The management of severely injured patients is demanding because trauma does not respect the boundaries of anatomy or surgical specialty. Yet the UK lacks training opportunities for trauma surgery and a service infrastructure, problems that other countries have recognised and started to remedy, write Professor James Ryan and colleagues.
Efforts to improve training have been retarded by the absence of a dedicated trauma service infrastructure within the NHS, while demands from surgical institutions for a national framework for trauma management and centralisation of expertise have not been heeded.
In North America, trauma doctors continue to enjoy dedicated training programmes and recognition of their discipline, while, in Britain, trauma has never been recognised as a separate surgical specialty, they argue.
As younger specialties such as emergency medicine, and critical care establish ever-expanding fields of responsibility, they warn that the general surgeon's role as provider of holistic trauma care risks being fatally eroded.
They believe that the UK's surgical institutions should fundamentally re-examine the issue of trauma training for surgeons. "In particular, Britain needs a robust way of identifying, training, and accrediting a cadre of surgeons with the potential to become clinical champions of trauma services."
"Sanctioning the birth of acute care surgery as a discrete discipline could provide a training path and career structure for trauma surgeons," they write. "More importantly, such a development may encourage a retooling of provision in a health service that has so far escaped all efforts to systemise the care of the seriously injured."
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