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National Trauma Awareness Month (which, as I’ve noted before, happens to coincide with Motorcycle Safety Awareness Month) is probably the best time of year to ask this question, even better than February, which was when an article titled “Trauma Surgery:  Discipline in Crisis” was published.  It’s an interesting read, and basically points out the exaggeration behind what we were all taught in paramedic school:  that “trauma is a surgical disease.”  (Apparently the phrase remains prominent in the ATLS textbook as well.)

Basically, the author paints a picture of trauma surgeons as increasingly demoralized as their lives are strained by the constant on-call nature of trauma surgery, their pocketbooks are strained by the number of uninsured trauma patients, and their experience is diminished as the percentage of trauma team activations that actually lead to an emergency surgery drop into the single digits (particularly for blunt trauma, and pediatric blunt trauma–the author reports that at his hospital, surgeons would see an emergency operation less often than every third year).  The most clear changes that fed this are improved imaging and the discovery that many spleen and liver injuries will heal themselves.

This all raises an excellent question about whether a hospital needs to have a surgeon present at every single trauma activation.  (The correct answer:  probably not.  At the very least, there is no solid proof that the surgeon-centric model is better than the non-surgeon model used in Europe; if anything, there are studies suggesting no difference between the two, even in clearly critical patients.)  More interesting to me, however, is how thoroughly the statistics destroy the myth of trauma being an exclusively (or even a primarily) surgical disease.  Maybe we can throw this saying on the stack of EMS sayings that have no merit, with the “Golden Hour” on the bottom of the pile.

Filed under: EMS