Toronto shootings take toll on hospital staff, emergency room doctor says

Trying to save the lives of people shot in Toronto takes an emotional toll on hospital doctors and nurses, says an emergency room physician at St. Michael's Hospital.

Dr. James Maskalyk is the author of Life on the Ground Floor: Letters from the Edge of Emergency Medicine

Two Toronto police officers stand on Queen Street West after a fatal shooting. Jahvante Smart, 21, and Ernest Modekwe, 28, were killed that day. A woman was also injured in the shooting. An emergency room doctor at St. Michael's Hospital says gun violence affects people trying to save the lives of those injured. (Neil Herland/CBC)

Trying to save the lives of people shot in Toronto takes an emotional toll on hospital doctors and nurses, said Dr. James Maskalyk, an emergency room physician at St. Michael's Hospital.

"As a human being, I can testify to the sadness of being in a trauma room when someone dies from it," said Dr. Maskalyk during an interview on CBC Radio's Metro Morning on Monday.

Grief that follows a shooting death is not confined to family members and friends of victims, according to Maskalyk.

The death toll from the rash of gun violence in the city is at 24. It has many in the city worried. At Toronto hospitals, ambulances pull in with the victims and the injured. Doctor James Maskalyk talks about the scene that plays out in emergency rooms. 7:32

It envelopes hospital staff as well because staff know that, when a person dies of gunfire, the lives of everyone, the dead, the injured, families, friends, and even the shooter, will never be the same. Gun violence creates much sadness, he said. 

"Bullets are designed to kill and maim. As soon as they enter human flesh, they start to break apart or collapse and tumble, creating greater and greater wounds," said Maskalyk.  
Dr. James Maskalyk, author of Life on the Ground Floor: Letters from the Edge of Emergency Medicine, says: 'We practise for this. We're prepared for it. But there's also that very human part that we endure.' (Michael Banasiak)

While staff do their work, shocked and grieving loved ones are often at the hospital. The environment can be intense, he said. Afterwards, images can reoccur in thoughts and dreams of staff, he added.

'Very human part that we endure'

"There's a certain emotional toll that it takes on the people who are working there. We practise for this. We're prepared for it. But there's also that very human part that we endure."

Maskalyk spoke after two shootings on the weekend that claimed the lives of two more men, one block apart in North York. A shooting early Sunday killed a man, 25, near Driftwood Avenue and Jane Street, and a shooting early Monday killed a man, a block north at Shoreham Court and Shoreham Drive. 

The deaths are the city's 53rd and 54th homicides of the year, according to Toronto police. 

Maskalyk, author of Life on the Ground Floor: Letters from the Edge of Emergency Medicine, said shootings also have an immediate impact on emergency rooms because once staff have been told that a wounded person is on the way, staff swing into action. Less urgent cases have to wait. 
The entrance to the St. Michael's Hospital emergency room in downtown Toronto. (Google Street View)

"Multiple shootings stretch us thin," he said. "Things really get backed up for us. People wait longer, which is frustrating for them. Frustration levels go up for everybody."

Hospitals react to 'snippet of information'

When a shooting occurs, emergency crews are called, and paramedics who arrive at the scene alert a hospital that a patient is being transported, he said. Paramedics report the location of the shooting and the severity of injury.

"We get a snippet of information from the medics on the scene. And they contact the triage nurses at the hospital to help them prepare for their arrival," he said. "Depending on that piece of information, the nurse at the triage desk activates the trauma call. The trauma code goes out to members of the trauma team, including people like myself."

The triage nurse will be told whether the injury is considered tier 1, which means grievously injured and unstable, or tier 2, which means less severely injured and more stable. In tier 1 cases, an operating room could be opened to prepare for surgery. A surgeon could be called. In tier 2 cases, staff are more likely to assess the condition of the patient once he or she is in the trauma room, before preparing for surgery. It's more of a wait and see situation, he said.

"The medics are making these calls in very real time, in urgent, busy situations, sometimes in difficult circumstances. Then you wait in the trauma room to see what the patient is actually like when they actually crosses the threshold." 

All of this happens quickly, he agreed.

Entry wound small, damage much larger

Bullet can cause major internal damage, hitting bone and tissue, and patients can bleed profusely. While a gunshot wound may appear as a small entry wound, the damage inside is much larger, he said.

With files from Metro Morning