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Mon Jun 8 10:07:44 BST 2009

In Germany:
- orthopaedic surgeons (Orthopäden) - main interest: non fractured bones
- trauma surgeon (Unfallchirurgen) - main interest: fractured bones

As these interest overlap specialization is now combined - only
one surgeon: orthopaedic and trauma (this is the official order
of the terms).

24 months of training in general surgery is required.

Polytrauma and trauma management is part of the curriculum.

After specialization they usually don't perform elective surgery
for the following main targets: head, thoracoabdominal organs
and vessels (but they drain and scope the thorax and
'go through' thorax and abdomen to reach the spine).

During the last years they have been very actively
promoting education and standardisation in trauma
(which is a very good idea).

Cooperation with other specialties is not always perfect:
the German Society for Trauma Surgery advises to
'inform' (and 'embed') anaesthesia and neurosurgery
whan planning for local trauma management
(http:/www.dgu-traumanetzwerk.de, German language).
Other surgeons (general, vascular, thoracic, ...)
are not so often mentioned.

Disclaimer: i am not a surgeon - and therefore not
familiar with all the details.

Kind regards
    Frank Fischer (Germany)

Marie-Anne Kettern schrieb:
> Sorry, but what you write about orthopaedic surgeons wanting to own the word trauma in Germany, is simply not correct.
>  
> Specially in Germany there are special trauma surgeons and they are not orthopaedic.
> They have a qualification as general surgeon and then specialise in Trauma surgery.
> They operate everything trauma related apart from cardiac, maxillo facial and neurosurgery.
> So a poly trauma patient with multiple fractures and abdominal injury will have surgery done by one single person.
>  
> Orthopaedic people normally hardly do any acute trauma, so from were do you have this strange idea regarding German surgeons?
> They do some ligament and shoulder stuff but not really trauma.
>  
>  
>  
> 
> 
> --- KMATTOX at aol.com <KMATTOX at aol.com> schrieb am Mo, 8.6.2009:
> 
> 
> Von: KMATTOX at aol.com <KMATTOX at aol.com>
> Betreff: Trauma Care in Europe
> An: trauma-list at trauma.org
> Datum: Montag, 8. Juni 2009, 3:33
> 
> 
> In an earlier post, I indicated that I attended and was invited to be a  
> speaker at the European Association for Trauma and Emergency Surgery (EATES)in 
> Antalya, Turkey.   This was a spectacular meeting with 1200 attendees,  of 
> trauma surgeons, critical care surgeons, orthopedic surgeons, thoracic  
> surgeons, abdominal surgeons, vascular surgeons, foregut surgeons, minimally  
> invasive surgeons, surgical intensivists, trauma resuscitatiologists,  
> anesthesiologists, emergency physicians, acute care surgeons, emergency  surgeons, 
> and trauma/emergency medicine public health  physicians.    The meeting was 
> in two different large rooms with  those interested in head, neck, 
> thoracic, abdominal, and vascular surgery in one  room, and those with primarily 
> osseous and soft tissue extremity injury meeting  in the other.  In addition, 
> medical students, residents, fellows,  registrars, administrators, CEOs, 
> CFOs, COOs, and public policy political  persons were present.     
> 
> The comments in this post are totally and solely my own.   NO ONE  has 
> suggested I write this editorial, and no one has reviewed anything I have  
> written here.    
> 
> Many of the above medical professional persons are listed due to the  NON  
> STANDARDIZED nomenclature of physicians in Europe and the Middle  East.   
> Around the world, but especially in EUROPE there is a great  need for a 
> standardization of nomenclature as to what physicians are  called.   EATES is in 
> an excellent position to accomplish this long  needed nomenclature 
> standardization.    More importantly, there  is great debate as to just what each 
> named "specialist" can do in the EMS,  resuscitation area of the hospital, 
> dispatch, disaster, OR, ICU and clinic  locations.    Many qualified physicians 
> are literally prohibited  from caring for patients because of this jealous 
> protection of turf, both in  Europe and in the United States.    EATES is also 
> in the most  ideal position to address these turf and credentialing 
> challenge.    THIS MUST BE DONE if there is to be progress in the care of emergency 
> surgery  patients, be it in disaster, burns, interpersonal trauma, war, 
> industrial  accidents, road traffic accidents, or others.    Furthermore, the  
> systematic public health approach to trauma care is going to be mandated by 
> the  consumerism movements of governments and the public in  general.    
> 
> I was struck with the protectiveism of the word "trauma" and just who owned 
> it.    In each country, different specialist tended to want to  "own" the 
> term "trauma" for their discipline.    No where did  this seem to be more 
> volatile than in Germany where the orthopedist who does  almost exclusively 
> bones, joints, and soft tissue wanted to continue to solely  own the term 
> trauma.   This may be an over simplification on my  understanding, but it seemed 
> to me that if the German orthopedic surgeons would  merely call themselves 
> orthopedic surgeons with interenst in "______" (pick any  term), much 
> progress would be made in Europe.    
> 
> It is time that all of us address a trauma and emergency surgery Integrated 
> Collaborative Network with a public health focus on our approach.    This 
> means a system approach.   
> 
> I am looking forward to EATES leading the entire world on their approach to 
> these issues.   There was much discussion in formal meetings and from  
> panels on these subjects, but no closure or total agreement.  I also found  a 
> significant disparity between what was said by the "elder" trauma and  
> emergency surgery statesmen (and officers of the organization) and the younger  
> less vocal surgeons from each country.   I noted none of the YOUNG  persons at 
> the table during formal panels.    I also did not note  ANY officers who 
> were female.     
> 
> Much progress will be made by EATES in the future and I do hope to be an  
> observer of these advances.   The whole world will benefit from such  an 
> EATES leadership.  
> 
> k
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