Trauma system lags far behind Ontario in lead. Quebec needs additional funding, 12 more specialists, experts say AARON DERFEL The Gazette
Saturday, October 02, 2004 Quebec's hospital trauma system lags far behind Ontario's, and at stake are patients' lives, experts in both provinces say. Quebec needs at least 12 more traumatologists to be able to respond adequately to victims of car accidents, gunshot wounds and other life-threatening injuries, according to Dr. Michael Churchill-Smith, associate director of professional services for the Montreal General Hospital. Level I trauma centres like the Montreal General and Sacre Coeur Hospital are chronically underfunded by the provincial government, observers say. Despite a steady rise in the number of trauma cases at both hospitals over the years, each centre's budget has stayed flat. By comparison, Ontario hospitals regularly adjust the funding of their trauma centres to handle a growing volume of cases. What's more, Ontario trauma specialists are much better paid than their Quebec counterparts, said Dr. Ronald Denis, director of trauma at Sacre Coeur. That makes it all the more difficult, Denis suggested, to recruit traumatologists from other parts of Canada. "All the trauma centres in Quebec are extremely fragile because of the shortage," he said. "Just to give you an example: One of our traumatologists got into a bike accident recently. We had to scramble to change our system because for several weeks he wasn't able to operate." The Gazette reported this week that the Montreal General has disbanded its trauma team - arguably the city's busiest - because of a lack of resources. General surgeons are now dispatched to the emergency room whenever a trauma patient is rushed in, and it's the ER doctor - not a trauma specialist - who co-ordinates the response. "A better way to do this would be to have an in-house trauma team, and that isn't broadly available in the entire province," conceded traumatologist Tarek Razek of the Montreal General. Razek, whose mother died after a car crash last year in Quebec, said he and his colleagues are doing their best,but trauma care no longer meets the standards it should. "The city is big. It needs both systems (the Montreal General and Sacre Coeur) running at high octane to provide the care that we need." Perhaps the most glaring difference between the trauma systems of the two provinces is that Ontario has trauma choppers and Quebec doesn't. In 1998, Churchill-Smith made a proposal to the government to operate a helicopter at an annual cost of $2 million. He estimated that each year such a service could transport 100 head-injury victims from 250 kilometres away (as far as Mont Laurier) to the Montreal General or Sacre Coeur. Normally, it takes four to 10 hours to transport these victims by ambulance - time that can make the difference between life and death. Churchill-Smith calculated that a trauma chopper would pay for itself by reducing the number of cases of long-term disabilities and hospitalizations. Six years later, there are no trauma choppers for the Montreal region. (AirMedic, a private nonprofit volunteer service, runs a chopper out of the Saguenay region, but doesn't have one for Montreal.) In contrast, Sunnybrook & Women's hospital in Toronto has been running a government air ambulance since 1977. It's been a success, said Fred Brenneman, chief of trauma at the hospital. "We have helicopters that pick up trauma patients right on the highway and get them to the trauma centre rather than just going to the smaller hospital," he said. Sunnybrook was the first hospital in Canada to set up a trauma unit, in 1976, and it's considered a model system. Doctors from around the world train there to learn about the latest innovations. Brenneman urged the Quebec government to accord greater importance to trauma, arguing that would "improve patient outcomes, for sure." Studies have shown trauma centres significantly reduce the number of deaths and complication rates compared with non-trauma centres. The Montreal General had earned a reputation as a top-notch centre, distinguishing itself in the aftermath of the ecole Polytechnique massacre on Dec. 6, 1989. But in the past four years, the trauma service has deteriorated because of dwindling resources. Denis Burdett, an ER nurse at the Montreal General, warned yesterday the current system is dangerous for patients. He explained that an ER doctor is caught between his regular duties and filling in as trauma co-ordinator. The same applies for the triage nurse. "What's going to happen if the doctor in charge of the ER is tending to a patient with a heart attack and then a trauma case comes in?" Burdett asked. Churchill-Smith estimated that the Montreal General and Sacre Coeur each require three more traumatologists. The Montreal General has three and Sacre Coeur has six. Churchill-Smith said the province's other trauma centres need another six. An aide to Quebec Health Minister Philippe Couillard told The Gazette this week that the government will analyze trauma staffing at the Montreal General. But Cathy Rouleau said preliminary information indicates there is no problem. [EMAIL PROTECTED] Please see TRAUMA, Page A3Unit must reopen, Page A30 � The Gazette (Montreal) 2004 http://www.canada.com/montreal/montrealgazette/news/story.html?id=39d7e21c-f0bc-43a2-a276-a2723cf29826 Trauma unit must reopen The Gazette Saturday, October 02, 2004 The Quebec health department did not come up with the right response to the news that the Montreal General Hospital has closed down its trauma service because of a lack of resources. It needed to do two things: Send money and order the trauma team reconstituted as fast as possible. A trauma team is not a luxury that hospitals can disband when there's a budget shortfall. Trauma patients are uniquely difficult to treat. They arrive shot, stabbed, bludgeoned or their bodies broken and twisted in road accidents. Life-threatening injuries must be identified within minutes, if not seconds. These patients must also be treated in conjunction with pre-existing medical conditions that are usually unknown to the trauma team. The patient is often in no position to help, being unconscious or in shock and unable to provide medical history. The margin for error is huge. American research has found that between two per cent and 50 per cent of combined life-threatening and non-life-threatening injuries are missed. Overlooked conditions include pelvic fractures, spinal cord, head, abdominal and nerve injuries. The cost in human lives and disability is also huge. In Canada, the U.S. and Britain, research points to the need for specialized trauma centres. Patient care is compromised - often severely - in the absence of such centres. In Quebec, a 1998 study analyzing the effects of establishing a trauma-care network between 1992 and 1998 found a greatly reduced death rate. The mortality rate in major trauma patients dropped from 52 per cent to 18 per cent. Earlier, in 1996 in Vancouver, a dedicated trauma program was introduced, resulting in important reductions in mortality. The study found that improvement in trauma care could be achieved by a multidisciplinary team offering a dedicated trauma service to manage the more seriously injured patients, within a single unit. Similarly, in Britain, research suggests that one in three people admitted to hospital with major injuries from traffic accidents suffered preventable deaths. This means that, in 2001, more than 13,000 people died needlessly. Most of the injured were taken to the nearest hospital, which often lacked the equipment and expertise to save them. In Canada, traumatic injury is a leading cause of illness and death. In both Canada and the U.S., it is estimated that between five per cent and 10 per cent of all injured patients brought to hospital require the services of the highest level trauma centre. Nothing in these statistics suggests that it is appropriate for the trauma service at the Montreal General Hospital to fold. The General is the city's busiest trauma team. It is downtown, which is where shootings and stabbings tend to happen. Ontario's trauma system, in contrast to Quebec's, is funded on the number of cases treated. Quebec hands out a lump sum, with the result in the General's case that it can't continue. Its trauma service is just the latest casualty of Quebec's unwillingness to face facts. This is unacceptable. http://www.canada.com/montreal/montrealgazette/news/editorial/story.html?id=1d8ec7e4-0a7e-4b09-b02c-1523598b7e30 --- URG-L Les archives de la liste d'echange sont disponibles pour consultation a l'adresse : <http://www.mail-archive.com/[EMAIL PROTECTED]>
