the sAn diego trAumA system model,
developed By you, hAs AChieved extrAordinAry
results over A 25-yeAr period. Could you Briefly
outline whAt hAs mAde the model so effeCtive?
The short answer is surgical commitment and leadership from
surgeons like David Hoyt, Steven Shackford, Richard Virgillio and
others. A second factor was the creation of an `inclusive trauma
system' that ultimately included all committed hospitals and
providers, especially all surgical specialties, anesthesiologists etc. One
of the major success factors was a common registry to which every
provider contributed data for outcomes analysis and continuous
quality improvement of care.
Finally, the monthly Medical Audit Committee (MAC), attended by
all trauma care leaders including the San Diego County Emergency
Medical Services (EMS the Lead Agency), where the outcomes of
every provider and institution are peer reviewed, is a key process. It
has resulted in best practice standards and common care guidelines.
The net effect is the reduction of our initial 22 per cent preventable
death rate, to 1-2 per cent every year since implementation of our San
Diego Trauma System in 1984. Ours is a good example of a private
(hospitals) public (San Diego County EMS) partnership.
you hAve plAyed An importAnt pArt in the
development of trAumA systems worldwide.
whAt, todAy, Are the key issues in trAumA system
development from A gloBAl point of view?
First of all, the absolute need for committed surgical leadership.
Trauma is a surgical disease. Also, the understanding that a system
must reflect the reality of the region in terms of available resources.
All trauma systems cannot be, and are not, the same, except for the
commitment to optimal care of the injured patient given available
A successful system must have a means of collecting and acting on
outcome data such as is provided by a trauma registry. It is imperative
that the regional government agency (lead agency) be committed,
including financially, to create a trauma system. It must be a system
that embraces the concept of regionalisation, meaning getting the
right patient, to the right place in the right time. This concept often
meets political resistance, and will not succeed without the political
will to make it happen. Trauma systems all around the globe face
the challenges presented by identification of trauma victims, as well
as the provision of communication and transport/triage systems to
minimise the time from injury to definitive care which is the sine
qua non of trauma care.
you hAve Been A response surgeon At A
numBer of the worst disAsters of reCent times
inCluding hurriCAne kAtrinA And the eArthquAke
in hAiti. whAt lessons from trAumA And surgery
perspeCtives hAve Been leArned from these
Be sure you are needed and, preferably, invited by a responsible
party `on the ground' at the disaster site. Understand the medical
needs and available resources in putting together your medical
response team. Crucially, ask what specialists are needed?
Don't forget to include the administrative support that becomes so
important in setting up your disaster operation things like supply
chain, record keeping, transportation and communication logistics
etc. Never forget you are in someone else's country, city and hospital.
You should be there to help not invade and occupy. Include, as much
as possible, local doctors and nurses in your operations. Help train
and support them for the long haul, as you will be leaving and they
will be staying. Create `check lists' and keep your medical response
team together with drills between disasters.
you were ConsultAnt to the white house
mediCAl unit, wAshington dC, when you were
ChAir of the ACs Committee on trAumA from 1990-
1994. whAt did the role involve?
It basically involved providing the White House Medical Staff,
the President's physician and the Secret Service with an up-to-date
data base of trauma centres and surgeons in the US who would
be prepared to care for the President of the US, if urgent trauma
care was needed in any state. The White House Medical Staff uses
this information on every presidential trip inside and outside of
Fortunately, it is rarely needed, but always ready. The current ACS
COT leadership continues in this important role today.
in your downtime, i understAnd you hAve A
pAssion for fly fishing. whAt Are your fAvourite
rivers in the us And hAve you hAd A ChAnCe to
fish in irelAnd?
Yes, I do love to fly fish, especially on the rivers of my home state
of Wyoming, where I can fish with our two sons who are excellent fly
fishermen and live in Jackson Hole, Wyoming. My favourite rivers
there are the Snake and Green Rivers. I have not yet had a chance to
go fly fishing in Ireland, but I know your trout streams are some of
the best in the world. Maybe someday...
CAn you desCriBe how you felt when you
reCeived the honorAry fellowship of rCsi?
The privilege of becoming an Honorary Fellow of the Royal
College of Surgeons in Ireland was, and will always be, one of the
single greatest honours of my surgical career. It is enhanced by the
fact that Sarita, my dear wife of 40 years, is a Doyle whose ancestors
came from County Wexford. RCSI President, Professor Broe, was so
kind to take us there during our visit for my Honorary Fellowship in
Also, my mentor and professor of surgery at the University of
California, San Francisco, J. Englebert Dunphy, was a true Irishman
who never let us forget that some of the greatest surgeons in history
were from Ireland. I was so proud to see his name emblazoned on the
wall of RCSI as an Honorary Fellow and I'm so proud to have joined
At the presentation of the Honorary Fellowship (l-r): RCSi President
Professor Patrick Broe and dr Brent eastman, Md FACS, President of
the American College of Surgeons