Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome.

Background: Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs).

Methods: We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center.

Results: Referred patients were older, more often women, and had more severe TBI (all P < .

Excelsior Surgical Society Edward D Churchill Lecture. Changes in combat casualty care.

There have been many positive changes in combat casualty care since Desert Storm. The Air Force has made a major change and significant improvement in combat casualty care, which is aided by the United States Army and Navy. The current care is second to none, including rehabilitation.

A proposal for enhancing the general surgical workforce and access to surgical care.

Objective(s): The goals of this focused meeting were to verify and clarify the causes and extent of the general surgery (GS) workforce shortfalls. We also sought to define workable solutions within the existing framework of medical accreditation and certification.

Background: Numerous peer-reviewed and lay reports describe a current and worsening availability of GS services, affecting rural areas as well as large cities, academia, and the military.

US Trauma Center Preparation for a Terrorist Attack in the Community.

Background: Since the 2001 terrorist attacks on the United States, federal and state funding, primarily from the National Bioterrorism Hospital Preparedness Program, has resulted in a surge of hospital activity to prepare for future natural or human-caused catastrophes. Trauma centers were integrally involved in the response to the 2001 attacks as first receivers of patients, communication hubs, and as convergence sites for families, the worried well, volunteers, and donors. After the Madrid train station terrorist attack, Congress identified the need to study trauma center preparedness as an essential part of the nation's emergency management system.

Long-term morbidity, pain, and disability after repair of severe chest wall injuries.

Long-term morbidity after severe chest wall injuries is common. We report our experience with acute chest wall injury repair, focusing on long-term outcomes and comparing our patients' health status with the general population. We performed a retrospective medical record review supplemented with a postal survey of long-term outcomes including the McGill Pain Questionnaire (MPQ) and RAND-36 Health Survey.

Battlefield trauma, traumatic shock and consequences: war-related advances in critical care.

Over the course of history, while the underlying causes for wars have remained few, mechanisms of inflicting injury and our ability to treat the consequent wounds have dramatically changed. Success rates in treating war-related injuries have improved greatly, although the course of progress has not proceeded linearly. From Homer's Iliad to the Civil War to Vietnam, there have been significant improvements in mortality, despite a concurrent increase in the lethality of weapons.

Rib fracture repair: indications, technical issues, and future directions.

Rib fracture repair has been performed at selected centers around the world for more than 50 years; however, the operative indications have not been established and are considered controversial. The outcome of a strictly nonoperative approach may not be optimal. Potential indications for rib fracture repair include flail chest, painful, movable rib fractures refractory to conventional pain management, chest wall deformity/defect, rib fracture nonunion, and during thoracotomy for other traumatic indication.

A growing crisis in patient access to emergency care: a different interpretation and alternative solutions.

In summary, the current U.S. health care system is broken.

The emerging crisis in trauma care: a history and definition of the problem.

The crisis in patient access to emergency surgical care as articulated by the Division of Advocacy and Health Policy of the American College of Surgeons is real. It is most likely that in the next 10 years this crisis will only get worse. At last count, there were 190 Level I trauma centers in the United States, of which, 48 have been verified by the American College of Surgeons.

The medical world is flat too.

Background: Tom Friedman, in his book,"The World is Flat," makes a very persuasive argument that our current economic policy transcends national boundaries. Friedman describes various processes that prove his point. These include workflow software, open sourcing, outsourcing, off-shoring, supply chaining, in-sourcing, and informing.

Emergency medicine in space.

Recent events, including the development of space tourism and commercial spaceflight, have increased the need for specialists in space medicine. With increased duration of missions and distance from Earth, medical and surgical events will become inevitable. Ground-based medical support will no longer be adequate when return to Earth is not an option.