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The training and scope of practice of today’s trauma surgeon has evolved into a burgeoning field known as acute care surgery. Acute care surgery both defines an advanced surgical training paradigm and describes a type of surgical practice. The history of this evolution is short, and somewhat cyclic. In 1922 Charles L. Scudder, a general surgeon from Boston who had a strong academic interest in fracture management, established the Committee on Fractures within the American College of Surgeons. This early forerunner of today’s Committee on Trauma was composed of 22 fellows of the College, and the work of this committee encouraged the specialization of trauma surgeons and laid the foundation for the modern concept of quality improvement. As the results of physical force injury from wars, motor vehicle crashes, and interpersonal violence fostered the training of “trauma care” during the mid-20th century, the scope of the trauma surgeon encompassed more than fracture management. In 1950 the Regents of the College authorized the current title—the Committee on Trauma—to emphasize this expanding scope of practice.1


Further advancement of a surgical discipline uniquely dedicated to the care of the injured patient in the United States occurred in the 1960s with the establishment of civilian trauma centers. These early trauma centers were almost exclusively within the domain of city–county hospitals in urban areas such as Chicago, Dallas, and San Francisco, but their impact and influence was rapidly spread by devotees of the charismatic leaders of these centers.2 During the ensuing two decades, trauma surgery became an attractive career based largely on the mentorship of trauma surgeons in urban city–county hospitals who epitomized the master technician, and who developed an academically productive career based on the physiology of the injured patient and lessons learned from the Vietnam War. These trauma surgeons operated confidently and effectively in all body cavities, and perhaps were the last of the “master surgeons” that once were the hallmark of general surgery. Operating primarily in large-volume public, “safety net” hospitals, these surgeons were also typically referred the most challenging surgical problems from the surrounding city or region, particularly if there was a financial disincentive to providing care in a private for-profit hospital. As a result, the city–county or “safety net” hospital trauma surgeons developed an active elective and emergency surgical practice while providing trauma coverage and care to the most critically ill and injured surgical patients.3


The academic success of these leading trauma surgeons (Blaisdell, Carrico, Davis, Freeark, Lucas, Ledgerwood, Mattox, Moore, Shires, Feliciano) fostered their incorporation into university hospitals, and the economic viability of civilian blunt trauma care, particularly in no-fault auto insurance states, led to an expansion of trauma programs out of the safety net hospitals and into private hospitals. The American College of Surgeons contributed to the widespread adoption of trauma programs by the remarkably successful and innovated activities of the Committee on Trauma, including hospital verification, the ATLS course, and the National Trauma Data Bank ...

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