Dr. R Adams Cowley, the brilliant, combative surgeon who pioneered the shock-trauma medicine that has saved thousands severely injured emergency patients here and across the nation, died yesterday at his home in Baltimore. He was 74.
A spokesman at the Shock-Trauma Unit in Baltimore said coronary disease was the apparent cause of Dr. Cowley's death. Funeral arrangements were incomplete.
Dr. Cowley, already a superior cardiac surgeon involved in early open-heart operations, was one of the first to recognize that emergency medicine should be a separate medical discipline, demanding doctors, nurses and paramedics trained in the needs of people with multiple, massive injuries.
In early 1961, he opened a two-bed research unit at the then-University of Maryland Hospital, called the Clinical Shock-Trauma Unit. He had launched what has become the Maryland Institute for Emergency Medical Services Systems. He remained director of the emergency services system until his retirement last May.
Just before his retirement, a 138-bed, eight-story, $44 million emergency services building opened at the University of Maryland Medical Center complex in downtown Baltimore. It was named the R Adams Cowley Shock Trauma Center. Cowley Center was called the most technically advanced life-saving facility in the world.
"R Adams Cowley's efforts in the field of emergency medicine has made the state of Maryland first in the nation," said William J. Kinnard, acting president of the University of Maryland at Baltimore when the center was dedicated. "He has established a standard of excellence the world over."
Dr. Cowley's innovations and techniques were widely credited with reducing the death rate among Maryland's most critically injured patients from about 60 percent to fewer than 10. The accident survival rate in Maryland was 2 1/2 times better than the national average, according to a 1986 study.
Typically, Dr. Cowley was not satisfied.
"We've done a hell of a job," he said during a tour of the new center. "But we've not done enough. People are dying needlessly."
The emergency medical system he launched with his two beds today encompasses a 50-hospital network with 10 trauma centers, 450 ambulances, a $15 million communications system and a $35 million fleet of high-tech Med-Evac helicopters.
Early in his research into trauma, Dr. Cowley identified what he called "the golden hour."
"What we've discovered," he told Alan Doelp and Jon Franklin, who wrote about him in their book "Shocktrauma," "is that if you stay in shock for very long, you're dead . . .
"If I can get to you," he said, "and stop your bleeding, and restore your blood pressure, within an hour of your accident . . . then I can probably save you. I call that the golden hour."
He preached for innovative, aggressive treatment of massively injured patients. Speed, skill and decision were his watchwords. He could have added courage, which he had in abundance. He fought tenaciously for his beliefs. And he was often in dispute with more conservative doctors and their wait-and-see attitudes.
"Victorian surgeons," he snapped, according to Gerri Kobren, a writer who interviewed him for The Sun Magazine. "They would say: 'This is my patient. I'm in charge of him. If I decide he needs this or that, I'll do it.'
"Well, that's fine . . ." he said, "but not in a program where people are dying. Because by the time you finish deciding, the guy is dead.
"Our whole goal is to keep the patient alive. If you stop to diagnose, half your patients are dead. We treat before diagnosing. That's is just the opposite of what you're taught in medical school."
A stocky, jowly man with a pugnacious stance and direct blue-gray eyes, Dr. Cowley could take care of himself.
Cowley was politically adept. He had close relations with several governors of Maryland. Gov. Marvin Mandel launched the Maryland Institute for Emergency Medical Services Systems, named Dr. Cowley director, separated it from the medical school and gave it a line in the state budget.
Gov. Harry R. Hughes sponsored the bill that provided the
money for the new center and broke ground for it in 1985. Gov. William Donald Schaefer was a great good friend.
"We have lost not only a great Marylander," Schaefer said. "He made Maryland -- and the world --a safer place to live. I have seen few people as dedicated as Dr. Cowley to grasping life when it is most threatened."
Dr. Cowley was equally astute at public relations. He was a favorite of reporters, feature writers and editorialists. Doelp and Franklin's "Shocktrauma" was a best seller, and a TV docudrama was made from it. Shock-trauma medicine was, of course, the essence of drama.
All of which sometimes offended his colleagues outside the unit. In the hospital, according to one observer, there was the feeling that shock-trauma "grabbed all the media attention, the money and the prestige."