Bystander help crucial for trauma victims

Dr. Louis Hugo Francescutti, an emergency physician and professor at the University of Alberta, said the kind of force from a vehicle striking a pedestrian can lead to devastating and fatal injuries, such as massive brain injury, crushing chest or abdominal wounds, traumatic amputations or uncontrollable bleeding.

“The leading cause of death from trauma is brain trauma, and some are so catastrophic there is just absolutely nothing you can do,” Francescutti, a past president of the Canadian Medical Association said in an interview from Latvia, where he’s attending a Word Medical Association council meeting.

Of the critically injured, those who are taken to a trauma centre within the “golden hour,” the first 60 minutes of the injury, have the greatest chance of recovery, he said.

“The rule of thumb is the sooner they are stabilized on scene and brought to a hospital there is a better chance of survival.

“Princess Diana is thought to have died because they stayed too long on scene and did not transport her to an OR quickly enough,” Francescutti said.

Sunnybrook Health Sciences Centre and St. Michael’s Hospital where the victims of the van attack were taken are among the top trauma centres in the world, he added.

“And then it’s amazing how smooth it actually works,” he said. “It looks hectic to the outsider, but when you’re in the middle of it there is a calm that takes over. We’re trained to do this.”

Hospitals deal with the unexpected influx with mass casualty protocols, he said: Elective surgeries are cancelled, extra operating rooms are opened up and the emergency department becomes a major triage area.

One doctor takes on the role of trauma leader and directs other trauma team members — one person to control the airway, another to look for bleeding, for example. Full body CT scans are performed. “In a very short period of time (people) are stabilized, imaged and then the surgical teams take over.”

Francescutti called Monday’s carnage on Yonge Street “sad, tragic and unimaginable.”

He said the attack underscores why Canadians need to be better trained in first aid care. “The first few seconds and minutes after such cowardly and inhumane attacks need our families, friends and neighbours to know what to do,” he said.

Bystander first aid is crucial, he said, to help stop bleeding, clear airways, support limbs, apply tourniquets and stabilize necks to prevent serious injures from turning into catastrophic spinal injuries.

“One of the most important things to ask is, if you would have been there, would you be prepared to step up? That’s the last missing link,” he said.