Trauma in the North

Note: Due to patient confidentiality there are no photos today.

It was mid-afternoon on a Friday at the Kitikmeot Regional Health Centre and like most of us I was trying to clear up my paperwork after a week of learning...in a new location...and getting ready for the weekend ahead. I had spent the week adjusting and fine tuning my placement of supplies, familiarizing myself with the equipment and had just finished mixing my fixer replentishment solution following the directions on the box as pointed out to me by Harry.

I had mixed the water and the two solutions in the proper proportions and had stirred, not shaken, as required. I figured I had enough now for the next few weeks and this might be the last fixer I might mix until I left town. So far, my table top processor had been working flawlessly. What went in had come out...and all was right with the world.

The logbook had been completed as the returned films from Stanton Regional Health Centre in Yellowknife had arrived and were now back in their master envelopes and filed away under the TD2 system. I was pleased with my films to date...a sense of satisfaction at having completed the week without a repeat. The patients, that I had done were a varied mix of size and shape. My Meditech training from last february in Rankin Inlet had returned.

The various functions, prompts, and related screens were familiar and my learning curve had been exponential. Since I was my own receptionist here, it was like being on call in Rankin Inlet and processing the paperwork and patient from there. It had flowed and worked all week despite the being first person in the health centre functioning under the Windows 8.1 operating system, an upgrade the support team had recommended and Byron from the Government of Nunavut (GN) IT family had performed on Wednesday

I had arrived only on tuesday afternoon along with six other staff members...most of us had been “weathered” or delayed due to the storms that had been in the Cambridge Bay area. No planes had been able to land here due to winds and blowing snow and the backlog had been tremendous. Here, we had met on the orientation tour of this facility....but many of us had previously crossed paths in Yellowknife at the Super 8 while we enjoyed blue skies and sunny days and much warmer temperatures there.

I was supposed to arrive sunday to start in Xray on Monday a.m...It didn't happen. Instead, like the others I spent countless hours on the phone trying to secure my room and re-book flights north. Thank goodness for cell and internet services.

I was just finishing my coffee around three when Mike, the NIC (nurse in charge) came by and told me to expect a trauma case to be arriving shortly. Details were sketchy, at best, but someone in town had been injured in a snow machine accident and were on their way in shortly. Here in Cambridge Bay, like Rankin Inlet, the fire department is staffed completely with volunteers, who also manage the ambulance response.

The regional meditech support person is Sandy, based in the health centre and I had noticed him earlier in the day with a t-shirt with the words FIRE DEPT. on its back and a radiophone for taking calls on his belt. In our conversations during the week, he had mentioned being a volunteer with the fire department and I wondered if he had been dispatched to the scene. No time to dwell...only enough time to start through a sequence that would prepare us for the moments ahead. Cassettes, grids and portable at the ready...we waited...not knowing what might lie ahead.

The doors of the ambulance bay swung wide and a stretcher with Mike at one end and someone else at the head wheeled towards our ER trauma area. The team stood ready. The 24 year old female had been T-boned by an SUV and the snow machine had rolled along with her. The driver of the SUV remained unhurt at the scene. Since no other people had been injured, our focus became entirely centred on the patient before us. The team had gathered and were immediately starting their work.

She was complaining of severe neck pain but her leg, just above the left knee, was acutely strange in angle and continued to bleed profusely as her clothing was cut off to allow for assessment. Two IV's were introduced to the veins in her arms before they could collapse. The lab was summoned...did we have blood on hand....yes, there were four units of O-Negative...in house.

Simon, our physician, was at the head directing the opera. Someone was documenting. Further assessments revealed that the pelvis and lower abdomen as well as her left ribs were involved in this trauma. To further complicate the situation, we had just discovered that she was 29 weeks pregnant. The midwives were summoned for her chart and to monitor the fetus.

I grabbed my portable from my xray room right next door, along with some films...ready to clear the spine when called upon or to look at that lower femur now that bleeding was controlled as a tourniquet had been applied. She was responsive and alert to our questions and we were all working to the best of our abilities when at 3:40 p.m., without warning, the lights went out in the trauma room, and indeed the entire health centre and this side of town. What had I gotten myself into, I thought.

All staff remained in their respective spots until the emergency generator kicked in. It had seemed like forever...but was probably less that 10 seconds. Our computers were down and rebooting was required. We had pulse, pressure, respiration and lights...a good thing since we had no outside windows and any light had left the sky hours before.

We continued to provide the level of care needed. Medevac options were being considered. Stanton Regional Hospital in Yellowknife had been contacted. Their staff wanted to talk to the physician. It would be some time before that plane would land. Ultrasound was alerted to standby, if required, once Mary had completed her current outpatient.

We continued our various functions, each performing tasks ...our focus directed towards the two on the stretcher in the centre of the room....until 1604 hours when Mike called it. It was over. We could do no more. It was quiet....

The simulation was complete. In less than an hour, the health care team had worked on a serious case. The next twenty minutes were spent analyzing our performances, trying to appreciate each others requirements, assessing our strengths and weaknesses, and finally, recognizing the faces and roles of the various staff members in the management and care of these “patients”. It was a drill...a realistic practice of skill and integration...let's hope it's the last time it's needed while I'm here in Cambridge Bay.