ACS COT Centennial Celebration Promotes Vision for the Future and a Transition in Leadership

The American College of Surgeons Committee on Trauma (ACS COT) hosted its 100-year anniversary celebration at its Annual Meeting, March 9−12 in Seattle, WA. Total registration for the event—the first in-person ACS COT Annual Meeting since 2019—was 743, with 571 in-person registrants, including staff, and 172 virtual registrants.

COT members, past COT leaders, Scudder Orators, Advanced Trauma Life Support^® (ATLS^®) Program partners from around the globe, and other colleagues attended the meeting, which recognized the committee’s history of improving trauma care. Since its founding, the COT has transformed the care of the injured patient by setting standards for emergency trauma care and industrial, automobile, and traffic safety, and is now working to support firearm injury and violence prevention, among other activities.

The theme of the 100th anniversary celebration is Looking to the Future through the Lens of Legacy, which underscores the role of the next generation of trauma surgeons in furthering the COT’s mission of developing and implementing programs that support injury prevention and ensure optimal patient outcomes.

A commemorative book, also titled Looking to the Future through the Lens of Legacy, is available for purchase at https://image3.source4.com/welcomehybrid.asp?UID=236634. In addition, an interactive timeline (cot100.facs.org/#timeline) was developed to provide a visual representation of the people and events that shaped how surgeons care for the injured patient.

A highlight of the meeting was the transition in leadership, with Jeffrey D. Kerby, MD, PhD, FACS, installed as Chair of the ACS COT. Dr. Kerby is the 21st Chair of the COT and succeeds Eileen M. Bulger, MD, FACS, in this role.

Program highlights included leadership reports from the ACS COT Advocacy, Quality, Education, and Systems Pillars, updates from Regional Committees, and the 45th Resident Trauma Papers Competition. First- and second-place winners in Basic Laboratory Science and Clinical Research were announced at the COT 100th anniversary banquet.

Presentations that focused specifically on the influence of the ACS COT on the evolution of trauma care included Reflections on the Impact of the COT, Recognition of Military Service, The Regional COT and Global Engagement, and Looking to the Future. These presentations are freely available for all to view at bit.ly/3ju4HBh.

Reflections on the Impact of the COT

This session featured past Chairs of the COT, including David B. Hoyt, MD, FACS, former ACS Executive Director (COT Chair, 1998–2002); J. Wayne Meredith, MD, FACS, MCCM, the 2020–2021 ACS President (COT Chair, 2002–2006); John Fildes, MD, FACS (COT Chair, 2006–2010); Michael F. Rotondo, MD, FACS (COT Chair, 2010–2014); and Ronald M. Stewart, MD, FACS, (COT Chair, 2014–2018).

“This really is a momentous event,” said Patricia L. Turner, MD, MBA, FACS, ACS Executive Director. “You are the most influential force in trauma care today,” she added. “I am sure Dr. [Charles L.] Scudder would be incredibly proud of the all the accomplishments of the COT.”

“The energy and impact of COT education is like the Old Faithful Geyser—impressive, and it looks like incredible energy, and it is,” said Dr. Meredith, who spoke virtually on The Impact of COT in Education. “But it represents an even more enormous energy beneath the surface, which periodically bursts forth to amazing effect.”

Dr. Meredith noted that millions of individuals worldwide have been trained in COT programs including ATLS, Rural Trauma Team Development Course™ (RTTDC), Advanced Surgical Skills for Exposure in Trauma (ASSET), Advanced Trauma Operative Management (ATOM^®), Basic Endovascular Skills for Trauma (BEST), STOP THE BLEED^®, and other courses. “But perhaps the most important impact of the trauma education programs is the way they bring us together to develop courses, promulgate courses, and teach the courses. Trauma education binds all of us to a common mission.”

In a session titled Quality Improvement: From Analog to Digital, Dr. Fildes outlined the pathway for how COT quality improvement migrated to a digital format:

• 1982: The Major Trauma Outcome Study was commissioned, with data extracted from 80,544 records by hand and analyzed by computer.
• 1988: The Centers for Disease Control and Prevention convened a group to define a data set for trauma.
• 1989: The ACS Board of Regents committed significant resources to establish the National Trauma Data Bank^® (NTDB^®).
• 1995: The ACS COT convened a consensus conference to define the 86 NTDB data elements.
• 1997: The first call for data was issued.
• 1999: The NTDB was analyzed and plans for an Annual Report were made.

“More than 1,515 publications have been developed from NTDB and Trauma Quality Improvement Program^® (TQIP^®) data,” Dr. Fildes said, including a growing number of ACS COT best practice guidelines. “We are on a curvy, uphill, unpredictable path,” he said, referring to the evolving nature of quality improvement data.

Dr. Stewart outlined the early history of injury prevention in the ACS COT, noting that three factors have led to the decrease in injury-related deaths:

Reduction in exposure to dangerous jobs (such as mining, manufacturing, and farming) and enhancements to safety improvements in the areas of transportation and housing

Enhancements in the medical care provided to injured patients, many of which originated with the military

Development of evidence-based injury control strategies, such as those related to motor vehicle safety

Regarding firearm injury prevention, Dr. Stewart noted that the COT followed specific guiding principles, including viewing the issue as a medical/public health problem rather than a political issue, seeking out evidence-based violence prevention programs, and establishing a forum for professional dialogue to develop consensus.

Dr. Rotondo outlined the goals of the ACS COT Trauma System Evaluation and Planning Committee (TSEPC) in a session titled Trauma System Development: Health Policy and Advocacy. Dr. Rotondo, the third chair of the TSEPC, noted that the committee’s aim of fostering trauma system development nationwide is driven by expanding the scope of the consultation program, broadening federal partnerships, and advocating for trauma system funding. Development and implementation of a National Trauma and Emergency Preparedness System (NTEPS) at the federal level, based on the 2016 National Academies of Sciences, Engineering and Medicine (NASEM) report, will support the daily needs of the injured patient and serve as the framework for mass casualty and disaster response and support. Dr. Rotondo emphasized the role of strong leadership at the federal level and ongoing advocacy efforts to implement a national system that supports state and regional systems and unites them within a common framework.

“My message to you today is that we are at a critical time right now when it comes to advocating for the right kind of quality improvement,” Dr. Hoyt said in his presentation, The COT and the American College of Surgeons. “Just as [Ernest A.] Codman, [MD, FACS,] faced real dilemmas when it came to transparency about care…we are at a critical time when it comes to authentic quality improvement that truly improves care.”

“The quality model, with the four guiding principles of continuous quality improvement that the COT established…is the way that we establish public trust,” he said. Those principles include standards, infrastructure, rigorous data, and verification, he said, noting that all 17 ACS Quality Programs are based on these four principles.

“The ACS and the COT inspire each other,” Dr. Hoyt said, pointing out that visionary leadership, system development, and research are integral to patient-centered care in the future.

In a brief video, C. Thomas Thompson, MD, FACS, (COT Chair 1978–1982), highlighted key milestones in the COT’s ongoing efforts to eliminate preventable death and disability from injury.

Recognition of Military Service

“Approximately 90% of ACS Fellows participated in World War II, many from academic surgery programs,” said M. Margaret “Peggy” Knudson, MD, FACS, Medical Director, Military Health System Strategic Partnership−ACS (MHSSPACS). At the end of World War II, surgeons who had served during the conflict gathered at the Excelsior Hotel in Rome, Italy, to discuss their experiences. This was the first meeting of what would be called the Excelsior Surgical Society, noted Dr. Knudson. The meetings continued annually until the death of the last World War II veteran member, Michael E. DeBakey, MD, FACS. In 2015, with the experiences from the conflicts in the Middle East and the renewed interest in combat casualty care, the Excelsior Surgical Society was revived, and the College was designated as its official home. At present, the Excelsior Surgical Society has more than 350 active members and offers a full day of programming at the annual Clinical Congress, including two Named Lectures.

Today, the primary objectives of the MHSSPACS include sharing information about surgical quality, trauma systems, surgical education, research, and more.

Future MHSSPACS goals include participating in a national trauma and emergency preparedness system; expanding trauma and emergency care throughout the US, including key military treatment facilities (part of the military-civilian partnership and the readiness mission); and expanding response to disasters by involving US military personnel.

Select attendees participated in a special recognition of all ACS members who have served or are actively serving in the military, as well as those who have participated in the Senior Visiting Surgeons Program. More than 65 members were honored with a Military Challenge Coin, which recognizes achieving success at the end of a mission, marks camaraderie in an elite group of individuals, and honors the actions of all coin recipients.

A letter from former US President Barack Obama, which describes his support of the mission and accomplishments of the COT and, in particular, “the heroic contributions of military surgeons,” was displayed during this session.

Regional COT and Global Engagement

Speakers who outlined the history and global impact of the Regional Committees on Trauma included Dr. Bulger, Raul Coimbra, MD, PhD, FACS (COT Vice-Chair, 2010–2015), Karen J. Brasel, MD, FACS (ATLS International Chair, 2014–2018), and Maria F. Jimenez, MD, FACS (past-Region 14 Chief, Chair International Injury Care Committee, 2016–2019). Sharon Henry, MD, FACS, ATLS Global Program Chair, and Patrick M. Reilly, MD, FACS, Vice-Chair of the ACS COT and Chair of the Regional Committee on Trauma, provided a brief overview of the session.

Dr. Bulger described the evolution of the Regional Committees, which began when Dr. Scudder charged members of the original Committee on Fractures (COF) with forming local committees to advance fracture care. “By 1947, there were 87 local committees with more than 1,800 members. To manage this growth, the COT divided the US and Canada into 13 regions and established new Section Chief roles,” Dr. Bulger said.

• The accomplishments of the Regional Committees include:
• Setting standards for ambulance equipment and training providers
• Setting standards for emergency departments
• Implementing the National Safety Council state motor vehicle safety program
• Establishing the first ATLS course
• Developing the surgical skills course
• Forming the RTTDC and the Disaster Management and Emergency Preparedness Course

At present, the COT has 10 US regions, two Canadian regions, one military region, and four international regions for a total of 17 Regional Committees on Trauma worldwide. “The grassroots of the COT are the regional committees,” Dr. Bulger said.

“In 2011, we had a dream to create a strategy to increase our international reach,” Dr. Coimbra said. “Trauma is a global disease that has been neglected globally. Our ultimate goal is to improve trauma care globally,” he said, noting that the goals of the COT international regions include:

Develop local, regional, and national trauma systems

Develop performance improvement processes in trauma care tailored to the reality and needs of the country

Promulgate the educational opportunities of the ACS COT according to the needs of the country, including ATLS, PHTLS, ASSET, ATOM, DMEP, and RTTDC

Collaborate with other stakeholders, societies, and specialty groups to improve the care of the injured patient

Dr. Coimbra also described the evolution and aim of the International Injury Care Committee, which seeks to advance the care of injured patients through education, advocacy, and quality improvement based on a foundation of understanding, trust, collaboration, and a free exchange of ideas.

Dr. Brasel summarized the global promulgation of ATLS, now in its 10th edition, which is the standard for educating physicians about early care of the injured patient. The course, which is region-run and offered in 84 countries in seven languages, has expanded to the point that the annual number of courses offered outside the US exceeds the number given within.

The Trauma Evaluation and Management (TEAM) Course, adapted from ATLS core content, provides a standardized introductory course in the evaluation and management of trauma specifically for medical students and multidisciplinary team members.

Dr. Jimenez described the evolution of the Latin America and the Caribbean Trauma Center Consultation and Verification Program and how that initiative intends to provide “a cost-effective framework from which global trauma systems can be developed worldwide.” She said the program “places trauma as a high health priority” and promotes the development of legislative health policies. A crucial initial step for this verification program was translating Optimal Resources for the Care of the Injured Patient into Spanish and Portuguese.

Dr. Jimenez and a team from Region 14 translated the text, adapting the US standards to create a manual that is relevant to the medical culture and conditions of that region. The first edition of the translated text was completed in January 2017.

Dr. Jimenez also covered lessons learned from trauma center site visits and the criteria for becoming a Region 14 verification reviewer. (This pilot program is still in development.)

Dr. Henry moderated a panel featuring the perspectives of both present and past international region chiefs regarding the role of the COT within their regions and surgical societies. Panelists included George Abi Saad, MD, FACS, Michael Hollands, MD, FACS, Scott D’Amours, MD, FACS, Saud Al Turki, MBBS, FACS, Andrew Baker, MD, and Joakim Jorgensen, MD, FACS.

Looking to the Future

Present and future COT leaders summarized new initiatives and emerging projects, particularly as they relate to the future of trauma care. Presenters included Avery Nathens, MD, PhD, FACS, FRCSC (Medical Director, ACS Trauma Quality Programs), Brian Eastridge, MD, FACS (Chair, ACS COT Trauma Systems Pillar and Committee), Kimberly Joseph, MD, FACS, FCCM (outgoing Chair, ATLS Committee and incoming COT Education Pillar Chair), Brendan T. Campbell, MD, MPH (Chair, ACS COT Injury Prevention and Control Committee), John H. Armstrong, MD, FACS (Chair, ACS COT Advocacy Committee), Meera Kotagal, MD, MPH, FACS (a participant in the Future Trauma Leaders Program, 2020–2022), and Dr. Kerby (outgoing Chair, ACS COT Membership Committee, and, as previously stated, incoming Chair, ACS COT).

Dr. Nathens underscored the importance of patient-reported outcome measures (PROMs). “PROMs assess the outcomes and value of care from the patient perspective,” Dr. Nathens said, noting that these measures reveal whether an operation or intervention was successful based on why the patient sought care and whether the treatment aligned with initial goals of care.

A TQIP PROMs pilot is set to launch this year, and participating sites will have access to a data collection platform that will allow patients to enter their own data. The PROMs in the pilot include mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Additional pilot measures include questions assessing the ability to participate in social activities and measures related to care transition.

Patients will provide feedback at 1-, 6-, and 12-month intervals. “Over time, data will inform treatment decisions and lead to innovative models of care focusing on trauma survivorship,” Dr. Nathens said.

Dr. Eastridge highlighted the COT Trauma Systems Pillar’s mission to “develop and lead programs, initiatives, and collaborative efforts that optimize regional and state trauma systems and establish a framework for a national trauma system to reduce preventable deaths and disability.”

He summarized the history and evolution of trauma system development via a condensed timeline of milestones, beginning with the 1966 report from the National Research Council, Accidental Death and Disability: The Neglected Disease of Modern Society,through the publication of the NASEM National Trauma Care System Report in 2016.

As for the future of trauma systems, Dr. Eastridge said a primary focus for trauma leadership is to develop a NTEPS that would:

• Reduce rates of injury in the population
• Ensure timely access to equitable, high-quality care
• Enhance survivability and minimize disability for injured patients
• Maximize survival after mass casualty events
• Accelerate high-quality research to advance trauma care

Dr. Joseph called on educators to “embrace adult education theory, instructional design principles, and project management skills,” with enhanced attention to ensuring diversity, equity, and inclusion (DEI). “When we look at our content, we need to always ask ourselves, ‘What voices need to be heard that are not in the room?’” she said.

An updated MyATLS app is in development, she said, noting that the new version will be more agile, easier to update, and include elements of gamification and more personalized education.

Dr. Campbell noted that the key to injury prevention includes advocacy at the federal and state levels with a focus on primary prevention, which targets risk factors for injury and disease, and primordial prevention, which targets social and economic policies affecting health. Dr. Campbell said the “COT has, and will continue to make, an enormous difference” in injury prevention, which he called a “major public health problem that typically follows predicable patterns.” He noted, “Many interventions are possible. The trick is to pick the most cost-effective one.”

“Advocacy moves minds and hearts to act,” said Dr. Armstrong. He identified pathways for trauma surgeons to engage in advocacy, including resources available at surgeonspac.org, surgeonsvoice.org, legislator-staff visits, and voting. “Let’s hear what some decision-makers in Washington have to say about what is on their minds when it comes to what we do,” he said, introducing a video clip of policymakers outlining their support of the ACS mission to provide affordable, high-quality care.

Dr. Kerby outlined the six primary principles that underpin the COT’s DEI Work Group: diverse representation, inclusive leadership, structural competency, accountability, lifelong learning, and sharing evidence-based knowledge. “We want to incorporate these DEI principles into strategic planning across all of the COT pillars and align our DEI initiative with the larger ACS DEI efforts,” Dr. Kerby said.

“Looking to the future, we’re going to have great leadership,” Dr. Kerby added, introducing the incoming COT Membership Committee Chair, Krista Kaups, MD, MSc, FACS.

Dr. Kerby also highlighted the Mentoring for Excellence in Trauma Surgery (METS) Program, established in 2015, which includes participants from the Future Trauma Leaders (FTL) Program, liaisons from the ACS Resident and Associate Society and Young Fellows Association, and the COT’s Firearm Injury Prevention Clinical Scholars. METS participants are paired with a mentor and assigned to research, quality improvement, injury prevention, advocacy, or education projects in their areas of interest and work appointed to COT committees for 2 years.

A video, “Advice to Young Trauma Surgeons,” concluded Dr. Kerby’s presentation. The video features clips of more than 40 interviews with trauma surgeons discussing mentorship, the benefits of collaboration, finding your niche, advice for problem solving, and the importance of putting the patient first. Interviewers included Drs. Kerby, Bulger, Hoyt, and Stewart.

Dr. Kotagal offered the perspective of a future trauma leader. “As we look to the next 100 years of the COT, the future lies in equity,” said Dr. Kotagal, who participated in the FTL Program from March 2020 to October 2022. “How do we improve outcomes, including long-term functional outcomes, for all our patients, so that the outcome for the patient who happens to be injured is not dependent on where they are born or who they were born to?” she asked, noting that the COT is “filled with changemakers…who need to develop interventions that target and close equity gaps.”

Conclusion

Throughout 2022 and beyond, the ACS COT will continue to work to raise public awareness of traumatic injury as a major public health issue and advocate for investment in the development of a national trauma and emergency preparedness system.

The ACS COT will continue the 100th anniversary celebration in conjunction with the ACS Clinical Congress 2022, October 16–20, in San Diego, CA, with events such as the Scudder Oration on Trauma and a Special Session examining the accomplishments and a vision for the future of the COT.