• History of Trauma Surgeon and Physicians Contribution to the Development of a Level 1 Trauma Center at Emanuel Hospital
   
• History of Trauma Centers and Trauma Systems

History of Trauma Centers and Trauma Systems
Calls for Action to Decrease the Death and Disability Rates from Traumatic Injuries

In 1966, the Committee on Shock and the Committee on Trauma of the Division of Medical Sciences of the National Academy of Science/National Research Council wrote a white paper, “Accidental Death and Disability: The Neglected Disease of Modern Society.” This document was prepared after three years of deliberations and is considered the inaugural event in what was to become a sustained effort sponsored by the U.S. government to deal with accidental injury as a public health problem.¹ This publication outlined the enormous magnitude of the personal and financial losses resulting from accidental injury to include the tragedy of death among the young, the personal costs of disability, and economic costs of trauma amounting to billions of dollars. The authors emphasized that the scope of the problem was even more concerning because the public had developed an attitude toward trauma care as we are doing the best we can. “Accidents and deaths happen.”

Ignoring the public's sentiment of indifference, the authors outlined a broad program of action that included training, education, and research to improve the expertise and fund of knowledge available regarding treatment, in particular emergency medical care. The authors believed that there could be a cooperative effort between medical professionals and the public, with the federal and state governments providing guidance and allocating funds for these projects.

This revolutionary manuscript made recommendations for the care of seriously injured patients. It pointed out that optimal treatment must begin in the prehospital phase, with ambulance services using established standards, including vehicle construction, equipment and staffing and credentialing of fully trained ambulance attendants. It emphasized that radio communication technology was essential for a timely dispatch to call for help. It spoke to the need for the emergence of a new specialty of physicians with special training in immediate care, providing additional support to Jim Mills' dream of having a specialty of emergency medicine.

This website asked that outside agencies with regulatory authority categorize hospital capabilities. Four categories were described that varied from first aid facilities to fully capable trauma centers able to manage all trauma patients. The committee believed all hospitals and care providers should be held accountable for patient outcomes. The development of registries of valid and reliable data would ensure that information from autopsies would be available to examine the outcomes of care. Moreover, the report pointed out that investment in prevention of injury though sponsored research, public education, or government regulation would have enormous benefits in reducing healthcare costs. Most importantly, the paper pointed out that the budget for injury research was inadequate, and it recommended the establishment of a National Institute of Trauma within the Public Health Service.

Congress appropriately responded to the accidental death and disability report by enacting legislations, the National Highway Safety Act of 1966 (Public Law 89-564), which had a profound effect on the treatment of the trauma patient in America.² The department of Transportation was given the responsibility to allocate money as well as instruction to implement the Law. Because one of the goals of the legislation was to reduce injury to occupants in motor vehicle accidents, this research resulted in the development of effective car safety devices. The bill also identified systematic changes that should improve the care of injured patients, including expanded capability for radio communication and the use of helicopters for medical evacuation of injured patients to hospitals. Funding of ambulance services was integrated into the National Highway Traffic Safety program.

In the beginning, Maryland, Florida, and Illinois were the major benefactors of the Federal Programs funded by the National Highway Safety Act of 1966. These states revolutionized the development of regional emergency services programs, including trauma systems. Under the leadership of R Adams Cowley in the Maryland Institute for Emergency Medicine, the University of Maryland Hospital joined with the Maryland Police Aviation Division in a revolutionary transport program.

REFERENCES:

¹ Committee on Trauma, and Committee on Shock, Division of Medical Sciences, National Academy of Sciences/National Research Council (US). Accidental Death and Disability: The Neglected Disease of Modern Society. Washington: National Academy of Sciences; 1966

² Highway Safety Act of 1966, Public Law No. 89-564, 89 Stat. 3052.