Dawson remembered

Level-one trauma centres are priceless community assets we cannot afford to be without

Ann Lynch, Director of Operations, McGill University Health Centre
Dr. Harvey Guyda, Associate Executive Director, Montreal Children’s Hospital of the MUHC

Bad things happen — and we need to be prepared. These are truths so obvious that we overlook them — until tragedy touches us. Just one year ago, tragedy did touch our community. A young man with a gun walked into Dawson College. Minutes later a student and the shooter were dead. Another 19 students were wounded, some critically.

Thanks to the lightning response of the Service de police de la Ville de Montréal, Urgences Santé and Dawson staff, the 11 most seriously wounded students were quickly transported to the MUHC trauma centre at the Montreal General Hospital.  Ultimately, all of them survived their injuries. An ongoing mental health effort, spearheaded by the MUHC, Dawson and other agencies has also helped heal the deep psychological wounds.

The shootings at Dawson College stunned Montreal and the world. Yet, every day, more or less unnoticed, car crashes, violence, or simple accidents take a terrible toll. Trauma is the leading cause of death for people under age 49, and by far the leading cause of death in children.

We cannot prevent all traumatic injuries, but we can at least give trauma patients the best possible care. We must be prepared for any eventuality, even one involving mass casualties. In the last two decades, Quebec has taken important steps to ensure we are prepared.

In 1993, the government designated six hospitals as level-one trauma centres. Two of these are part of the MUHC, with both the Montreal General and the Montreal Children’s Hospital designated as level-one facilities. They have the staff and equipment to treat the most severe traumatic injuries—around the clock, seven days a week. This high level of readiness is a must because trauma can happen any time, and trauma patients often have injuries to every major system in their body.

The MUHC adult trauma centre, which received most of the victims of the Dawson incident, treats over 9,000 trauma patients each year including close to 1,500 who must be hospitalized. Headed by Dr. Tarek Razek, it is the designated trauma centre for adults in the downtown Montreal region.

The MUHC pediatric trauma centre, managed by Debbie Friedman, specializes in the treatment of children with traumatic injuries. Last year, over 14,000 children were treated for trauma at the Montreal Children’s Hospital, and 600 were hospitalized.

Gaining accreditation as a level-one trauma centre is difficult. To qualify, a hospital must be able to assemble multi-disciplinary teams of specialists in a matter of minutes, any time of the day or night. It must also be able to make sophisticated diagnostic and surgical facilities and staff available at a few minutes notice.

Fast response is of the essence. As soon as emergency responders arrive at the scene of a trauma-causing event, as in the case of the Dawson incident, they evaluate the victims, and if necessary, alert the nearest level-one trauma centre.

At the MUHC, the trauma team leader—an expert in trauma resuscitation—arrives at the hospital no more than 20 minutes after being paged. He or she notifies the blood bank and assembles an interdisciplinary team that includes nurses, surgeons, respiratory therapists, social workers and other health care professionals—often before the patients arrive. The team leader then decides what must be done first and performs emergency procedures as needed.

This high level of readiness pays off. In 1993, before level-one trauma centres were established, only half of those with the most severe traumatic injuries survived. By 2002, the survival rate had increased to over 90 per cent—an almost unheard-of improvement in medicine.

Level-one trauma centres deliver care that is little short of miraculous. But like most good things, these centres come with a cost. Staffing and equipping a level-one trauma centre is an expensive undertaking. Even so, level-one centres are priceless community assets that we cannot afford to be without. For thousands of people, they have made the difference between life and death.

As we remember the Dawson incident, let us also remember how important it is to be ready—around the clock, every day. Positive outcomes can happen on difficult days, but only as a result of right decisions and excellent preparation.