The Losers in the Shock Trauma FightDr. R Adams Cowley...


March 06, 1993

The Losers in the Shock Trauma Fight

Dr. R Adams Cowley must be spinning in his grave. The editorial in regard to the mauling of Dr. Kimball Maull (Feb. 27) would suggest that the highly politicized Emergency Medical System in Maryland might need a serious review soon lest it be dismantled.

I am a former chairman of the American College of Surgeons Committee on Trauma. During my tenure, EMS development with the "trauma center" as the crown jewel of the system was its major emphasis. To separate EMS from the trauma center is literal heresy.

I have followed closely the distinguished and productive career of Dr. Maull in Virginia, Tennessee and now Baltimore. It would seem that this talented man was given an impossible task:

1. To cast Shock Trauma in a solid academic mold with the University of Maryland.

2. To ensure that quality patient care was the primary focus of the system.

How could this be accomplished without the solid support of the governor, the university, the hospital system, and indeed Shock Trauma itself? Several pertinent questions should be answered if Dr. R Adams Cowley's integrated EMS system is to be salvaged:

1. Why separate the EMS system from its trauma center?

2. Who advises the governor and the legislature in these matters?

3. Is the leadership of the medical system interested in patient care or the bottom line?

4. Why is there such resistance to review by outside trauma experts? There are many parameters to measure the system, including valid outcome studies.

Maryland has had the great opportunity to be a paradigm in the care of the severely injured patient who frequently cannot speak for himself.

It seems that ugly politics will prevent that from happening. The devastation wrought on Dr. Maull is certainly cruel, but the real losers in this unseemly debacle are the severely injured people of Maryland.

C. Thomas Thompson, M.D.

Tulsa, Okla.

____________ This letter is prompted by my overwhelming distress at the news Dr. Kimball Maull's resignation as director of the Maryland Institute for Emergency Medical Services Systems.

I am a neurosurgeon, and I worked at Shock Trauma from July 1979 through June 1981. During my first year there, I did a fellowship in neurotraumatology at Shock Trauma. I was hired by R Adams Cowley and the University of Maryland Hospital. I had a joint appointment. I was to stay one year but was given the opportunity by Dr. Cowley to develop and open the neurotrauma intensive care unit at Shock Trauma.

I must honestly say that those two years were perhaps the most educationally rewarding and personally satisfying of my career. I immediately identified with Dr. Cowley's dream and truly believe that at that point in time Maryland had the best trauma system in this country and perhaps the world.

I did, however, have another observation. I had never seen such political mayhem in my life. I was concerned at that time that the bloodthirsty politics and the monumental ego battles with the Maryland state educational and health system would eventually undo Dr. Cowley's prize system.

Since leaving Shock Trauma in 1981, I have kept in close contact with the leaders of both Shock Trauma and the University of Maryland.

I had been asked on several occasions, both by the representatives of the University of Maryland Hospital and of Shock Trauma, to return and work there in the area of neurotrauma.

However, over the past decade, it became more and more

obvious that these political games were allowing stagnation and mediocrity to descend on this premier trauma center. The place became significantly inbred. There was no progression as a system when compared to newer and better systems.

The relationship between Shock Trauma and the University of Maryland Hospital continued to be one of "cat and dog" rather than of two strong teammates working together to achieve a common goal. My biggest concern was that the bridges of collaboration were never built between Shock Trauma and the University of Maryland Hospital that should have resulted in the world's best state-of-the-art trauma center.

When I heard that Dr. Maull was going to become director of emergency medical services, I was once again optimistic. I have known Kimball Maull for the past seven years, and I had been familiar with his work in trauma for many years prior to that. He is one of the most respected trauma experts in this country, not just in acute trauma care but in trauma care delivery systems. Even more important than that, he knew Dr. Cowley's vision and he had a perception of what new things needed to be done to bring Dr. Cowley's dream into the 1990s.

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