Trauma teams at Toronto’s St. Michael’s Hospital spent countless hours in the last year and a half trying to shave minutes and seconds off treatment times for critically injured patients.

But in the type of Level 1 trauma centre the hospital opened this past week to the city’s most gravely injured patients, minutes and seconds are the medicine of life.

Victims of shootings, stabbings, beatings and the more casual calamities of the town’s daily run — the falls, the crashes, the fires — will make their way here to be assessed and resuscitated.

And in mayhem’s wake — with people on the brink of death — the quicker, more co-ordinated and efficient the treatment, the greater the chance of survival, says Dr. Bernard Lawless, medical director of the hospital’s trauma program.

“This room has a much better layout to more smoothly, efficiently manage patents as they come through the doors,” says Lawless, who was dressed casually and sporting a mohawk haircut.

The shiny new equipment is certainly an upgrade in the incremental way that new versions of technologies typically improve on the older — like the stuff arrayed in the former trauma bay down the hall. But it’s the placement of those lights and monitors and things that go “peep” — the logistical layout of the cabinets, the shelves, the smallest details — that will make the most difference, Lawless says.

And co-ordinated order in a trauma bay is likely more critical than in any other medical setting.

“This room is designed to bring in the sickest, most severely injured, unstable patients,” says Lawless.

Trailing close on the toes-up heels of those souls in limbo would be a masked parade of nurses, respiratory therapists, X-ray technicians, anesthetists, emergency room physicians and trauma and orthopedic surgeons.

These professionals would converge on either of the room’s two beds — which can be doubled to four during mass-casualty events, such as 2018’s Yonge St. van attack and Danforth shootings.

“You can imagine having that many people respond to one patient, there is a lot of co-ordination that’s required,” Lawless says. “So one of the interesting things about this space is that there have been simulations to inform what is the best way to set this room up.”

Those simulations — complete with dummy patients — were conducted in part in empty offices in another part of the hospital that were built out to the same dimensions as the new bay and fitted with mock equipment.

They were co-ordinated by Dr. Andrew Petrosoniak, an emergency room physician who specializes in simulation-based technical skill acquisition.

“You’re going to do a pop quiz: where are the chest tubes?” Petrosoniak asks a reporter, standing beside a cabinet with that piece of equipment marked in hand-sized letters on its front.

“Subtlety is not something we’re interested in. We want it just right in your face,” he says.

Petrosoniak says every detail of the room — from signage, to equipment placement, to sight lines — has been designed to make the flow of the gravest emergencies as smooth as possible.

“If you’re taking care of a gunshot wound, then you have to be able to do things in an incredibly fast, timely manner,” he says. “They need blood quickly, maybe they need to be intubated, they might need a chest tube (and) if you don’t design things well, it’s going to take a while for these interventions to happen.”

Thus space around the treatment tables, for example, was designed through the simulations and consultations to accommodate every technician, nurse or specialist that any set of injuries might require.

“We want to have an entire team be able to kind of get right on a patient from all angles,” he says. “And vital signs are vital for a reason … so we don’t just want one monitor, we want to make sure that nowhere in this space can you not see the patient’s heart rate, blood pressure, everything like that.”

Planning for the new space also included running simulations in the relatively cluttered and dingy older bay about 20 metres down the hall.

“That was to understand what people do,” Petrosoniak says. “Then once you understand … their needs and all the challenges that they feel on a daily basis — the annoyances with certain design features and the work-arounds — then suddenly you can make a design that people want.”

Petrosoniak compares his work with the safety testing employed in the automobile industry.

“You wouldn’t get in a car is it wasn’t crash-tested beforehand,” he says. “That’s the expectation of the driver and the user.

“And we expect that no space here in the trauma bay is rolled out until it’s tested fully. As a patient I would want to make sure that the space is designed for my needs and the (needs of the people) taking care of me.”

Loading... Loading... Loading... Loading... Loading... Loading...

Nurse educator and trauma veteran Candis Kokoski — who also helped in designing the room’s set-up — says the new space will ensure those needs will be met.

Kokoski says, for example, that all the medications and supplies her nursing colleagues might need have been placed in one accessible side of the room, where they were often lost in a warren of shelves, cupboards and partitions in the old bay.

As well, she says, the simple deployment of equipment on the side of a patient where it makes most sense to have it has led to sizable improvements.

“It kind of just spreads people out a bit so that they’re not tripping over each other, which is amazing.”

This fresh orchestration will be centred on patients for whom only one thing is certain. They will come in increasing numbers.

Lawless says a combination of general population growth and larger concentrations of vulnerable people such as the homeless downtown are increasing the volumes of severe trauma cases rushed into the hospital every year.

As well, he says, new triage algorithms employed by emergency medical services are directing more patients straight to St. Mike’s instead of taking them first to the closest hospital as has often been the case in the past.

Lawless says the unit can treat a dozen or more people a day and will likely see some 800 patients roll in this year.

The new centre is part of a multi-year, multimillion-dollar renovation of the hospital’s vaunted emergency department. The hospital said it couldn’t attach a cost to the new centre.

St. Mike’s is one of two Level 1 adult trauma centres in the city, the other being housed at North York’s Sunnybrook hospital. Toronto’s Hospital for Sick Children runs a pediatric trauma unit.

“Sunnybrook’s trauma bay has three stretchers that are always at the ready, 24/7,” hospital spokesperson Laura Bristow said in an email. “In the event of a mass casualty incident, Sunnybrook can expand its trauma capacity into a specially designated zone with additional beds,” Bristow said.

In case of large-scale events patients would be split between St. Mike’s and Sunnybrook, with triage teams determining treatment orders. St. Mike’s was the main trauma site for the Danforth shootings ion July 2018, as well as the Raptors parade last summer.

The new room has the hospital’s trauma teams excited, says Dr. Carolyn Snider, chief of emergency medicine at St. Mike’s.

“I can’t wait to work Sunday night, my trauma shift,” Snider said during an interview in the centre this past week.

“This space and design allows us to just step it up even more and that’s really exciting.”

But in the end, Lawless says, the new space is just a more co-ordinated complement to the emergency staff who will populate it.

“If we didn’t have the right people with the right enthusiasm and the energy for looking after multi-system injured patents … then this room would not realize its potential.”