Learning from early adopters: Pioneers in trauma
What do Abraham Lincoln, the Revolutionary War, and an orthopedist named Thomas all have in common? They all played a pioneering & influential role in trauma care within the U.S.
Sure, we can talk about how helicopters greatly impacted both the Vietnam and Korean war eras, or how whole blood and ultrasound technology are currently changing the paradigm of emergency medical services, today. But, let’s take a little bit of a deeper history lesson and look at some of our early adopters – pioneers – in trauma as we know it today (or at least as we remember it from yesterday).
The Revolutionary War
Among many other historical actions and implications, our Revolutionary War also played a role in the development (or division) of trauma services as we know them today.
Prior to the War, common practice within the field of medicine was to incorporate all categories of care into one individual; one physician.
Recognizing that trauma (specifically surgical care) was becoming a specialty of its own first took shape during the Revolutionary War when John Morgan, a colonial physician, initiated the separation of internal medicine from surgery.
Among the likes of Morgan were physicians like John Bard, who was the first individual to publish a scientific paper on a surgical topic from the American colonies; and John Jones, who authored the first surgical works written by an American and printed in North America. Jones also – more importantly – published “Plain, Concise, Practical Remarks on the Treatment of Wounds and Fracture” in 1775, which became the guide for surgeons during the War.
Moving forward toward our nation’s Civil War, President Abraham Lincoln actually played a pretty significant role toward the progression of trauma care within our country. Marked by significant battlefield injuries, the Civil War initiated systems of care for injured soldiers, which helped to shape the triage, aid stations and rapid transport to field or general hospitals as we know it today. This time period also set the stage for the developments in injury management that came about during both World Wars and the Korean War.
As for Abraham Lincoln, he drove creation of the first trauma manual, which was the first time that processes to care for injured patients were formally documented. So, the next time that you pick up your protocol manual and turn to the procedures section, or flip open your agency’s own field reference guide, you can thank President Lincoln for spearheading the idea!
Hugh Owen Thomas
Prior to the Hare or Sager traction splints was the Thomas Splint for reducing femur fractures. Pulling traction on the fractured bone was touted to not only stabilize the fracture, but to also prevent infection as a result of the fracture. As an orthopedist, Thomas also made a large impact through other innovations related to hip and foot fractures. His Thomas Test aided in detecting hip fractures, his Thomas Heel shoe device helped to treat heel fractures on the foot, and his Thomas Collar was used to treat tuberculosis of the cervical spine.
George W. Crile
Entering into the 20th century, physician George W. Crile introduced the concept of a rubberized suit with pneumatic pressure as a means of controlling blood pressure in neurosurgical patients.
This was first reported at a meeting of The Southern Surgical and Gynecologic Association in 1903. While it later evolved into the military anti-shock trousers (MAST pants) that we know of today – or the pneumatic anti-shock garment (PASG) – its additional uses extended not only into the world of EMS shock and trauma care, but also into the realm of NASA research and even World War II pilot support as a means to prevent blackout during high G-force flying maneuvers.
Now, an item of the past, Crile’s pioneering innovation certainly made an impact on many of our initial education and careers within the EMS profession.
Still having an impact in today’s ambulances, and in more ways than originally designed, are the works of Richard (Rick) Kendrick. The Kendrick Extrication Device – or KED board – has become a staple device not only for our National Registry testing station, but also for nearly every ambulance in America. Among other product lines that have come out of Kendrick EMS, Inc., the KED has certainly made a profound and lasting impact on every EMS provider and classroom, and continues to leap above the old practice of using a CPR or short spine board to restrict the movement of seated cervical spine-injured patients.
Looking toward the future of trauma innovation – both within the EMS and the hospital settings – what will be our next big invention? Who will be our next leaders and innovators? Who will we look back and write about 100 years from now and see as a pioneer of their time? Will it be you?