Trauma no longer defined as a Surgical Disease

In Annals of Emergency Medicine today (Volume 55, Issue 3, Pages A20-A24 (March 2010):

The new 8th edition of the Advanced Trauma Life Support (ATLS) course manual1 contains a small but significant change. The phrase, “trauma is a surgical disease,” long a point of contention with other specialties caring for trauma patients, has been removed.

John B. Kortbeek, MD, FACS, professor of surgery and critical care at the University of Alberta and a member of the COT who was instrumental in the revision process for the manual, confirms that the deletion is intentional.
Dr. Kortbeek explains the change in historical terms. “The intent of making that statement,” he says, “was to emphasize that to have a successful trauma system and a successful trauma hospital, surgeons needed to be included in the management team and the care of the trauma patient. That remains true today. What changed over time is that that statement became a focal point and could be interpreted in varying ways, including in a negative, exclusive way, suggesting that only surgeons should be managing trauma patients, which is not correct and never was the intent of the statement.” The ATLS, he says, presents a “common language” for a safe and effective response to trauma, not a mandatory formula.

Hmm. Our Trauma Center is going to be surveyed soon, and at the last survey we were told Trauma needed to admit All Trauma. A sea change occurred, and they did. Now this.

And not everyone needs a rectal exam? Surgeons are getting soft…

Heh. Some things haven’t changed:

One source of unnecessary friction between fields, Dr. Green notes, is that the ATLS minimizes the role of emergency physicians and offers no explicit recognition of emergency medicine’s expansion and maturation as a specialty over recent decades. “One thing that hasn’t changed in the manual, which has always been kind of a source of irritation to emergency medicine, is throughout the entire ATLS student manual, a big thick book, the phrase ‘emergency physician’ never occurs. We are like the ghosts of trauma care. Everything is oriented around the surgeon. It’s as if we don’t exist.”


  1. Ron Hekier MD says:

    Thanks. Now ER docs can admit and follow the non operative blunt trauma patients.

  2. the phrase ‘emergency physician’ never occurs. We are like the ghosts of trauma care. Everything is oriented around the surgeon. It’s as if we don’t exist.”

    That archaic mindset that EM physicians are not a vital role is still present, mainly in academia. Maybe they should come down out of their ivory towers and see how the other 99% of trauma patients are being (well) cared for.

    Some things (minds) are slow to change.

    We know who makes the difference.

  3. This is a partial recognition that general surgery and trauma surgery are under siege and shrinking as parts of the
    surgical population. Trauma surgery is expensive and not well covered by 3d party payers (ie people with insurance
    tend to need trauma surgeons less often than people without). Just as internal medicine is wilting on the vine,
    so are general surgeons. Prospective surgeons can see the hand writing just as well as prospective primary care MD.