Quebec needs public helicopter ambulances

Humboldt tragedy should prompt review of our own management of rural trauma, David S. Mulder says.

Like all Canadians, North Americans and many others around the world, I deeply sense the grief related to the recent tragedy in Saskatchewan. It is particularly poignant to me, as I have lived the team bus experience while playing amateur hockey in Saskatchewan, the province of my birth.

This horrendous accident occurred in a rural agricultural community, on a clear day, with the Humboldt Broncos team bus and the semi-trailer truck ending up in a snow-covered field. There were 29 young athletes, coaches and staff injured, almost half of whom perished at the scene.

Within a short time, the RCMP were on the scene and were able to summon helicopter support to transport the seriously injured to a Level 1 trauma centre at the Royal University Hospital in Saskatoon. To respond to the number of injured, there were at one point three helicopters on site from the Stars Air Ambulance program, sent from Saskatoon and Regina. This clearly reduced the time for the grievous injuries to reach definitive care at the Level 1 trauma unit, which had been readied by a Code Orange, signalling a multiple-casualty event.

How would we cope with a similar magnitude of trauma in Victoriaville, or any rural Quebec site?

Quebec has made great strides in the regionalization of trauma care, with the development of three Level 1 trauma centres, staffed by specialized and highly trained teams capable of providing total care for every aspect of a grave injury. These centres are located at the Montreal General Hospital, Sacré-Coeur in Montreal and at Hôpital de l’Enfant-Jésus in Quebec City, and this has resulted in a drastic improvement in mortality and morbidity. Since the establishment of a provincewide trauma system in 1993, the mortality rate from traumatic injuries, which used to hover at around 50 per cent, has now dropped to close to five per cent. Nevertheless, trauma remains the No. 1 cause of death among Canadians under 44 years of age, and there is more we could be doing to save lives in these situations.

It is essential to address the time it takes to transport seriously injured patients from rural Quebec to our Level 1 trauma centres. Our measured times on patients transferred from rural areas are unacceptably long and well beyond the “golden hour” in trauma care. I am concerned and chagrined that our city of Montreal is the only urban centre in North America with no prehospital helicopter program. I am further troubled that our province of Quebec is the only province in Canada without a pre-hospital helicopter program.

While my bias is toward improved trauma care, a sophisticated pre-hospital transport program, including fixed wing and helicopter, would also offer support to the pediatric population, and to those in need of acute stroke care or complex obstetric care, and to those undergoing complex cardiac emergencies. In addition, inter-hospital transfers of complex cases would also be expedited. Current infrastructure projects on our province’s roads and highways make timely road ambulance transport a major challenge, hindering our ability to provide rapid care to both critically ill and trauma patients.

Very remote areas, such as northern Quebec, have an established fixed-wings airplane transport program. However, for the surrounding areas of Montreal, such as Mont-Laurier or Sherbrooke, which are within helicopter flying distance, there is no public air medical evacuation program in place.

Let us use this major tragedy to review our own management of rural trauma and indeed, all aspects of pre-hospital care, to achieve equality of care for every Quebec citizen, whether of rural or urban residence. David S. Mulder, MD, is Rocke Robertson Professor of Surgery at McGill University and chief surgeon for the Montreal Canadiens. The Dr. David S. Mulder Trauma Centre at the Montreal General Hospital was named in his honour in 2015.