June 20, 2017, was a day like any other on the construction site, until the 14-inch diamond blade on Adrian Molloy’s power saw jammed in the concrete he was cutting and kicked back into his arm, slicing through to the bone. Though he was not particularly close The Ottawa Hospital’s Trauma Centre at the time, a new 60-minute bypass initiative brought him straight there to an assembled team of trauma experts who were ready for him.

The 40-year-old contractor had been using power saws on the job for 20 years. He was down in a hole cutting concrete when the saw kicked back. He was covered in dust so couldn’t see his arm, but knew he’d hit himself. He grabbed his right arm above the elbow, and his fingers landed on bone. Adrian knew it was a serious injury, and managed to get out of the hole and head to the road for help. His arm was bleeding badly.

“It happened so quickly, I didn’t even know I was injured,” Adrian said.

*Contractor Adrian Molloy underwent two four-and-a-half-hour surgeries to repair his partially severed arm.*

Quick thinking

At the road, two Hydro One workers were sitting in their truck getting ready to leave. When they saw Adrian, the passenger called 911. The driver jumped out, and quickly took off his belt and tightened it around Adrian’s arm in a tourniquet. He was calm, and kept Adrian talking until the ambulance arrived.

In the ambulance, Adrian heard the paramedics talking with the dispatch.

“I knew they were looking to bypass Kemptville, but didn’t know what was going on,” said Adrian. “I knew my best hope was The Ottawa Hospital, so was happy they said we were heading to the Trauma Centre at the Civic. I was going somewhere where they could handle my injury.”

60-minute bypass initiative

What Adrian didn’t realize was that he was one of the first patients to be part of a quality improvement initiative that the Ottawa Regional Trauma Program was testing in an effort to get patients to trauma care and provide more successful outcomes.

“Adrian was a direct recipient of our 60-minute bypass initiative,” said Mathieu LeBreton, Trauma Coordinator of the Ottawa Regional Trauma Program at The Ottawa Hospital. “Provincially, paramedics have rules that can permit them to bypass local hospitals to get to a lead trauma hospital if they are within 30 minutes of getting to a trauma centre. With the approval of all regional community hospitals, we expanded it to 60 minutes. Much of the literature suggests the sooner a patient receives definitive trauma care, the better.”

Where Adrian was injured was about a 45-minute ambulance drive to the Trauma Centre. Previously, he would’ve had to go to the nearest community hospital. LeBreton said trauma patients who need resuscitation from life-threatening injury need very resource-intensive care. They require more medical staff, access to operating rooms, imaging capabilities, more blood, and other resources that community hospitals do not have in their emergency departments. There is a team of health-care professionals at the Civic Campus specifically trained to deal with trauma situations.

Trauma team assembles

When paramedics notify the Civic Campus Emergency Department that they are bringing in a patient with multiple or life-threatening injuries, a Code 1 Trauma is called over the hospital’s intercom. This alerts the trauma team, which includes trauma surgeons, emergency physicians, nurses, anaesthesiologists, respiratory therapists, and trauma coordinator Mathieu LeBreton, to prepare for the patient’s arrival. A Code 1 Trauma also notifies the blood lab, radiology department, and operating room staff that blood-work, X-Rays, CT scans, and surgery may be needed.

“Sometimes a trauma code comes in without advance notice, and then we’re reacting to it in the moment,” said Kelly Barnett, Clinical Manager of the Trauma Unit. “Everyone has a job, and it’s a code that runs smoothly to diagnose, triage, and save the patient.”

“I’d never been to a hospital injured like this before,” said Adrian. As he lay in the ambulance, his mind raced with concerns. “I asked, ‘Do they know I’m coming? Are they ready for me?’”

Rushed to surgery

The answer was yes. The trauma team was ready and waiting for him when the ambulance arrived. When he was rushed through the emergency room doors, Adrian said he couldn’t believe, “You can get so many people in one room for one patient.” He was in the operating room within 47 minutes from the time he entered the emergency department.

“I knew my best hope was The Ottawa Hospital, so was happy they said we were heading to the Trauma Centre at the Civic. I was going somewhere where they could handle my injury.”

The power saw had cut 75 percent of his right bicep, two arteries and a nerve. In the operating room, surgeons reattached his arm. The four-and-a-half-hour surgery repaired arteries and his severed nerve. He underwent a second four-hour surgery to repair the damaged bicep with a donor muscle in November 2017.

The Ottawa Hospital’s Civic Campus is the adult lead trauma hospital for eastern Ontario. This takes in an area of 1.3 million people that includes Ottawa, stretches west to Pembroke and east to Hawkesbury. People with life-threatening injuries from Gatineau and western Quebec, as well as patients from Baffin Island and eastern Nunavut are brought to the Trauma Centre. Twenty percent of the population it serves lives in a rural area.

The Centre treated 856 trauma cases last year. One hundred and ninety-two of those patients benefited from the extended time guidelines from accident scene to trauma centre, with the average transfer time being 42 minutes.

Trauma care for 1.3 million people

The eight-bed trauma unit is dedicated to patients who have multiple injuries. This could include head or brain trauma, limb loss, vascular, spinal cord, internal organs, multiple broken bones, broken spine, or neck injuries.

“Patients come into trauma from emerge [emergency department], and once they are stabilized, they then move through the hospital, as soon as possible, in order to get them back home, into rehab, or somewhere they can convalesce,” said Kelly.

Kelly said a patient’s length of stay in the trauma unit can be as short as 24 hours or as long as several months, depending on the severity of the injury and the ability to recover and heal. The health professionals in the Centre plan the patient’s follow up care or work closely with physiotherapy, and rehabilitation services to assess their need for rehabilitation.

“I know we often compare ourselves to similar standards from regional trauma perspectives: other hospitals we benchmark against in standardizing trauma care. We look to hospitals like St. Mikes [St. Michael’s Hospital] in Toronto to see their practices, and share ideas and common goals that we are trying to achieve,” said Kelly.

The Ottawa Hospital is part of the Trauma Association of Canada where members from across the country share vibrant practices about ways to improve patient care.

Hamilton and Kingston also have trauma centres, though The Ottawa Hospital is bigger because of the larger area patients come from.

The Ottawa Hospital has one of the largest trauma centres in the province, with Sunnybrook and St. Michael’s as the two largest. However, both Toronto hospitals cater to a dense urban population. The Ottawa Hospital covers a larger geographical area, so the timing to get patients to the trauma centre from a distance and the reason why the 60-minute bypass initiative is critical.

“What we found is there have been no negative outcomes yet. People like Adrian have benefitted directly from this,” Mathieu said.

Back to work

A year later, Adrian is back on the construction site with full use of his right arm and hand.

“I lost the motion for using a screwdriver. I use it as an excuse to get out of work I don’t like. I use it to my advantage now,” laughed Adrian. “I’m doing everything I was doing before.”

Adrian Molloy with his wife Shelly — *Adrian Molloy stands with his wife Shelly outside their home.*

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Innovation and Technology, Patient Care, Patient Care

Life can change in an instant. Thankfully, Ashley Ruelland lived to tell the story of her ‘instant’ after a head-on car crash brought her to The Ottawa Hospital’s Trauma Centre with extensive, life-threatening injuries followed by months of intensive rehab.

In early March 2015, then 27-year-old Ashley was living in an apartment with her two cats. She was busy working as a construction manager, part time as an office administrator, and she had started a catering business. She had never really been sick, and had no idea where the Civic Campus of The Ottawa Hospital was located.

That changed on Friday, March 13. Ashley was driving the bride-to-be and another friend to a bachelorette party in Mont Tremblant. It was a clear day and the three were brimming with excitement.

A head-on crash

About an hour from their destination, on highway 323, a car crossed over the centre line, head on into their lane. That was Ashley’s instant. The noise from the impact was horrific, with the earth-shattering sound of grinding metal and fragmenting glass.

Ashley Ruelland lying in hospital bed — *Ashley, her mother Cheryl Ruelland-Jackson, Therapeutic Paws of Canada therapy cat Pecan, and her brother Robbie Ruelland.*

Miraculously, one of the first people on the scene was a resident from The Ottawa Hospital. She quickly assessed how serious Ashley’s injuries were. It took first responders over an hour to extricate Ashley from the car. She was rushed to the Hull Hospital, but because of the severity of her injuries, she was transferred to the region’s only trauma centre at The Ottawa Hospital Civic Campus.

While her friends had relatively minor injuries, Ashley had a grocery list of broken bones: from her right big toe to her ribs and just about everything in between. Most significant were an open compound femur fracture, an open left elbow fracture, right humerus fracture, crushed and broken left and right foot and ankle fractures, an open book pelvis fracture, and multiple broken lumbar vertebrae.

“This lady’s life changed forever that day,” said Dr. Guy Hébert, Head of the Department of Emergency Medicine, when he looked at the hundreds of files related to Ashley’s surgeries and treatment.

She remained in an induced coma in the intensive care unit for two months. She endured numerous reconstructive surgeries, 100 hours of orthopaedic and internal surgery, and over 100 blood transfusions and infections.

Beginning the long road to recovery

Ashley walking in parrallel bars — *A year and a half after her “instant”, Ashley was able to walk again with the help of a walker.*

Four months after the crash, Ashley began physiotherapy in her hospital bed and could finally eat solid food.

She had lost all of her hair and had severe nerve damage, chronic illness myopathy and neuropathy.

“I was scared to think of the life that was waiting for me outside those hospital walls.” — Ashley Ruelland

“I couldn’t feed myself, brush my own teeth or move much at all. The first couple of weeks seemed like torture. The nurses would set little goals, like sitting up in my wheelchair for 20 minutes a day. The physiotherapist and occupational therapist didn’t know if I’d ever walk again. I was scared to think of the life that was waiting for me outside those hospital walls,” said Ashley.

But then her first real sign of recovery came a few weeks later when she was able to feed herself.

Intensive rehabilitation

In August, Ashley moved to the rehabilitation centre at the General Campus where she began an intensive regime of physical, occupational and psychological therapy programs. Just before Christmas, nine months after the accident, Ashley left the hospital. Although she was in a wheelchair and hadn’t made many functional gains, Ashley felt stronger and healthier.

The young woman continued as an outpatient with rehab, and had her last surgery in February 2016, which allowed her to transfer from her bed to chair, independently.

“In May 2016, I stood independently for the first time,” she said. “And after many more weeks of painful standing and walking in the hospital’s therapy pool, I started to walk with the aid of a harness within the parallel bars. By the end of the summer, I was able to move with a walker.”

Over two years later, Ashley is walking again. In fact, not only is she walking but she’s travelling, recently returning from Ireland. She’s also in school and looking to buy a home.

Listen to Pulse Podcast Episode 55: When Ashley Ruelland met her instant.

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Patient Care, Rehab, Trauma, Trauma, Trauma

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