Emergency Medicine Research Series: Emergency medicine researcher strives to optimize trauma care

“In this Emergency Medicine Research Series, the Department of Medicine will be highlighting the work of dedicated physicians and researchers who are shaping the future of patient care. These features will delve into the research and clinical advancements of leaders in the field of emergency medicine, focusing on how they address some of the most pressing challenges in healthcare today. From improving patient outcomes in high-pressure environments to incorporating cutting-edge technologies, these researchers are at the forefront of transforming emergency care.” – Dr. Erin O’Connor, Department Division Director for Emergency Medicine

In the high-stakes world of emergency medicine (EM), Dr. Brodie Nolan is using research to rewrite the rules of trauma care.

Dr. Nolan is an EM physician, clinician scientist and trauma team leader at St. Michael’s Hospital, as well as a transport medicine physician for Ornge, Ontario's air ambulance and critical care transport provider.

“When I was an undergraduate, I remember seeing someone collapse in front of me and paramedics rushing in,” says Dr. Nolan. “It was very intense and I thought, ‘that’s really cool; I want to do that.’”

This experience, along with having friends involved in emergency services as paramedics, helped to shape his career path. Dr. Nolan’s initial interest in research started with a desire to create change in the emergency care system during his residency.

“What I found as I was becoming more familiar with the system is that there’s aspects of it that could work better,” he says. “While talking about it wasn’t an effective way to create change, you could use research and data to show that things either are or aren’t working well, and that could be a lever to then improve the system.”

During residency, Dr. Nolan began working with Ornge, sparking his fascination with how air transport is used within Canada. While data indicates that patients with severe injuries generally have a better chance of survival the earlier they are brought to a trauma center, transportation, triage delays and other logistical challenges can hinder timely transport.

“If you’re severely injured, you need to be at a trauma center within 60 minutes of your injury, which is impossible for about 40% of the population in Ontario due to geography,” he says.

To address this barrier, Dr. Nolan and colleagues established FIRST60, an inter-professional team of clinicians, researchers and trainees seeking to understand and improve care from time of injury or illness to acute resuscitation.

“I wanted to bring together like-minded individuals interested in this research space, and that has encompassed paramedics, nurses, EM physicians, trauma surgeons and others,” he says.

The community now consists of junior, mid-career and senior investigators, as well as graduate students and frontline clinicians, who mentor each other and supplement their clinical experiences.

“Trauma is a disease that can affect young, otherwise healthy people, and these are devastating injuries that take a long time to recover from,” says Dr. Nolan. “If we can't get patients to a trauma center within 60 minutes, then how best can we deliver emergency care to try to optimize them.”

Another project Dr. Nolan is passionate about is the Study of Whole Blood in Frontline Trauma (SWiFT Canada), a pilot randomized controlled trial assessing prehospital whole blood versus component therapy in traumatic hemorrhage. The study involves randomizing patients to receive whole blood compared to specific blood components such as red blood cells or plasma in the prehospital space to determine how that affects outcomes down the line.

Prior to the 1960s, blood transfusions were performed using whole blood. However, the invention of separating blood into its individual components later became the standard of care and blood transfusions changed to primarily giving patients only the components they need. In recent years, new filters have been developed that reduce the white blood cells in donated whole blood, lowering the risk of transfusion reactions while preserving plasma and platelets.

“This makes whole blood a safer and more efficient option in emergency settings as it allows a single unit of blood to be used rather than several units of red cells, plasma and platelets,” explains Dr. Nolan. “It also means that whole blood can be used on a helicopter or plane, as platelets can’t be optimally stored in that environment.”

With SWiFT Canada being the first prehospital transfusion trial in Canada, Dr. Nolan and his team are eager to evaluate the effectiveness of whole blood transfusions in civilian emergency care.

Dr. Nolan is also working with Ornge to refine trauma center triage criteria, ensuring patients are transported to the appropriate facilities.

“Some symptoms are strong indicators of a patient needing to go to a trauma center, however, other symptoms are not as predictive and it’s possible that a patient may be severely injured despite not showing specific signs,” he says.

In 2021-2022, Ontario's Regional Trauma Networks identified hospital sites to function as Level III trauma centers, which manage single-system injuries and triage or stabilize multi-system injuries for transfer to a Level I or II trauma center. Dr. Nolan is now working to determine how triage checklists can be adapted to better determine which patients need to be transported where.

Looking to the future, he hopes to establish FIRST60 as a leading international center for prehospital trauma and resuscitation research. FIRST60 is excited to be hosting an inaugural Toronto Resuscitation Conference, in partnership with Ornge, this June.

Additionally, he is exploring the integration of artificial intelligence and machine learning in trauma resuscitation, including real-time patient monitoring to optimize decision-making and reduce cognitive burden for medical teams.