The one-line bio on Dr. Trevor Jain’s (MD ’99) Twitter account says: “Emerg doc, pilot, disaster medicine specialist, medivac doc, EMS educator, flight surgeon, PhD student, damage control resuscitation in austere conditions.” Scroll through his tweets and you’ll see him sharing COVID-19 news and medical updates, information on testing and vaccinations, feel-good stories about people who have recovered from the illness and heartbreaking stories about how others have struggled. Dr. Jain is frank and honest, and doesn’t mince words.
The highlights of his Twitter feed, though, are the photos celebrating the unsung heroes of COVID-19 — essential workers who have helped Prince Edward Island deliver one of the country’s most effective pandemic responses. Dr. Jain surprises them at their workplace to present them with the COVID Warrior challenge coin, which is based on military challenge coins presented by unit commanders in recognition of special achievement.
On a Tuesday afternoon in late April, for example, when COVID cases were spiking in neighbouring Nova Scotia and New Brunswick and new lockdown restrictions were being implemented, he dropped by the Island EMS paramedic based in Charlottetown to surprise Darcy Clinton, the paramedic chief for PEI. Scroll further down his feed and you’ll find accolades heaped on a range of COVID Warriors: chief technologist Vanessa Arseneau from the Queen Elizabeth Hospital (QEH) lab, sanitation worker John Kingate, high school vice principal Steve Wynne, Jo-Anne MacPherson of the QEH laundry department, pharmacist Kilby Rinko, paramedic Mike MacKenzie, hospital cleaner Jennifer Vanderaa, grocery store worker Lacy-Jane Kamphuis, and on and on and on. More than 70 people have been bestowed the COVID Warrior coin since the pandemic began.
Dr. Jain, a 34-year veteran of the Canadian Armed Forces and a married father of two, came up with the idea early in the pandemic when he realized most media attention was being given to a handful of health officials, with very little recognition of the contributions of essential workers to battling COVID-19.
“I saw that there was a lot of anger or resentment from people — from healthcare workers but also from grocery store workers and sanitation workers and others — that their contribution to confronting the crisis wasn’t being acknowledged,” he says. “So I asked myself, ‘What can I do to bring attention to these people whose actions every day are helping keep us all safe and limit the spread of the disease?’”
The answer was the COVID Warrior challenge coin, which is inspired by Dr. Jain’s own highly decorated military career. He had the coins designed and made by a fellow veteran and paid for them out of his own pocket. Now, surprising essential workers is not just the highlight of their day but his day, as well.
“It’s a simple way to say ‘thank you’ to people, to make them feel valued and let them know their contribution is just as important as anyone else’s,” he says. “And I feel so honoured to be able to acknowledge these people on behalf of all Islanders. If I’m having a bad day, I know that it will turn into a great day if I’m giving out a coin.”
The response, Dr. Jain says, has been overwhelming, and not just from the recipients who have shed a few tears, shared a few hugs and become internet famous (at least in PEI). “One sanitation worker I surprised was so excited he couldn’t wait to show his kids,” he says.
Other provinces have even reached out with plans to adopt their own COVID Warrior challenge coin initiative, and the Lieutenant Governor of PEI has stepped up by offering to help award the coins. “It’s definitely gaining a lot of traction and starting to grow beyond my ability to administer,” says Dr. Jain.
A parallel from the past
That’s not surprising given his day job as an emergency medicine physician at the Queen Elizabeth Hospital and disaster medicine consultant for the province.
“When COVID hit in January and February of last year, I was hearing from colleagues overseas about how bad it was,” he recalls. “By March, there were a few of us designated to take over our hospitals and get them ready. The hospital stood up its emergency operations centre even before the province stood up its emergency operations personnel,” he says. “I had our incident command structure whiteboarded on a Sunday, by Monday we started putting things into action, and within nine days we had taken the hospital down to 54 per cent capacity, we had a 22-bed negative pressure ICU ready to go and a 30-bed COVID ward with oxygen.” At that point, PEI’s Minister of Health appointed Dr. Jain the disaster medicine consultant for the province. “We got prepared very quickly and because our province took a very hardline approach to health guidelines and to travel and border control, we have been very fortunate in the low number of cases we’ve experienced,” he says.
Reflecting back to when he and his colleagues first began preparing the province for COVID-19, and all of the unknowns they were facing, he says, “it was the same feeling I had during the Swissair disaster.”
Born and raised in Coldbrook, in Nova Scotia’s Annapolis Valley, Dr. Jain earned his Bachelor of Science at nearby Acadia University while serving as a reservist in the Canadian infantry. His sights were set on becoming a plastic surgeon when, at the beginning of his fourth year at Dalhousie Medical School in 1998, he got an early morning phone call from the duty officer at Brigade Headquarters: a passenger jet had crashed in the waters off Peggy’s Cove and the military was assigning him to be the pathology operations officer in charge of designing, setting up and running the makeshift morgue in a hangar at nearby CFB Shearwater.
“The army gave me the best leadership training possible. It’s based on chaos — they give you a chaotic situation and you have to solve it in a calm and methodical manner,” he says. “When I walked into the hangar that morning there was a leadership void.” At 28, he was the youngest person on the team, but through “hard work, example and good humour I was able to get folks to pull in the same direction,” says Dr. Jain, who was awarded the Meritorious Service Medal of Canada by the Governor General for his efforts. He was decorated by the Governor General a second time in 2018 with the Order of Military Merit (officer level), one of the country’s highest honours, for his leadership in crisis situations over his career.
The Swissair experience, which he wrote about in the book Everyday Heroes by Jody Mitic, has left a deep and lasting impact on him. “The first autopsy I will never forget. The amount of trauma the people on the airplane suffered was nothing like I had ever seen,” he wrote in The Guardian to commemorate the 20th anniversary of the crash. “My team did the autopsies on the babies on the flight. These were the most traumatizing and emotionally taxing. I remember asking them to leave the autopsy suite and conducting them on my own.”
Dr. Jain has only been back to Peggy’s Cove once since that time, he hates flying over water, he occasionally smells JP4 jet fuel for no reason, and when he shakes hands, he sometimes finds himself taking mental notes on what the hand looks like. But it’s also made him a better physician, he believes, “stronger but more reflective.”
“After that experience, I realized I like emergency medicine, the unknown, the chaotic environment, solving problems,” he says, which set him on a path to becoming one of Canada’s leading experts in disaster medicine.
Trained for disaster
Disaster medicine is about preparing physicians for mass casualty incidents, “essentially any sort of event or hazard that causes damage for which you don’t have the resources to treat patients in a timely and proper fashion,” he says. More than just emergency medicine, disaster medicine “teaches physicians to wield clinical firepower and medical logistics in the most effective way possible to achieve the most saves and reestablish some semblance of health care in the region.”
The subspecialty is quite new in Canada —Dr. Jain has a master’s degree in disaster medicine from Vrije Universiteit Brussel in Belgium and is working on his PhD—and there are very few who have the credentials and experience he does.
Joining the Royal Canadian Medical Service branch in 2001, he completed additional disaster medicine training at Queen’s University, is dive-medicine and flight-surgeon qualified, and has deployed to multiple global hot spots, disaster areas and war zones, providing medical support to both armed conflicts and humanitarian operations. “I’ve been in some nasty places,” he says, “from being trauma team leader in support of combat operations in the Middle East to medical director of a surgical hospital in post-civil war Bosnia, where we were taking Tiger Team helicopters to get people who were injured by landmines.” In fact, as this story was coming together, Dr. Jain, who continues to serve in the army as the 36 Canadian Brigade group surgeon and deputy commanding officer of the Prince Edward Island Regiment, was preparing to leave Charlottetown for another assignment to an undisclosed location, without any of the comforts of home, where his skills, knowledge and leadership are desperately needed.
In 2008, he joined the Queen Elizabeth Hospital in Charlottetown as an attending emergency physician. He is also medical director for Paramedicine Programs at Holland College and was the driving force behind the creation of UPEI’s Bachelor of Science in Paramedicine degree program in 2017, and now serves as the program’s director. “It started because I wanted paramedics to have the same opportunity to develop critical thinking skills, leadership skills, academic skills and medical skills at a much deeper level than currently available,” he says.
That BSc program admitted just three students to its inaugural class, but in 2020 admitted 25 first-year students, he says proudly.
“Our paramedics in Canada are the Swiss Army knife of the healthcare system,” he says. “You can take a well-trained paramedic and put them anywhere—in emerg, in mental health, in palliative care, in an ambulance, in a helicopter. They are key to any disaster medicine response, and one of the courses they take is disaster medicine and crisis response.”
It was his ability to respond — and to lead — during a crisis that helped shape PEI’s pandemic preparations. “There are three types of power: authoritative, educative and positional. Just because you’re in a leadership role does not make you a leader, especially during a crisis. They will have a lot of institutional knowledge and expertise about policies, processes and procedures, but a lot of times those are barriers to getting things done,” he says. “You will also see natural leaders step up in a crisis, and they need to be recognized, molded, supported and force-multiplied to accomplish the mission.”
That’s what happened to Dr. Jain during his Swissair assignment, and that’s what he’s tried to do during COVID, even with something like the COVID Warrior coin to recognize the contributions of natural leaders within their own organizations, whether it’s a nurse or paramedic or someone working in the laundry department or janitorial services. “When you see those people using their own personal leadership and solving problems at the lower levels that impact problems at the higher levels, that’s something to be celebrated,” he says. “In the same way, I really think the health-care system needs to open its eyes wide, identify the natural leaders and empower them to take action and make decisions.”
Follow Dr. Trevor Jain on Twitter @TrevorJain.