In the late 60’s the Birmingham Accident Hospital was regarded as one of the premier places for a surgical trainee to be exposed to accident and emergency care. When I went for an interview, I walked past a rather diminutive brick building.
William Gissane was clearly a “systems of care” genius. I enjoyed his company over meals at the Edgebaston Golf Club.
Besides the significant clinical experience (up to 12 wrist fractures on one icy morning) I learned these things which have followed me through my life as a trauma, critical care surgeon:
The team system – the three teams on, off (elective surgery) and backup each with full compliments of consultants (attendings), senior and junior trainees
Disciplined multidisciplinary management under a “team leader”
Early integration of postmortem pathology to the clinical experience – thanks to Simon Sevitt
Separation of serious injured from the walking wounded – the ambulance use to back into the resuscitation area of the Major Injuries Unit (MIU) where patients where immediately subjected to major resuscitation procedures prior to operative care as necessary
The leadership role of the consultant e.g. PSL and others Badger et al
After a period at the Royal Infirmary and University of Edinburgh, I arrived at the Shock Trauma Unit at the University of Maryland in Baltimore in 1973 and witnessed R Adams Cowley screaming at a hoard of individuals surrounding trauma patients that had been admitted directly from the heliport or ambulance to an intensive care unit bed without any structural process to guide or secure their care.
As a result of my experience at the Birmingham Accident Hospital I was able to institute the team system, roles for team members, cross disciplinary training and quality management techniques and tactics. I was also able to design and build a resuscitation area with an adjacent operating room. These basic structures I brought to Washington, DC in 1975 to the trauma center I ran for about 20 years.
They were adopted by many of the leading trauma centers in the United States in the late 70’s / early 80’s
In Washington, I was able to place the helipad and ambulance ramp with direct access to my resuscitation bays and operating rooms as at the Birmingham Accident Hospital and at a separate entrance from the walking wounded/emergency department.
The Washington DC ambulance service and surrounding jurisdictions soon caught on to the superior service that critically injured patients could be offered from much immediate access to advanced resuscitative care.
The data from the United States show a continued reduction in in-hospital mortality, as a result a trauma center implementation across the country in the 80’s.
As a member of the Committee on Trauma of the American College of Surgeons I was able to help instantiate the standards I acquired from the Birmingham Accident Hospital into the American College of Surgeons Guidelines.
In short, as an SHO at the Accident Hospital had profound impact on my own career and probably trauma care throughout the world as I continued to propagate my US experience into many other countries and through the International Association for Trauma Surgery and Intensive Care which I founded under the guidance of Martin Allgower, Secretary General of the International Society of Surgery.