Emergency Traumatologist or Trauma and Acute Care Surgeon: Decision Time

摘要

Imagine this scenario: your phone rings at 11 PM, and a nurse who is working in the community trauma center informs you that your son has been injured in a high-speed motor vehicle crash and presented in shock. The nurse tells you that there are obvious head and extremity injuries and an enlarged mediastinum on the initial chest x-ray. As you hold the line, waiting to speak to the physician in charge, do you pray that the physician will be an emergency "traumatologist" who assures you that they will do a thorough evaluation, including a CT scan of the head, neck, chest, abdomen, and pelvis, and then call in surgeons as necessary; or a trauma surgeon who is experienced in assessing multiple injuries, tailoring resuscitative efforts, prioritizing diagnostic testing, and conducting emergent operative intervention as required? Since 1976, the American College of Surgeons Committee on Trauma has advocated that the trauma surgeon in designated trauma centers be integrally involved in all aspects of the continuum of care ("road to rehabilitation") for critically injured patients. A recent evaluation of outcomes of patients treated in trauma centers versus nontrauma centers confirms that risk of death is considerably lower when care is provided in trauma centers meeting the American College of Surgeons Committee on Trauma Level I criteria, including the immediate presence of an experienced trauma surgeon in the emergency department for all critically injured patients. The recent report by Grossman and his colleagues in the University of Pennsylvania Trauma Network challenges the American College of Surgeons Committee on Trauma's fundamentals and contends that an emergency physician with an additional year of training in a trauma fellowship can provide trauma care equivalent to a board-certified surgeon with additional formal fellowship training in trauma and critical care.