FILLING THE VOID
Over the last century, general-practice physicians guided our medical care, which evolved into treatment that focused within specific areas of expertise. The generalist, for example, is still pertinent for overall health issues; however, there is far too much knowledge and specific care options available for the generalist to have a required expertise. There is no area more demonstrative of this than the field of orthopaedics. It began as the care of musculoskeletal injured patients, but orthopaedics has evolved into subspecialties that include chronic and acute elements, which further divides into anatomic specific areas. As a result, the care of the multiply injured musculoskeletal patient has fallen into its own subspecialty of expertise—orthopaedic traumatology.
Most of our expertise in traumatology comes from the care of high-energy injuries including high falls, gunshot wounds, and motor vehicle accidents. These injuries are often life or limb threatening or at the very least, life altering. In today’s world of seatbelts and airbags, we are experiencing a higher percentage of patients involved in high-energy accidents who survive. Additionally, the results of post-traumatic early care and resuscitation (administering emergency procedures to sustain life) have shown dramatic survival improvements.
“The golden hour”
Much of the knowledge gained in trauma came from wartime experiences. One example is Dr. R Adam Cowley, who noted that early care within the first hour, in a subset of these traumatically injured patients, could result in higher rates of survival. He called this timeframe, “the golden hour.” From Dr. Cowley’s training, experience, and research, he established the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, which saves thousands of lives annually. Again, growing from experience in combat situations, Dr. Cowley realized an aviation component was essential to the speed of delivering care. Even now, when a call comes in the clock starts: the time of injury, time for the helicopter to reach the accident site, and the time the patient reaches the trauma center and into the hands of trauma physicians. It is out of these early origins that trauma care in the United States was developed.
With a national need for trauma care, centers grew, but mainly in large metropolitan and university settings. Unfortunately, tragedy often is the impetuous of change: An orthopaedic surgeon, Dr. James Styner, was piloting an aircraft in rural Nebraska when he crashed. His wife was killed and 3 of his children were critically injured. Dr. Styner found inadequate and ill-prepared resources at the small regional hospital where he and a Good Samaritan took his family for treatment. As a result, Dr. Styner influenced the American College of Surgeons to develop advanced trauma life support as an educational foundation for those providing primary trauma evaluations and care nationwide. This additional preparedness enabled more patients to survive through “the golden hour.”
Initially, large level I trauma centers in metropolitan areas were the go-to place for critical care. However, over time limited resources began to change the ability of these centers to support the expertise required. More regionalized centers took an interest, keeping patients closer to home thereby reducing overall cost of care. Many of these regional hospitals did not appreciate the expertise that orthopaedic traumatologists provided and felt their general orthopaedist or other sub-specialized orthopaedist could provide the care necessary for these situations. Over time, the strain of these expectations on these orthopaedic surgeons caused many of them to abandon their exposure to such injured patients. This left a void that needed filling by experts in the treatment of musculoskeletal-injured patients.
Speciality orthopaedic trauma service
Leaders of the Hughston Clinic recognized this need, and therefore, the Hughston Orthopaedic Trauma service was born. The Hughston Trauma mission is to provide excellent orthopaedic trauma care in underserved areas by operating as a co-management organization. This means that we not only provide the physicians who have the needed expertise; but we also provide administrative staff who help these trauma centers understand and care for their community’s musculoskeletal injuries.
Each trauma center is part of a larger system that uses state and local resources, including hospitals and their specialized equipment, physicians, surgeons, healthcare staff, ambulances, helicopters, paramedics, and emergency management teams. Currently, Hughston Trauma employs 17 orthopaedic traumatologists, all of which are fellowship-trained and many are leaders in training other orthopaedic traumatologists. The partner-hospitals are spread from Sanford, Florida to Terre Haute, Indiana with further reaching areas in the works. The Hughston Foundation trains orthopaedic traumatologists through their fellowship program in an effort to continue to fill these needs. The mission of the Hughston Clinic research, education, and patient care exemplifies this endeavor. We hope you never need us, but know that we are here and providing excellent care for those times of tragedy.
Author: John C.P. Floyd, MD, FACS
Reprinted with permission from the Hughston Health Alert, Volume 30, Number 1, Winter 2018.