Scudder Oration to address success via reproducible trauma strategy

Lenworth Jacobs, MD, MPH, FACS
Lenworth Jacobs, MD, MPH, FACS

Trauma and emergency medicine focus on solving problems. That means identifying the problem, devising a solution, and implementing it.

“Those three steps are a skill set, a reproducible skill set,” said Lenworth Jacobs, MD, MPH, FACS, professor of surgery and of traumatology and emergency medicine at the University of Connecticut, Hartford. “If you follow those steps, there is a high likelihood that whatever problem you encounter will have a successful outcome. We use that reproducible strategy for success in our practices every day, and the American College of Surgeons Committee on Trauma (ACS COT) has used it to very successfully address key problems in trauma surgery.”

Dr. Jacobs will discuss three seemingly intractable problems in trauma surgery during the 2021 Scudder Oration on Trauma, Trauma, Education, Communication and Implementing Change, at 1:00 pm Central Time on Tuesday, October 26. The presentation honors Charles Locke Scudder, MD, a founding member of the ACS known for his major contributions to the surgery of trauma. This year’s oration also honors the 100th anniversary of the COT.

“Dr. Scudder’s main mission was to improve patient care through education and practice methodologies,” Dr. Jacobs said. “That’s the approach the ACS has taken in applying this three-step reproducible strategy for success to very different problems, starting with Advanced Trauma Life Support®, or ATLS®, in the 1970s.”

Trauma practitioners worldwide take the standardized approach to resuscitation embodied in ATLS for granted today, Dr. Jacobs noted. Half a century ago, resuscitation outcomes were as wildly divergent as the ways practitioners tried to achieve it. ATLS incorporated clear clinical principles that guided practitioners to identify the greatest threat, then devise and implement a solution.

Twenty years later, the COT used the same approach to address the growing gap between surgical education, focusing on minimally invasive techniques and the increasing surgical need for open procedures to treat penetrating injuries.

“Minimally invasive surgery is a very different skill set from open surgery,” Dr. Jacobs said. “A minimally invasive approach using angioembolization is useful, but if you’re presented with a ruptured spleen or liver, a serious stab wound, or a gunshot wound, you need somebody who knows how to open the abdomen, stop the bleeding, remove the spleen, repair the aorta, and deal with severe injuries. This is critical, both in the civilian world and in the military world. In the 1990s, those skills were atrophying.”

The other side of the problem was a lack of training opportunities. Penetrating trauma cases weren’t uncommon in trauma centers, but they typically present at night with little to no warning. Patients are more often emergencies than training opportunities.

“The Advanced Trauma Operative Management (ATOM®) course changed our paradigm,” Dr. Jacobs said. “We teach procedures in a simulated environment, with a full operating suite. The surgeon learns to identify the problem, devise a solution, and fix it in real time.”

The third problem is severe bleeding. Sparked by mass casualty events such as the Sandy Hook Elementary School shooting in Connecticut in 2012 and the Boston Marathon bombing in Massachusetts in 2013, the ACS launched STOP THE BLEED® to train individuals as immediate responders to stop severe bleeding.

“Most people know to call 911, but with mass casualties, 911 can be overwhelmed.” Dr. Jacobs said. “We have trained more than 1.8 members of the public to recognize severe bleeding and to stop it immediately.

“Like ATLS and ATOM, STOP THE BLEED is a reproducible strategy for success,” he continued. “It’s an approach that saves lives.”

The Scudder Oration on Trauma is sponsored by the ACS Committee on Trauma. This and other Named Lectures will be available to registered attendees for on-demand viewing for a full year following the Clinical Congress on the virtual meeting platform.