical Secretary

 

Our programs

Trauma program:

Specializes in emergency, acute care, early rehabilitation and outpatient follow-up for all types of trauma including: musculoskeletal; spinal; thoracic; abdominal; pelvic; ocular; dental; poisoning; and near drowning.

Neurotrauma Program:

Specializes in emergency, acute care, early rehabilitation, and outpatient management for all types and severities of brain, neck and spinal cord injuries.

Concussion Clinic/Mild Traumatic Brain Injury (MTBI) Program:

Specializes in the management of mild traumatic brain injuries (also known as concussions), including: assessment, intervention plan, recommendations for return to school, and individualized plan for return to sports and recreational activities.

Burn Trauma Program:

Specializes in emergency, critical care, early rehabilitation and ambulatory management for all types and severities of burns.

Injury Prevention Program:

Involves injury prevention recommendations, education, public awareness, community outreach, partnership development, networking, and research. The MCH Trauma approach to injury prevention balances activity and fun with promoting awareness of the risks involved and making informed choices.

Trauma Research Program:

Research is a key component of trauma activities. It is important in verifying the effectiveness of our interventions and evaluating our projects and programs. Trauma team members are involved in a variety of clinical research projects and many have been published in peer-reviewed journals such as The Journal of Trauma, Brain Injury and the Journal of Head Injury Rehabilitation.

Trauma Team Leader (TTL) Program:

This program ensures urgent accessibility of the trauma team leader in charge of severe, complex and critical trauma cases in a fast and efficient manner. The trauma team leader leads the inter-professional group and ensures the delivery of excellent care from the time the patient arrives at the trauma centre through the different areas of care until the patient's final disposition to the OR, PICU, or Trauma Unit. The TTL Program is well integrated in the already established Trauma Code System.

Affiliated Programs

CHIRPP:

The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is a Canada-wide program of the Injury and Child Maltreatment Section of the Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of the Federal Government.

Each centre involved in CHIRPP has a designated Director and Coordinator. In 2011, CHIRPP was integrated into the MCH Trauma System. In order to meet the government mandate it has been closely linked to the MCH Injury Prevention Program for research activities, development of educational materials and injury prevention awareness.

Trauma Inter-professional Education

MCH Trauma offers year-round Interprofessional CME-approved Trauma Rounds, which take place on a monthly basis. Topics include a wide variety of trauma-related subjects. Staff from many departments and services, community physicians, residents, students and trauma network partners attend rounds. The MCH Telehealth Program makes the rounds available to regional centres.

 

How to refer a patient to the concussion clinic

Criteria for EARLY referral to Concussion Clinic (5-17 years of age):

We encourage early referral to our Concussion Clinic to favor optimal recovery time and minimize long term complications. Patients should be referred immediately and certainly if there is no significant improvement within 1 week following the concussion

Please send consultation if any of the following apply to the patient:

High level activities

  • Competitive sport or partakes in several team sports at the same time
  • High performance music or drama

Past medical history 

  • Previous concussion especially if symptoms lasted > few days
  • Migraines

Current event

  • Immediate onset of dizziness for current trauma
  • Immediate onset of sensitivity to motion

Current symptoms

  • Responding to questions more slowly at the time of the exam or even if briefly right after the event
  • Showing poor concentration
  • Abnormal tandem stance
  • GCS <15

Anxiety about the concussion - patient and/or family

MD discretion – Early referral recommended

 

Referral process: If patients present with any of the above findings, please send a medical referral to the attention of the Concussion Clinic Fax: 514- 412-4254 or call 514-412-4400 x 23310 (8am -5pm)

 

Click here for more information on Concussions

How to transfer a patient

The target clientele

Trauma categories determining if a child/adolescent (0 to 18 years of age) needs to be transferred to a tertiary pediatric trauma centre:

  • Child/adolescent who is intubated
  • Child/adolescent with a head injury: signs of lateralization, Glasgow Coma scale < 14
  • Child/adolescent with a mild head injury requiring observation
  • Child/adolescent with a spinal cord injury
  • Child/adolescent with a depressed or open skull fracture
  • Child/adolescent with a burn (more than 15% TBSA, 2nd degree)
  • Baby with a burn over 10% TBSA (nutritional needs)
  • Child/adolescent with a burn on the face, hands or feet
  • Child/adolescent with a burn on the perineum
  • Child/adolescent with a major trauma who is hemodynamically stable
  • Baby/infant (< 4 years old)
  • Child/adolescent requiring complex and extensive reconstruction
  • Child/adolescent with a Salter fracture or another serious type of fracture
  • Child/adolescent with a major trauma requiring cardiovascular, renal or nutritional support
  • Child/adolescent whose trauma is evaluated as non-accidental

Stabilization criteria before the transfer

Even in the case of an urgent transfer, the referring hospital must ensure that the child/adolescent is hemodynamically stable before transferring.

The following are signs of instability of vital signs in patients under 18 yeas of age:

  • Respiratory rate under 10 or over 60 per minute;
  • Systolic arterial tension under 70, over twice the patient's age in years;
  • Heart rhythm:
    If < 2 years, < 100 and > 160/min.
    If between 2 and 10 years, < 80 and > 150/min. 
    If > 10 years, < 60 and > 140/min.

In the presence of an urgent medico-surgical condition where the trauma threatens the child/adolescent's organs or life, the transfer is to be done after stabilization.

The stabilization includes an adequate evaluation and the beginning of the treatment so that, with reasonable probability, the transfer does not result in death or serious damage to the vital functioning of one of the organs.

The stabilization of the patient must include, when required:

  • Maintaining the permeability of the airways.
  • Control of any haemorrhaging.
  • Adequate immobilization of the patient or of a limb.
  • Setting up intravenous access for the administration of a solution or blood product.
  • Administering the necessary medication.
  • Necessary measures to ensure optimal stability during transfer.
  • Adequate accompaniment of the child by professionals deemed necessary to safeguard the life or corporal integrity of the patient during the transfer between the two hospital centres.

Modalities concerning the process for transferring to the MCH

Axis of communication to ensure transfer:

The emergentologist at the referring hospital must communicate the transfer request to the Emergency Department through the direct line for transfers        514-412-4499 (Emergency Department). An automated system will be activated, press 1 for transfers.

Pertinent documents to submit with the transfer:

Initial pre-transfer documents MUST be faxed to 514-412-4217 (Emergency Department Green Zone).

Ideally, this information should be transmitted prior to the patient’s arrival at the Montreal Children’s Hospital, using the polytrauma form and/or medical notes and nursing notes from the ER.

Documents to accompany the transfer:

1. Pre-hospital history (ambulance, police), forms: AS 803, AS 810, others as necessary.

2. The standard trauma form or a legible copy of the physical exam, evolutions notes and any treatments done.

3. All tests and imaging: hematology, biochemistry, blood gas, medical imaging, ECG, etc.

4. The name of the referring hospital as well as the name and contact information of the emergentologist must clearly be indicated on the first page of the transfer documents.

If the referring centre encounters a problem and needs to quickly contact the responsible parties:

  • Dr Laurie Plotnick, Medical Director, Emergency Department
    (514) 412-4400 ext. 22772 
  • Sylvie Levesque, Nurse Manager, Emergency Department, 
    (514) 412-4400 ext. 22270
  • Debbie Friedman, Director, Trauma (514) 412-4400 ext. 23310 between 8am and 5pm
Parent Resources
Media

Trauma Stories

Lucas Romano

Lucas Romano was a midget level hockey player. He suffered a concussion and lost consciousness during a hockey tournament after an opposing player hit him in the head. Lucas was followed by the Montreal Children’s Hospital Concussion Clinic. Here is his story.

Laura Rea

Philipe-Alex

(video available in French only)

Jean-Philippe Lambert

(video available in French ony)

Injury Prevention
Brochures / Pamphlets
Refer a patient 

Phone : 514-412-4400 ext. 23310

Fax : 514-412-4254

514-412-4499, Emergency Department (for patient transfer) / 514-412-4399 (fax)

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