The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.

Oct. 11, 2009
Oct. 13, 2009
Oct. 15, 2009

Contents:
• Evolution of trauma care in the U.S. should focus on inclusive systems
• Surgeon shortage one area that health care reform should address
• National Safety Council Surgeons’ Award for Service to Safety
• Distinguished Philanthropist Award
• Award-winning geneticist to participate in Surgical Forum
• Young Fellows Association debuts
• Bernard Fisher, MD, FACS, is recipient of 2009 Jacobson Innovation Award
• No easy answers to medical industry support for CME
• Commission on Cancer Paper Competition winners announced
• ACS-Emerson Scholar-in-Residence in Medical Ethics established

Scudder Oration
Evolution of trauma care in the U.S. should focus on inclusive systems

The general public might be surprised to learn that as many as 38 percent of the U.S. population may not be covered by a statewide trauma system, explained A. Brent Eastman, MD, FACS, Vice-Chair, ACS Board of Regents. These findings, culled from the 2009 COT State Chair Survey, emphasize the need to enhance trauma systems in all states to ensure optimal emergency preparedness for all U.S. citizens, said Dr. Eastman, chief medical officer and N. Paul Whittier Chair of Trauma of Scripps Health in San Diego, CA, during his Scudder Oration on Trauma, Tuesday morning.

“Inclusive trauma systems are designed to ensure expeditious transfer to the appropriate level of care commensurate with the patient’s injuries—whatever the geographic location, hence my title: “Wherever the Dart Lands,” explained Dr. Eastman. During the session, titled Wherever the Dart Lands: Towards the Ideal Trauma System, Dr. Eastman also underscored the importance of an inclusive system, which should include not only major injuries, but minor and moderate injuries as well.

“Everyone living or traveling in the U.S should be able to expect prompt transport to the appropriate level of care proportionate with their injuries,” added Dr. Eastman. “That’s the vision [I have] when I say that wherever the dart lands on a map of the U.S., there should be a system of care [in place] to take care of you if you suffer from a traumatic injury.”

“Prior to 1966, there were no formal trauma centers or trauma systems, but there were certainly trauma surgeons,” noted Dr. Eastman. “Trauma centers and trauma systems are only successful because of the volunteerism, commitment, and passion demonstrated by surgeons.”

The 2009 COT State Chair Survey revealed three distinct problem areas for trauma care in the U.S today: Lack of funding, political barriers, and leadership-related issues. “I would submit that trauma care in the U.S. needs a surgeon,” said Dr. Eastman. “We must bring this message to the health care reform debate.”

As an ideal model of an inclusive trauma system, Dr. Eastman pointed to the highly developed trauma systems for Iraq and Afghanistan, where the injured are readily transported from combat zones to sophisticated care in-field hospitals, combat support hospitals, the more advanced Landstuhl Regional Medical Center in Germany, and eventually to the continental U.S.

“The military has developed a superb Joint Theater Trauma System, and this system is a lesson for rural trauma care,” noted Dr. Eastman, after remarking on the growing crisis in accessing trauma care in rural America, fueled in part by the growing shortage of general surgeons who take emergency trauma call in hospitals.

Assembling, for the first time in a formal setting, maps of the U.S. that show death rates due to trauma per 100,000 population, travel times to the nearest trauma center and populations of surgeons, Dr. Eastman showed that a combination of a shortage of surgeons and gaps in regional trauma systems has stymied access to timely, appropriate trauma care in many areas of the country. This has led to unnecessarily high health rates due to trauma in those areas, and has contributed to the fact that trauma is the leading cause of death for those under the age of 45 in this country and in developing countries around the world.

Dr. Eastman’s presentation included several patient stories that highlighted the “triumphs” of trauma systems, including the story of Johan and Jenna Otter, a father and his daughter who survived an attack by a grizzly bear in Glacier National Park in 2005. In addition, Marine CPL William Gadsby, who lost his right leg in Iraq, was present and offered the chance for session attendees to acknowledge both CPL Gadsby’s service and to pay tribute to the military surgeons in the audience.

“Our challenge, as surgeons, is to persuade the powers that be to support inclusive trauma systems,” said Dr. Eastman in his closing remarks as he called on fellow surgeons to advocate for trauma systems in states or regions where fully developed states are still lacking.