Myles is a 24-year-old male arriving at a tertiary trauma centre from Manitoulin Island after a witnessed jump off a local railway crossing bridge. Myles was initially brought to the local community hospital where ATLS protocol was initiated by the rural ER physician. He was found to be hypotensive 82/45 mmHG, tachycadiac 120 bpm, and hypothermic at 34.5 C. X-rays revealed a pelvic fracture, a pneumothorax requiring a chest tube and bilateral open calcaneal fractures. Myles was then stabilized and transferred to the nearest tertiary centre 2 hours away via helicopter. Myles is well known to the local ER team in his home community of Zhiibaahaasing First Nations on Manitoulin Island for persistent suicidal ideation episodes. Myles comes from a large close-knit family with many of his relatives reunited over the past few years due to their own issues with being victims of the Residential School Act in their early years. Myles has tried to take his own life on several occasions, stating “I cannot take the pain forward from my ancestors anymore, it must die with me”. According to his sister and uncle, Myles began consuming more illicit substances and marijuana after his father took his own life 10 years ago and his mother was unable to take care of Myles and his siblings. His mother moved away, and Myles and his siblings were split up amongst several family members and placed in foster care. Despite leaving high school in grade 10, Myles has had some landscaping jobs and tree planting jobs over the past few years. Myles has been sent on two occasions to rehabilitation centres in Ottawa for substance abuse, but feels his problems are not addressed in these environments due to lack of cultural awareness. Myles enters the ER setting intubated with a chest tube in situ as well as a pelvic binder on. His lower extremities are in soft splints with dressings applied. The transfer team established additional IV access and has administered 2L of crystalloid fluids on route as well as rewarmed patient as he was quite cold when he left the Manitoulin hospital with a temperature of 35.4 degrees. They also report that Myles was given antibiotics and tetanus before leaving