A Dream to Save Lives, A Plan to Save Money

WILLIAM P. PACER

November 01, 1991|By WILLIAM P. PACER

He saw his dream become a reality. Now Dr. R Adams Cowley's hard-won dream may perish with his last breath. In a few months, a statewide emergency medical-services system of NTC rapid response and swift transport to the appropriate hospital may be buried by spadefuls of indifference and blind economics.

A pioneer in trauma care and disaster management, Dr. Cowley, who died this week, is revered from Maine to Moscow, Boston to Beijing, New York to the Netherlands. Under his influence, traumatology became a profession. Dr. Cowley received thousands of honors, but one eluded him. His efforts altered daily medicine more than those of any other man in this century, yet he never won the Nobel Prize for Medicine. And if the president of the University of Maryland at Baltimore, Errol L. Reese, has his way, he will honor Dr. Cowley and his Maryland Institute for Emergency Medical Services Systems by decimating Dr. Cowley leaves a legacy of life. Like a street fighter, he clawed and grappled to create the world's premier emergency medical-services system. Dr. Cowley was determined, dedicated, rebellious and arrogant. He needed those dynamics to succeed. Because of his electrifying personality and stamina, thousands of people throughout the world have survived severe trauma.

A Mormon, Dr. Cowley cared about everyone. The emergency department was a classless meeting place where screams of pain from rich and poor, addict and elite, were mingled. He enjoyed being in SYSCOM, the communications center responsible for coordinating medevac helicopter transports and shock-trauma admissions throughout the state. He was pleasant and warm and very honest.

He admittedly lacked subtlety. ''Diplomacy takes time. There are people dying every day from traumatic injury and they don't have the time.''

This visionary rankled the traditional medical community, which bridled at his pointed -- and accurate -- attacks on a philosophy that the ''emergency patient really interferes with the hospital's day.''

He accepted cast-off patients from the University of Maryland Hospital emergency room. These dying men and women were welcomed to his experimental two-bed death lab in 1962. Soon, it became a life lab. In emergency rooms, only 40 percent of severe trauma patients survived. Under Dr. Cowley's care, it was 90 percent.

He ascertained that a severely injured person has a ''Golden Hour'' of survival. ''If you can get a patient from the time of injury to an appropriate facility in less than an hour, he has a chance to live,'' Dr. Cowley preached.

He changed attitudes. He chastised those who promoted transport to the nearest hospital. The community hospital three miles away might not be able to save the patient; the trauma center 10 miles away might be able.

Under Dr. Cowley's leadership, Maryland developed the nation's first statewide EMS system, a system now in jeopardy. It includes education, training, communications, medevac helicopters and echelons of specialty-care hospitals. The system begins functioning from the moment someone calls 911. A responding paramedic, who has been certified and trained, may request a medevac helicopter. Through SYSCOM, the medic can talk directly to a shock-trauma doctor for guidance. The helicopter will then transport the injured patient to the nearest appropriate specialty-care facility.

A strict set of protocols for treatment was initiated by Dr. Cowley. ''We do it on all patients,'' he said, ''because the most obvious injury may not necessarily be the worst.'' A severe scalp laceration may be messy, but concentrating on that injury will not save a patient with gross internal bleeding.

At the R Adams Cowley Shock Trauma Center in Baltimore, people are saved by teamwork. Every member knows his specific duty. But the Shock Trauma team actually begins out in the field. Every player is an integral component in the vast effort ,, to save a life. The medic in the field, the helicopter crew, SYSCOM, all serve a role. And the instructors, the people who certify the ambulance personnel, the radio technicians and others also are significant factors in the emergency medical-services daily mission. Besides Shock Trauma, the network has nine trauma centers and specialty-care centers for burns, pediatric trauma, extremity trauma, etc.

Now, this system is threatened by a budget cut. UMAB President Reese views it as a liability because it does not generate income. While Shock Trauma may survive, the supporting infrastructure may perish. SYSCOM is faced with drastic cut in staffing. Pre-hospital training and certification may be completely axed. Dr. Cowley dedicated himself to saving lives. Today's fashion is for saving money.

William Pacer is a free-lance writer who worked for 12 years in the Maryland Institute for Emergency Medical Services Systems.

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