Trauma Surgery in
Khandahar and Toronto
Homer Tien is a trauma and emergency general surgeon at Sunnybrook
Health Sciences Centre who spends half of his clinical time in elective general
surgery practice. He serves as an acute care surgeon (1) for one full week six to
eight times per year. He is usually able to link this to his trauma call.
Homer spends 40% of his time on clinical epidemiology in two areas: combat
casualty research, and civilian trauma research. He is working with Andrew
Smith and Fred Brenneman to assure that acute care surgeons are consulted
expeditiously - that a patient is seen within 30 minutes of arrival and a decision
is made within two hours. Their current goals are to speed up the recognition
of surgical problems by the emergency room staff, and to facilitate better access
to the operating room despite the competing services that are prevalent in academic
settings. Whether decreasing the "door to operating room time" brings
about objective improvements is one of the research questions addressed in their
prospective clinical database.
The acute care surgeon system has proven to be good
for patients and staff. There is more continuous care,
more resident interaction, and better life balance for
the surgeon. When a general surgeon with a significant
practice performs emergency surgery at night, she may
be distracted by major elective cases from follow-up
care of emergency patients in the ensuing days. Family
life is more manageable when the acute care surgeon
can predict times of intense and heavy responsibility
and match family activities and vacation to predictably
lighter periods.
Trauma care is becoming more and more non-operative
because of better imaging. 64-slice CT imaging has
brought a better understanding of the natural course
of solid organ injury. Liver and spleen injuries can be
watched without exploration when it is clear that there
is no bowel injury. Ultrasound helps determine the need
for immediate surgery. It is far better for a patient to go
home without a laparotomy after a small splenic injury;
late rupture is rare if the patient is observant and wellinformed.
Splenorrhaphy is now rarer in adults, but may
be more commonly used in children. If the CT shows
extravasation or aneurysm and the patient is stable
without other visceral injuries, embolization may be the
procedure of first resort.
Trauma surgeons prioritize care in the ER, orchestrating
the interaction with subspecialties such as orthopaedics,
neurosurgery, vascular and thoracic surgery.
Most of the thoracic trauma is managed by the trauma
surgeons at Sunnybrook, while the thoracic surgeons
from Toronto East General provide prompt and excellent
backup.
|
Homer's military practice includes two-month deployment
to Khandahar, Afghanistan every 18-24 months.
He has served there three times and will go again in
October. The spectrum of military injuries is quite
different from civilian practice with more penetrating,
blast, and burn trauma. The surgery is challenging and
there is less subspecialty backup, so emergency neurologic,
vascular and plastic operations expand the scope of
practice for military surgeons. Care is excellent and the
equipment is very good at the Canadian forces hospital.
Expectant treatment of splenic injury is replaced by
splenectomy if the patient requires air evacuation to the
Landstuhl/Ramstein US Army medical center/ hospital
in Germany.
Homer's acute care and trauma surgery group is supportive
of his military practice. He is now the Canadian
forces national practice leader for trauma. Sunnybrook
and the University of Toronto receive good publicity
for their contribution to the Canadian forces' academic
and research activities. Homer now brings military personnel
to Sunnybrook to train, and the surgeons from
Sunnybrook teach at CFB Borden, the Canadian Forces
Base near Barrie. Homer serves as "block leader" for
trauma research for the Canadian forces. He has been
able to help Sandro Rizoli and his colleagues improve the
protocols for hemostasis in trauma, working with a $350
thousand grant for a randomized trial. A larger study in
collaboration with US forces is in the planning stage.
Homer grew up in Hamilton and Toronto. He was
a biochemistry major at Queen's and then attended
McMaster medical school. He is the first in his family to
study medicine. He completed a rotating internship at
Scarborough General Hospital, then served as a general
practitioner in the military for five years - "one of the
best times of my life". He learned from participating in a
counter-terrorism team, travelling to Yugoslavia, Burma,
the Middle East and Tanzania. He learned countermeasures
for biological weapons, hostage rescue, how to
parachute and dive.
All this adventure preceded his marriage to Vivian
during his surgical residency. Vivian has a dental practice
is Stouffville, and together they have three daughters,
Abigail, 8, Julia, 6, and Evalyn, 2. They live across the
street from Sunnybrook. Most of Homer's spare time is
spent participating and watching his children in soccer,
T-ball and other school related activities. He is currently
reading Conn Iggulden's Emperor series, a four-volume
historical fiction about the life of Julius Caesar. He particularly
enjoyed the Henry V module on Leadership
Day. His military experience makes him very appreciative
of the surgical training he received in the Gallie
program, and in particular, the senior surgical training
he received from Tom Gilas at Toronto East General,
Bryce Taylor at Toronto General Hospital, and the entire
Division of General Surgery at Sunnybrook.
M.M.
(1) http://www.surgicalspotlight.ca/Article.aspx?ver= Fall_2008&f=AcuteCareSurgeon
|