At the forefront of resuscitation science

March / April 2018   Comments

Clinician, educator and scientist Matthew Douma is one of only a few nurse leaders in his field

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Matthew Douma first used a life-saving technique he now teaches to first responders on the day a man was shot metres in front of him.

On Aug. 15, 2012, Douma was out walking his dog after his shift as a staff nurse in the emergency department of Edmonton’s inner-city Royal Alexandra Hospital. He heard men arguing in the parking lot of a nearby restaurant. Then came multiple gunshots.

Douma dropped until the gunshots stopped. Then he tossed his dog back into his backyard and jogged to the scene. As soon as it was safe, he ran to the victim to check his breathing and secure his airway. The man, who had been shot several times in the abdomen, pelvis and high in his thigh, was bleeding profusely, barely breathing and unresponsive.

Douma tried a tourniquet, but it didn’t stop the bleeding. “His death was imminent.”

Then Douma remembered an obstetrical technique to stop internal hemorrhage he’d learned during pre-deployment training for an internship with UNICEF and had watched midwives use in Vietnam. He made a fist, covered it with his other hand, and placed it between the man’s belly button and sternum. Douma pressed down hard, creating a non-surgical aortic cross clamp.

“The bleeding stopped. He regained consciousness, and we were able to speak with him.”

For about 12 minutes, Douma and an off-duty paramedic who rushed over to help kept the man alive. But after being transferred to paramedics who did not know how to perform external aortic compression, the man lost vital signs. He eventually died in hospital. That’s when Douma resolved to study the technique and teach it to others.

At one point, the off-duty paramedic, a slightly built woman, had tried to assume the aortic compression. But she wasn’t able to apply sufficient pressure to stop the bleeding entirely.

“We determined that a heavier person might have to perform this intervention. Out of that clinical case came the first research questions,” Douma says.

He has has since studied, researched and published on how the technique can be applied to life-threatening hemorrhage from the abdominal-pelvic region — the leading cause of potentially survivable death in conflict zones. He’s also used it successfully in other instances to keep patients alive long enough to get them to definitive care.

Convinced of the importance of nursing’s potential contribution to resuscitation science, Douma enrolled in 2012 in a master’s in nursing (nurse practitioner stream) and a collaborative specialization in resuscitation sciences at the University of Toronto. Non-compressible junctional hemorrhage was his research focus. He completed the specialization program in 2016, then transferred into the health systems leadership and administration stream to complete his degree and focus on research and system change.

Now in the role of clinical nurse educator in the ED, Douma has the opportunity to teach life-saving skills every day. He holds CNA specialty certification in emergency, critical care and cardiovascular nursing; last year he led one of the largest ever emergency nursing exam preparation study groups, mentoring and setting up synchronous and asynchronous learning sessions for exam candidates from the ED. “Specialty certification is an important tool for demonstrating proficiency in a nursing specialty,” he explains. “I think it is an essential part of progression within our profession.”

In his capacity as a resuscitation scientist, Douma is an adjunct professor at the University of Alberta’s department of critical care medicine. He also leads RescueScience.org, a working group of multidisciplinary colleagues on three continents. Relentlessly and passionately pursuing reductions in traumatic injury and cardiac arrest is the group’s goal, he says. The members volunteer to develop curriculum, share clinical resources, train students and conduct research on various life-saving practices, including external aortic compression.

“What our group has done is translate a manoeuvre that has been used in obstetrical and midwifery care — probably for centuries — without ever having been rigorously studied,” he says. “We’ve used it clinically, studied its effectiveness and then updated trauma life support guidelines to include it.”

Douma likens knowing how to perform external aortic compression to learning to use the Heimlich manoeuvre.

“We believe in this. We think it can be used. People just have to know when and how to use it.”

His interest in life-saving techniques comes from his roots, first as assistant captain of the First Aid Ski Patrol on Grouse Mountain in North Vancouver, where he grew up, and a member of the Central Fraser Valley Search and Rescue team, and then through his experience in disaster and relief work after completing his undergraduate nursing degree at the University of the Fraser Valley.

Currently, Douma, 35, is a doctoral student at University College Dublin, researching the quality of cardiac arrest care. He’s combining distance education with periodic in-person sessions in Ireland and his hospital shifts, and raising his two young sons, with his partner, Katherine Smith, an emergency physician.

“I’m a parent, a clinical nurse educator and a resuscitation scientist, in that order,” he says. “I am grateful to have so many generous colleagues and my family, who support me to function at the intersection of these roles.”


10 questions with Matthew Douma

What is one word you would use to describe yourself?
Disruptive

What are you most proud of having accomplished?
My relationship with my kids

What is one thing about you that people would be surprised to learn?
I believe traditional academia is failing our profession

“If I had more free time, I would...”
Have a bigger garden

Where did you go on your last vacation?
Fredericton

Name one place in the world you’d most like to visit.
Pyongyang, North Korea

What is your biggest regret?
Not speaking up more

Who inspired you to become a nurse?
Walt Whitman (1819-1892), who wrote The Wound Dresser

What was the best piece of career advice you’ve received?
Make eye contact, smile and introduce yourself

Name one change you would like to make to the health system.
Have the calls to action of the Truth and Reconciliation Commission taken seriously

Laura Eggertson

Laura Eggertson is a freelance journalist in Ottawa.

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