Shock Waves at Shock Trauma

August 02, 1992

The commotion generated by the dismissal of three doctors at the Maryland Shock Trauma Center deflects public attention from what should be the overriding concern: the quality of emergency medical service in Maryland. We can no longer rest on our laurels of a decade ago, when the shock trauma system here was heralded as the nation's best. The system needs improvement if it is to keep up with advances in handling shock-trauma cases.

Without question, Dr. Kimble I. Maull, the new director of shock-trauma center and the statewide emergency medical system, handled the dismissals badly. His abrupt action caught political leaders by surprise and created a furor within the shock-trauma network. Yet while Dr. Maull may need a refresher course in bedside manners, he is entitled to make personnel changes he deems appropriate and to bring in a team of specialists of his choosing. That's what founder Dr. R Adams Cowley did -- and won international acclaim for his efforts.

Dr. Maull was hired to make changes. He was able in just a few months to end a long-running dispute between the center and University of Maryland Hospital over treating badly injured trauma patients from West Baltimore. In the past, the hospital ran its own trauma center in the same building. That was a costly duplication of effort. Now there is only one trauma center, with Dr. Maull's much larger unit handling all badly injured patients. That's a common-sense solution that had eluded other medical leaders in the past.

Other aspects of the EMS system need updating and modernization. Innovations that are working well in other cities should be adopted here, too. But it won't happen without some major changes that are likely to create more commotion.

Dr. Maull comes to Baltimore with a solid reputation in emergency medicine. He succeeded, despite intense opposition in the medical and political communities, in creating a first-rate trauma unit for adults and children at the University of Tennessee Medical Center, which only two years earlier didn't even have accreditation. He also won high praise for pioneering steps he took at the Center for Trauma and Emergency Medicine in Richmond.

For that to happen in Maryland, Dr. Maull must be given the chance to do things his way. Dr. Cowley's approach may no longer be appropriate in the 1990s. Medical technology continues to evolve rapidly. Better management techniques could eliminate many of the center's on-going problems. A cooperative rather than a confrontational attitude toward University Hospital could also reduce internal tensions and let doctors concentrate on patients, not medical in-fighting.

Both Dr. Maull and Gov. William Donald Schaefer say they are committed to bettering the quality of Maryland's shock-trauma system. It is an outstanding system already. Dr. Maull's task is to make it, once again, the nation's best.

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