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Fri Apr 13 18:47:34 BST 2007

Jeff:   I recognize the sentinel fantastic work that the ACS COT  and you as 
the Chair of the Disaster Committee are doing for disaster  planning.  From my 
own reviews, (and they may be faulted, ) I have found a  methodical EXCLUSION 
of the trauma directors from the EOC and Joint Unified  Commands of the 
governmental and sub-governmental structures across the  country.   I report what I 
am able to document to have worked  collaboratively during real disasters and 
during realistic drills.   

Should I be in error in citing that New Jersey has not fully integrated its  
trauma directors, trauma centers, and trauma programs as the  infrastructure 
of its medical response, then I apologize and would publicly  commend you and 
your surgical colleagues for this effort and  accomplishment.  

I have discovered repeatedly that lip service is given to the trauma  
programs by the governmental EOCs, etc, but practically the doctors are  relegated to 
just be there in the hospitals when the public health people want  to dial 
them up.   It is essential that the trauma directors be part  of the strategic 
state and national trauma and disaster planning and  implementation process.   
I can count on ONE HAND, yes one hand  the trauma surgeons that I know 
personally who are actively involved with  their city, county, state, or national 
governmental leaders in disaster, mass  casualty, and incident command.     Until 
this happens,  we as trauma programs will not optimize our capabilities and  
talents.   

Jeff:  I am personally aware of the gigantic efforts you have made in  moving 
in the right direction.   However, as was pointed out by  EVERY speaker on 
the Disaster Panel at the recent Trauma Critical Care  & Acute Care Surgery 2007 
conference in Las Vegas:  WE are not  ready, we have NOT learned from the 
past, we cannot rest on our laurels, we have  much integration, collaboration, 
and networking to do yet.  

Only ONE medical integrated collaborative network for trauma  and disaster 
planning and response exists in the United States and  that is our trauma 
systems, developed by the ACS COT and now supported and  amplified by your 
SubCommittee on Disaster.  I applaud you, but we  still are boxed out of the EOCs and 
the Unified Commands, being replaced by  public health doctors.  I support all 
that we can do collaboratively  with the public health doctors, but we the 
trauma system have assets that  they do not have.   AFTER the disaster, as was 
the case at the time of  911, is NOT the time to, as an afterthought, think 
about the trauma  system.   During 911, much of the trauma response occurred at 
the  hospital, waited for patients to be brought to them in large numbers, later 
to  find that patients were taken to non-trauma hospitals (both in NYC and in 
 Washington DC).    

It is time we recognize the value of our trauma systems to the Nations  
Health Infrastructure safety net.  

We are on the same page on this one and I applaud your leadership.  

Kenneth L, Mattox, MD
Houston 

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