Osvaldo Chiara - Trauma Centers and Acute Care Surgery: A Novel Organizational and Cultural Model

The aim of this series is to provide informative updates on hot topics in the areas of breast, endocrine, and abdominal surgery, surgical oncology, and coloproctology, and on new surgical techniques such as robotic surgery, laparoscopy, and minimally invasive surgery. Readers will find detailed guidance on patient selection, performance of surgical procedures, and avoidance of complications. In addition, a range of other important aspects are covered, from the role of new imaging tools to the use of combined treatments and postoperative care.

The topics addressed by volumes in the series Updates in Surgery have been selected for their broad significance in collaboration with the Italian Society of Surgery. Each volume will assist surgical residents and fellows and practicing surgeons in reaching appropriate treatment decisions and achieving optimal outcomes. The series will also be highly relevant for surgical researchers.

More information about this series at http://www.springer.com/series/8147

Revision and editing: R. M. Martorelli, Scienzaperta (Novate Milanese, Italy)

This Springer imprint is published by the registered company Springer Nature Switzerland AG

The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

It is at the same time a pleasure and an honor for me to introduce to the surgical community the excellent work of Professor Chiara in the traditional format used by the Italian Society of Surgery. It is also the appropriate occasion to congratulate my colleague on the extensive documentary work that offers the most qualified surgical readers an organic analysis of the modern problems surrounding the general management, logistics, and organization of a trauma center, while emphasizing the universally acquired model of coordinated multidisciplinary management of polytrauma, without overlooking the peculiarities of the different anatomical districts and systems.

The result is a complete, specific, and highly specialized review of the most important aspects of trauma care.

This book carefully guides the reader through the complex world of trauma centers and related aspects. It is destined to become a reference text in the variegated bibliographic landscape of monographs devoted to trauma and trauma centers, bringing the readers up to date on the most advanced techniques of polytrauma management, the results acquired, and the scientific debate surrounding the principal, yet still controversial, topics.

Looking at the results of this major endeavor, I would like to express, on behalf of the SIC, our gratitude to the editor and authors for presenting us with a tangible sign of their extensive field experience in a monograph that maintains the traditional high standard of the monothematic publications of the Italian Society of Surgery.

The history of trauma systems started in the US and, since the beginning, surgeons were launched into a full stewardship. In Europe, anesthesiologists and emergency physicians were more involved in trauma leadership but few surgical groups in the UK, Germany, and Italy, with a visionary interest toward emergency situations, joined in this path. Some studies on preventable trauma deaths attracted the attention of politicians sensitizing them to the need to institute an organized system founded on the concept that pre-hospital health care personnel should recognize and transport severely injured patients in the shortest time to the appropriate hospital capable of treating all injuries 24/7. Emergency Medical Systems and Trauma Centers were developed in almost all countries, both in North America and in Europe, with different models, different criteria for hospital standards, but with the same aim: to improve the care of the injured and to decrease the mortality due to trauma. In this period, a strong foundation and a springboard for the development of a trauma surgery discipline was established. In the first Trauma Center in the US, the Cook County Hospital in Chicago, Illinois, the Trauma and Burn unit greatly influenced the development of other activities, such as trauma radiology, trauma anesthesia, laboratory support, and computerized trauma registry. The first statewide trauma system was developed in the 1970s in Maryland with the Maryland Institute of Emergency Medical Service System (MIEMSS), which set up a sophisticated communication system, interfacing the emergency call center, paramedics on the scene, and doctors in the emergency room. The Baltimore Shock and Trauma Center, later dedicated to its founder, Dr. R. Adams Cowley, rapidly became one of the most crowded around the world, a model for the organization, protocols of care, and research in the field of trauma. Hundreds of well-equipped emergency ambulances, with thousands of pre-hospital providers, State Police helicopters, a level-one adult and a pediatric Trauma Center in Baltimore, and several lower-level facilities, realized an impressive network for the care of the injured.

The decrease in penetrating trauma and the improvement of techniques for non-operative management of solid organ injuries significantly reduced the number of operations by the general surgeon and a trauma surgery career became less attractive. This crisis had its nadir at the beginning of the new century and the solution was found with the creation of a new discipline that encompassed general and emergency surgery, trauma, rescue surgery, and surgical critical care. The discipline of Acute Care Surgery was born. This model had already been applied in Italy since the 1970s. Professor Vittorio Staudacher founded the first Italian surgical school for Emergency Surgery: the care of trauma and non-trauma emergencies all over the body was the proposal, with the knowledge of the pathophysiology of critically ill patients as a guide to make the most appropriate choices in time-dependent illnesses. In the Milan Institute of Emergency Surgery, led by Professor Staudacher, general surgeons developed different skills: some were interested in thoracic surgery, others in vascular surgery, others still in musculoskeletal surgery. Dedicated anesthesiologists, an emergency physician, and a cardiologist all worked exclusively inside the institute. A surgical intensive care unit with three beds (the so-called anti-shock room) managed by general surgeons was availablean