• 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
The Golden Hour Concept

Dr. R Adams Cowley is known as the Father of Modern Trauma Surgery. After being trained as an open heart surgeon, he knew that the lives of trauma patients bleeding profusely from wounds could only be saved in an operating room, in a Shock Trauma Center.¹ Dr. R Adams Cowley had clearly identified a goal for his life, "I want to save the lives of injured Americans."

Dr. Cowley's concepts of trauma care began in the mid-1950s, when his studies of shock in animals demonstrated the importance of immediate care.² He focused on the trauma patient who had lost blood, suffering an extreme drop in blood pressure. When he took a quart of blood from an anesthestisized laboratory animal, Dr. Cowley caused the animal to develop shock or critical low blood pressure. By returning the blood to the animal quickly, the animal would recover. If the animal remained in shock more than 1 hour, the "golden hour," death came slowly and inevitably to all animals. Dr. Cowley had developed a simple, but revolutionary concept. He related the duration of shock directly to life expectancy. He concluded that the trauma surgeon must restore the patient's blood pressure within that "golden hour" to save the patient's life.

Cowley built upon the classic foundation of Walter B. Cannon's book Traumatic Shock, published in 1923.³ Cannon's experience grew out of his investigations as an investigator in combat surgery during the battles in France during World War I. Dr. Cowley's early clinical studies of shock in trauma and critically ill patients were funded by an Army Research Development Contract, which later supported the development of his two-room Clinical Shock Trauma Research Unit in 1961.

Patients dying from all types of shock were transferred to this Research Unit only as a last resort. When all conventional measures of treating shock had failed Dr. Cowley applied to the trauma patient and other shocked patients the same monitoring used in open heart surgery. Shock causes the heart to fail, if this can be anticipated, the patient will survive. Half the patients brought to this did not die. Cowley realized the potential impact of this care on the 50,000 people who were dying on the Nation's highways each year, more than 800 in his own state of Maryland. If he had a big enough trauma center, he knew he could save at least half of these lives lost in Maryland.

REFERENCES:

¹ Edlich RF, Wish JR, Britt LD. An overview of revolutionary advances in emergency medical care in the United States. J Long Term Eff Med Implants 2004; 14: 375-399.

² Franklin J, Doelp A. Shocktrauma. New York: St. Martin's Press, 1980:11-12.

³ Cannon WB. Traumatic Shock. New York: D. Appleton Co., 1923.