An in-depth look at how Toronto’s paramedics work to save victims of gun violence, trauma
When it comes to providing urgent medical care, 2018 was a hard year for Toronto‘s emergency crews as the city grappled with two major mass casualty incidents and a record-high number of homicides.
Although Toronto’s approximately 4,800 police officers and 2,700 firefighters often are called upon to provide first aid, initial treatment and comfort to victims of trauma, it’s the city’s 1,400 paramedics whose sole responsibility is to provide critical medical assistance to patients before they get to hospital.
“I like to think we bring the emergency room a little bit closer for some things,” Kaleigh O’Brien, an advanced care paramedic and a field training officer with Toronto Paramedic Services (TPS), told Global News.
“(We) treat the patient, look for life threats, stabilize the life threats and as quickly and safely as possible, we get them to the hospital,” Kevin Sam, a TPS level one paramedic, said.
In an effort to better understand what happens in the seconds and minutes after a person receives a traumatic injury, TPS and St. Michael’s Hospital conducted full, realistic simulations for Global News. In a mock scenario, an 18-year-old man was shot in his torso while at an establishment.
At the TPS multi-function station on Wilson Avenue, O’Brien, Sam, and Kelvin Woo leapt out of their ambulance carrying a stretcher full of gear — a backboard, bags of supplies, monitors and breathing devices. At the beginning of the exercise, all they knew was that there was an unknown patient who was unconscious.
Shortly after O’Brien approached the patient, she began what’s known as a rapid trauma survey. Starting at the top of a patient’s head, paramedics checked for hemorrhaging. They then worked their way down, methodically assessing the scope of a victim’s injuries. They also need to check the patient’s airway, breathing and circulation.
“OK, I’ve got good air entry (on the right side). I have no air entry on the left side,” O’Brien calmly noted while calling on Woo to finish the survey.
“I’m going to need to patch through a chest needle.”
VIDEO: Paramedic Kaleigh O’Brien discusses training exercise, explains assessment steps
This situation meant a long, slender needle needed to be inserted below the victim’s left shoulder in order to decompress his chest.
As O’Brien calmly worked to insert the needle, Woo found a gunshot wound on the patient’s torso with bleeding into his abdomen. The focus turned to maintaining pressure to slow down the blood flow, which can be done through specialized dressings or by physically applying pressure.
While the trio continued preparing to transport the victim as part of the exercise, O’Brien was on the phone with a doctor at Sunnybrook Health Sciences Centre — the base hospital for TPS. Depending on their level of certification, Ontario’s paramedics can often provide certain types of surgical intervention and work under a physician’s licence.
After receiving further instructions, O’Brien, Sam and Woo finished securing the patient — a fully weighted mannequin — onto the backboard and transferred him to the power stretcher.
“Kevin, you’re going to drive, and can you give St. Mike’s an update for us, please … We’re going to go FTT (field trauma triage) CTAS-1 (the most serious condition under the Canadian Triage and Acuity Scale),” O’Brien said while climbing into the back of the vehicle.
“Eighteen-year-old male with one confirmed shot in the abdomen, chest needle on board, we’re going to do vital signs once we get in the ambulance.”
VIDEO: How bystanders can provide help to patients before emergency crews arrive
During the full-scale exercise, seconds can seemingly feel like minutes. However, it took just over 11 minutes for the TPS team to leave the ambulance, complete the necessary assessments and initial treatments for the patient, return to the ambulance, and leave the scene.
When asked about the most crucial things to consider after approaching a patient with gunshot wounds, O’Brien methodically explains the triage process.
“First and foremost, our safety … as well as proper patient care assessment. We also need to preserve evidence. If we had seen bullet casings and things like that, this is something that I need to alert police to,” she said.
“Next, I’m conscious of the patient and their level of consciousness, and with gunshot wounds, first and foremost is massive hemorrhage. This is what we’re really concerned about.
“Gunshot wounds require definitive care at the trauma centre. What we’re trying to do is to stabilize the patient, provide some fluid resuscitation, if that’s required, if the blood pressure is significantly low, and we need to get that patient to the trauma hospital.”
O’Brien noted that as medical treatments evolve so must the training and procedures to treat gunshot wound victims and those afflicted by serious trauma.
VIDEO: Paramedic Kaleigh O’Brien explains how trauma treatment techniques have changed
“For a long time, the idea of tourniquets was thought to be detrimental to patients … so it was shown through trauma studies [that] tourniquets are not,” she said.
“Before, we would have to put [gunshot wound victims] on a backboard and strap them down … but we found this is detrimental to the patient. Once that study came out, we changed our practice. We’re constantly adapting to what’s new in medicine.”
O’Brien, who is one of dozens of advanced care paramedics at TPS, knows first-hand what it means to deal with traumatic events. In addition to her current roles, she is also a TPS peer support volunteer — someone with lived experiences who provides a sounding board for colleagues. O’Brien attended the Yonge Street van attack and Danforth shooting scenes to provide support to those who were first on the scene.
“I really care about the people that I work with. We really are a team,” she said.
“You show up on the Danforth scene, for example, and the devastation just keeps continuing, just keeps going … Knowing how hard all of my colleagues worked — and the impeccable patient care they were able to provide and the comfort that they were able to provide for the citizens of Toronto — was outstanding.”
When it comes to the jobs that paramedics do, Sam said there are some common misconceptions.
VIDEO: Paramedics Kevin Sam, Kaleigh O’Brien address misconceptions people may have about their duties
“I think people believe we’re not taking the city’s safety seriously when they don’t see us blaring lights and sirens, when they don’t see us running out of the vehicle, when they don’t see us yelling and screaming at each other on scene,” Sam said.
“When, really, we are at all times trying our best to keep the safety of the public, the safety of the patient, our safety and the safety of the family — the safety of everybody overall.”
O’Brien also had a message for the general public as paramedics go about their work: slow down and move over for ambulances with lights on.
“It might be your loved one that we’re working on,” she said.
“Time is muscle. Time counts.”
In part two of this series, to be posted next Thursday, Global News speaks with St. Michael’s Hospital trauma team members about how they use treatments and procedures often seen in military battlefield zones.
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