idencies. If academic ians in emergency medicine are to ~chieve recogni t ion and acceptance by the t r a d i t i o n a l specialties, then qua l i ty research (with its accompanying ~ d e r s t a n d i n g of values) needs to be demons t ra ted by those who are involved in emergency medicine academic programs. Inc luding the thought processes and scientif ic studies of medical disciplines, involved with t r e a t i n g the emergency pa t i en t bu t outs ide the sphere of the pre- defined f ie ld of emergency medic ine , wi l l a l low more rapid evolut ion toward the u l t ima te recognit ion by the academic communi ty of th is special ty.

Although ind iv idua ls who have commit ted themse lves to fal l- t ime pract ice of emergency medicine have given highest p r io r i ty to depa r tmen ta l recognit ion of th is spe- cialty and its accompanying board examina t ion , perhaps a higher pr ior i ty ought to be the commi tmen t to subject- ing academic thought and research projects to peer re- view in a na t iona l forum. Such exposure requires courage typical of pioneers.

The 8th Annua l Meet ing of the Univers i ty Associat ion for Emergency Medicine will be held in San Francisco at the Hyat t on Union Square May 18, 19, and 20, 1978. The call for abs t rac ts and the abs t rac t deadl ine are an- nounced on page 485. The t i t les of 15 excel lent research projects have a l r e a d y been r e p o r t e d to the p r o g r a m chairman.

What pr ice commi tmen t? C o m m i t m e n t r equ i r e s in- volvement, i nvo lvemen t r equ i r e s courage, courage re- quires commi tmen t . This has been a p ivota l y e a r for UA/EM, and we are all now commit ted to an excit ing, progressive and evolu t ionary future.

Joseph Waecker le , MD, of K a n s a s City and I wil l serve as program cochai rmen for the 1978 scientific mee t ing of UA/EM. It is not too ear ly to now send abs t rac ts to Dr. Waeckerle, c/o the UA/EM Headquar te r s , 3900 Cap i t a l City Boulevard, Lansing, Michigan 48906.

Kenneth L. Mattox, MD

(Dr. Mattox is assistant professor of surgery at Baylor College of Medicine, Cora and Webb Mading Department of Surgery, Texas Medical Center, Houston, Texas and UA/EM Program Committee chairman.)

Trauma Service and Emergency Medicine

~ V E N W I T H I N T H E A R E A S of " c l a s s i c a l s p e c i a l t y , " there is a need for a service t ha t can cross the ar t i f ic ia l divisions w i t h i n m e d i c i n e e s t a b l i s h e d over the y e a r s for a va r i e ty of reasons, usua l ly hav ing l i t t le or no th ing to do wi th care of the pat ient .

Such a concept is the t r a u m a service, one of which is described in "The In tegra ted T r a u m a Service," by Maul l

and H a y n e s (p 497). For yea r s in many ins t i tu t ions , the emergency d e p a r t m e n t has had the unenviable t a sk of sor t ing out which service to involve in the care of mul t i - ple o rgan-damaged pa t ien ts . How many pa t ien t s have suffered from the inevi tab le "ping-pong? .... You're r ight , tha t ' s a very sick pa t ien t , but not on my service!" How easy has it been to convince the genera l surgeon to admi t the pa t i en t wi th a head injury, a f ractured femur and a microscopic hema tu r i a? To have a single service capable of orches t ra t ing the mul t ip le superspecia l ty needs of the t r aumat ized pa t ien t is indeed a luxury.

How s h o u l d such a s e r v i c e r e l a t e to e m e r g e n c y m e d i c i n e ? In a n u m b e r of i n s t i t u t i o n s w i t h s t r o n g t r a u m a services, emergency medicine has been unable to gain a foothold. Or if emergency medicine res idents a r e

t r a ined there , they p lay a minor role, l i t t le advanced beyond tha t of a s tuden t or f irst pos tgraduate yea r house officer. I t is s ignif icant and ha rd ly accidental t ha t these emergency depa r tmen t s have poorly organized emergency me d ic a l s e rv i ces (EMS) s y s t e m s and very poor ca re of any but the most l i fe - th rea tened pat ients .

There need not be a n t a g o n i s m be tween e m e r g e n c y medicine and surgery. Both services will profit from a well run paramedic p rogram wi th s trong medical control. A well run sys tem can de l iver advance informat ion as to wha t is coming and when to d iver t cri t ical pa t ien ts when the t r a u m a service is complete ly t ied up in the opera t ing room. F u r t h e r m o r e , the e m e r g e n c y medic ine r e s iden t and a t t end ing s taff can direct the ini t ia l resusc i ta t ion and s tab i l i za t ion of the pa t i en t and assis t in the pro- curement of appropr ia te d iagnost ic studies. There is no need to exclude e i the r service. In fact, this was the pat- tern of care in World W a r II and the Korean War. In civi l ian practice, the emergency service assumes a role of the Ba t ta l ion Aid Stat ion.

Wha t about the inevi tab le conflict over who does the in i t ia l s tab i l iz ing procedures? There is rea l ly noth ing ar- cane about s t a r t i ng in t ravenous lines, p lacing nasogas- tric tubes and very l i t t le concerning the more sophist i- cated procedures such as thoracos tomy or thoracotomy. The t r a u m a service can work as a t eam with the emer- gency personnel to insure t h a t appropr ia te procedures are done in a t ime ly fashion and in a safe and h igh qua l i ty manner .

Improving the qua l i t y of care to all pa t i en t s in the emergency d e p a r t m e n t not only enables bet ter manage- ment of the t r a u m a pa t i en t but produces a sys tem tha t can respond to even subt le in jur ies tha t would otherwise be lost in the genera l crush of busy hours.

I can only hope t h a t more ins t i tu t ions will make a commi tment to the organ iza t ion of a t r a u m a service, and an emergency medical service. We shal l then experience a subsequent improvement not only in service to cr i t ica l pat ients , but also in the educat ion of s tudents and house officers, and research into improved c a r e .

Peter Rosen, MD

" ~ (Dr. Rosen is director of the Division of Emergency Medicine at Denver General Hospital and a JACEP con- tributing editor.)

J ~ P 6:11 (Nov) 1977 . 514/sl