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In the midst of Canada’s months-long blood shortage, researchers and clinicians at St. Michael’s Hospital are examining how gun violence contributes to depleting hospital blood supplies.

Dr. Katerina Pavenski, Head of the Division of Transfusion Medicine and clinical hematologist, Dr. Brodie Nolan, trauma team team lead, physician and scientist, and Dr. Ali Tabatabaey, a senior emergency resident, are collecting data about how much blood it takes to treat gunshot wounds.

“What we’re seeing is that a small percentage of patients – the most severely injured – are requiring the vast majority of the blood products,” says Tabatabaey. “From the perspective of patient blood management if we are able to optimize the treatment of that small percentage it will have a huge impact on overall usage.”

Canada has been dealing with a blood shortage since June. Pavenski says that in the past, shortages have lasted a week or so. To have the problem persist for so long is indicative of a worsening problem.

“What people need to understand is that the blood we have isn’t just for those dramatic violent crime scenarios, but to save the lives of people coming in for hip surgery or heart surgery and for kids who have cardiac defects,” says Pavenski. “We’re now constantly in a state of being one very big bleed away from not having enough blood.”

Trauma events are always going to lead to depletion of blood products – it is the nature of the field. But while most trauma events are unavoidable, gun violence and the injuries it causes could be prevented through regulation, education and social change.

Tabatabaey says that preventing even one major gunshot injury could save many units of blood, making them available to other patients who need them – a possibility that is even more meaningful during a shortage.

Nolan, who also works as a transport medicine physician for Ontario’s air transport service Ornge, says that blood isn’t just critical once patients arrive at hospitals, but also for patients in transit.

“When you’re transporting patients from smaller communities, you need units of blood to get them where they need to go,” says Nolan. “Blood is the bridge that gets them to the operating room and to the surgeons who can repair the damage.”

Dr. David Gomez, an acute care and trauma surgeon and scientist at St. Michael’s, has studied firearm-related injuries and deaths for years.

In one study which, collected data between 2002 and 2016, Gomez and his colleagues identified 6,483 gun-related injuries in Ontario alone, with 2,823 resulting in fatality. Assault made up about 40 per cent of the non-fatal injuries and 25 per cent of fatalities, and self-harm accounted for 1,842 of the recorded deaths. Young men in urban areas and older men in rural areas were more likely to be injured or killed by firearms.

Pavenski says that the idea of doctors staying out of advocacy is a thing of the past.

“If it’s not us advocating then who is going to do it?” she asks. “It’s exhausting watching the patients suffer. Some of these patients haunt me.”

Pavenski says that gun violence is complicated on a case-by-case basis, but even worse when you start to see trends of young, healthy people losing their lives or having to live with life-altering injuries.

Dr. Najma Ahmed, Chief of the St. Michael’s Emergency Department, has been a longtime advocate for ending gun violence. She hosted a conference earlier this year to spread awareness for the cause.

So what can people do to support physicians and protect patients?

“Donate blood,” says Pavenski. “There is really no alternative to just having blood.”

By: Olivia Lavery