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T
he trauma care session featured a panel of expert
speakers: Mr Eddie Myers, Consultant General
and Colorectal Surgeon, Portiuncula Hospital,
Ballinasloe; Mr John Rice, Consultant Orthopaedic
Surgeon, Kerry General Hospital; Professor Stephen
Cusack, Consultant in Emergency Medicine,
Cork University Hospital and Professor of Emergency Medicine,
University College Cork; and Dr Conor Deasy, Consultant in
Emergency Medicine, Cork University Hospital.
THE `NEGLECTED DISEASE'
Mr Myers shared his experience of trauma care from the perspective
of a general surgeon. Trauma surgery has traditionally been a key
aspect of what attracts medical students/interns to general surgery, he
noted. Interest in trauma care tends to be at its highest at that early
stage and exposure to trauma surgery plays a vital role in the training
years forming an important part of the intercollegiate examination
curriculum. Unfortunately, he noted, it does not retain that appeal for
the experienced consultant.
There are a number of reasons for this, he explained: "The schedule
is unpredictable and disrupts elective responsibilities. There is poor
compensation relative to the amount of work required. On top of that,
trauma care is an increasingly litigious arena in which to practice and
it comes with an growing burden of non-operative responsibilities."
There is also a trend toward less operative opportunites. "There is
a decrease in instances of penetrating trauma. Better non-invasive
diagnostic imaging, as well as endovascular and critical care advances
are also reducing the need for operative solutions."
Modern trauma care requires a disproportionate share of non-
operative responsibilities, he adds: "In most Irish institutions this has
traditionally been and remains the remit of the general surgeon."
However, these challenges can be met and overcome, according to Mr
Myers: "The development of trauma networks, audit and registry can
play a vital role in providing the efficiencies, data and information
that can streamline the trauma care sector. Most of all, with the
introduction of hospital networks, the implementation of the cancer
strategy and the establishment of the acute and elective surgery
programmes, it is urgent that a co-ordinated plan for trauma care be
implemented.
"Such a plan should include specific steps to make the specialty more
attractive such as an integrated strategy to share the burden of care
more equitably. Maybe then trauma care may no longer be dubbed
`the neglected disease'."
EVOLUTION OF TRAUMA CARE
Mr Rice outlined the story of the development of trauma care.
For as long as mankind has been around, there's been trauma, he
noted: "Trauma care dates back to the time of the Romans and the
Egyptians, with the Romans treating fractures to a level that would
impress even Professor John McElwain!"
After something of a decline in the Middle Ages, Mr Rice explained,
the 19th century was an era in which the modern concept of trauma
care began to take shape, inspired by pioneering individuals such
as, notably, Robert Jones (1857-1933), widely acknowledged as the
father of modern orthopaedics and driven by new ideas, methods
and technologies, such as the introduction of anaesthetists and x-ray
machines.
In the 20th Century, the ravages of two world wars spurred
unprecedented level of innovation in trauma care. "In the First World
War for instance, there were significant advances in the treatment
of open femoral fractures with a reduction in related mortality rates
from 80% in 1916 to 18% in 1918."
The 1950s and 1960s saw significant movement towards non-invasive
trauma treatments. "At this time, it became increasingly popular not
to operate on fractures. In another major trend, the advanced trauma
life support (ATLS) approach, which prioritises treating the greatest
threat to life first, was adopted widely for initial assessments and
trauma treatment."
Mr Rice's whistle-stop tour of the history of the development of
trauma care amply demonstrated that today's practitioners are
equipped with a rich heritage of techniques and skills which they, in
turn, are ready to build on, given the opportunity that an integrated
PRIORITISING
`NEGLECTED DISEASE'
MILLIN SESSION HIGHLIGHTS NEED FOR
URGENT REFORM OF TRAUMA CARE
TRAUMA CARE WILL BENEFIT FROM THE INTRODUCTION OF AUDIT
BUT THERE IS MUCH WORK STILL NEEDED TO MAXIMISE THE QUALITY
OF SURGICAL CARE THAT THE TRAUMA PATIENT RECEIVES. THAT WAS
THE OVERALL MESSAGE FROM SESSION 1: INTEGRATED CARE IN
TRAUMA AT THE MILLIN SYMPOSIUM IN NOVEMBER
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