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Fri Apr 13 21:18:52 BST 2007

In a message dated 4/13/2007 12:43:10 P.M. Pacific Daylight Time,  
rtappan at gwu.edu writes:

Why are they that critical? Trauma  is an acute disease and in the aftermath 
of a disaster, their role is usually  delegated to pt. care and follow 
through, where the realities of the aftermath  of a disaster situation call for 
primary care and public  health.  What do you envision as the role  for 
traumatologist, other then the acute care of victims and possibly  pre-planning  I am 
neither a physician, nor a  nurse or public health official, but an emergency 
manager with a role on  response teams locally and nationally, so my perspective 
tends to be broad,  while I realize the importance of trauma centers in the 
acute phase of an  incident, I am curious as to your perspective and increased  
involvement

Excellent and pertinent questions.   

1.  The role of acute care (emergency or trauma) surgeons in the real  
disasters that have been reviewed and reported is significant in many areas,  often 
the least important of which is the technical treatment of  injuries.   In the 
real time multi-casualty mass casualty events in  Houston, be it chemical, 
biologic, mechanical, or movement of multiple personnel  via evacuation and 
sheltering, it is the mentality of the acute care surgeon  that as emerged as a 
natural leader.    This has been repeated in  many locations around the world.  
Other disciplines also naturally emerge  as local leaders, but the recurrent 
theme over and over again, observed by many  reports, written and verbal are 
the acute care surgeons.  

2. Surgery, especially acute care surgeons, trauma and emergency surgeons  
are much more than a technician.  These individuals are trained and are  
genetically wired to be first just good people understanding music, art,  literature, 
society, religion etc.  Second, such people are among the most  respected and 
often called to do medical and mental health triage in their  community.  
Third, acute care surgeons are very often among the best  diagnosticians in the 
local medical catchment; trained to know about radiation,  chemicals, 
infections, drugs, tests, and operations.   Fourth, acute  care trauma and disaster 
surgeons are technicians, applying this art of  operation only about 15-20 % of 
their time.  From a technical expertise  standpoint they are often the master 
surgeons of a community.   Fifth,  such persons are among the medical and 
system thought leadership of a  community.    I am not just being naturally 
prejudiced, but I am  reporting what I have seen in multiple countries, states, 
counties, cities and  hospitals.    

3. I fully recognize the need for the incorporation of emergency managers,  
paramedics, nurses, coordinators and others in the strategic planning for  
disasters.   I also recognize the need for you and the others in the  last 
sentence in the Joint Unified Command.    

4.    My great concern is the methodical EXCLUSION of  those in highly 
successful trauma systems, trauma centers, and trauma programs  from such planning 
and implementation, especially since they very frequently  have been the 
natural leaders in disasters that have been reviewed.

Your comments were very germane, to the point, and greatly  appreciated.  

k

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