Like any other multi-billion-dollar enterprise, hospital care can develop hide-bound routines, protected by high priests of orthodoxy. Rare is the individual brave enough to challenge that orthodoxy with solid analysis of its weaknesses and a plan of action for improvement. Rarer still is that individual with the staying power and tenacity to bring the improvements finally into being.
Dr. R Adams Cowley, who died Sunday at 74, was such a man. Beginning his surgical practice in Europe after World War II, he found himself on a treadmill, racing to save lives cast into grave jeopardy by the left-over instruments of war. He concluded, rightly, that the procedures intended to save lives were themselves hindering the process. His tenure in a German hospital, watching Europe's best surgeons use techniques that sharply reduced the time American surgeons would have taken to correct injuries, drove the point home.
His return to Baltimore was thus a happy conjoining of ideas and opportunity. Beginning in 1961 with a small, Army-funded "laboratory," Dr. Cowley kept pushing his then-new notions of radically altering trauma treatment until he had demonstrated their success.
The key, he insisted, was rapid medical care for accident patients within what he termed the "golden hour." A patient is flown from an accident scene to the shock-trauma center where teams of doctors and nurses work on the patient simultaneously. The results speak for themselves: When Dr. Cowley began his unorthodox approach, accident survival rates were 40 percent; now the survival rate nears 90 percent.
Dr. Cowley had to fight the medical and political establishment to establish what is now the Maryland Institute for Emergency Medical Services, which includes an eight-story building at University Hospital recognized as the most technically advanced life-saving facility in the world. There is also a statewide fleet of twin-jet helicopters to speed victims to trauma centers; uniform emergency medical-team training, and the nation's first
statewide telecommunications system linking trauma-care centers, helicopters and ambulances.
Dr. Cowley did not stop there, pushing for a national center for trauma and emergency medical systems at University Hospital. He alone was responsible for turning emergency medicine into a separate medical discipline, with his beloved R Adams Cowley Shock Trauma Center as a worldwide model. In 1989, when the center opened, The Sun called it a monument, and it was -- to the enormous contributions of Adams Cowley.