A new coalition of Canadian health-care workers is hoping to “revolutionize” frostbite care in Canada, in part by promoting a groundbreaking treatment protocol popularized years ago by several Yukoners.
Whitehorse General Hospital surgeon Alex Poole and pharmacist Josianne Gauthier — who are part of the new Canadian Frostbite Care Network — published a study in 2016 which described a treatment for severe frostbite using a drug called Iloprost.
Since then, the approach has been used on Himalayan climbers in Kathmandu and saved fingers and toes in Helsinki. But it’s still not widely used in Canada, where conventional frostbite treatment can require patients to wait months before eventually receiving amputations.
Iloprost was approved by the FDA for use in the U.S. earlier this year, but is still not commercially available in this country. It currently requires a special access request to Health Canada.
Dr. Catherine Patocka is an emergency room physician and department head for emergency medicine at the University of Calgary. She remembers reading the article by Poole and Gauthier back in 2016.
“It was galvanizing for some of our leadership here who said, ‘well, why aren’t we doing that in Calgary?'” said Patocka. “We see lots of frostbite. It seems like we could have a major impact on a particularly vulnerable population.”
Frostbite frequently disables people already affected by homelessness or struggling with substance abuse.
“The goal is always to try and help patients move through that and return to a life where they don’t struggle with those challenges,” said Patocka. “And you can imagine that keeping your digits, your feet, your toes, is incredibly important in order to be able to walk around and make a living for yourself.”
Patocka credits the treatment protocol popularized by Poole and Gauthier for helping reduce amputation rates in her city.
The treatment is now available in most areas of B.C., some areas in Ontario and Quebec, and in Calgary. But with frostbite amputations on the rise in Edmonton, Winnipeg and Toronto, there’s still a ways to go.
What’s taking so long?
Over email, a Health Canada spokesperson told CBC News that the onus is on drug companies to sponsor new medications and “present substantive scientific evidence of a product’s safety, efficacy and quality.”
But if a company chooses not to begin that process, drugs like Iloprost can remain difficult for Canadian physicians to access. CBC News reached out to Iloprost manufacturer Bayer for comment but did not receive a response.
Several doctors also told CBC News that as provinces and territories have separate, independent health authorities, it can take time for new treatment approaches to become standard practice nationally.
It can also depend on the willingness of individual physicians to research new treatments and advocate for their use.
“It underscores the tremendous amount of work that Dr. Poole, the physician who originally published the protocol, must have done to try and improve care for those patients he was seeing in the Yukon,” said Patocka.
Frostbite data ‘pretty slim’
Poole said the treatment he and Gauthier introduced in the Yukon helped reduce the amputation rate for the most serious frostbite cases by 50 per cent in the first five years they began using Iloprost.
The Canadian Frostbite Care Network aims to improve treatment of frostbite and to understand the full scope of its impacts across the country.
“Most of the data related to frostbite is pretty slim,” Poole said. “We do know some stuff, but we don’t know nearly as much as we’d like to know.”
Poole says every winter, the Whitehorse hospital receives calls from doctors across the country looking to get advice on treating frostbitten patients.
He would like to see a national database for frostbite cases, as well as a better avenue for health-care workers to share their findings and compare notes – and he’s hoping the Canadian Frostbite Care Network can help.
“We see a handful of bad cases in the Yukon every winter. But if we spread this across the country, if we’re collecting data from all the cases, then we would probably be able to understand frostbite a lot better.”