Excellence in Trauma Surgery via Multidisciplinary Efforts

We are all familiar with the caduceus, a symbol derived from ancient Greek mythology that depicts two snakes wound around a staff, sometimes topped with wings. The caduceus often appears in medical logos and insignia where another symbol, the rod of Asclepius, depicting one snake wound around a staff, might be seen. The rod of Asclepius is associated with the ancient Greek deity of medicine and has always denoted healing. In contrast, the caduceus is linked to Hermes, Greek god of travelers and commerce, and it is sometimes thought to be used in medicine only in error—although, in third-century London, it was a marker for ophthalmological medicines, in apparent reference to a Homeric poem linking it to the healing of eye disease.

Both symbols, however, connect with the vision of the ACS (although we do not formally use either) as the House of Surgery for all surgical disciplines. Integrating all elements of surgeons and surgery into what’s best for our patients and our profession helps us tackle tasks that no single specialty could achieve as effectively alone.

One example of this is in our longstanding work advancing trauma surgery. Surgeons of all kinds are essential to this work, including those in vascular, pediatric, reconstructive surgery, and virtually all other surgical disciplines—more than any one column can describe. In this column, I’ll share some examples of how neurologic, ophthalmologic, otolaryngologic, plastic and maxillofacial, and orthopaedic surgery connect with our work in trauma.

Ensuring Trauma Care Is Comprehensive

The ACS engages with multiple surgical disciplines on trauma care in important but straightforward ways. Our Verification, Review, and Consultation program, which began in 1987 and engages approximately 590 participating hospitals today, uses a standards manual, Resources for Optimal Care of the Injured Patient (2022), that details program requirements for trauma care. These are, by design, highly multidisciplinary, as effective care of the trauma patient requires engagement across the spectrum of physician specialty and nonphysician care.

For example, among many standards for appropriate trauma care are requirements for access to craniofacial care in Level I adult and pediatric trauma centers and access to ophthalmological, plastic, otolaryngological, and other surgical specialists in Levels I and II adult and pediatric trauma centers. In addition, the standards require all trauma centers to provide neurological and orthopaedic surgical care.

Similarly, our Advanced Trauma Life Support^® (ATLS^®) course, which will soon celebrate its 50th anniversary, ensures comprehensive care by including instruction on trauma care across the spectrum of surgical needs. For example, this includes head and neck trauma, ear, nose, and throat trauma, and neurotrauma. ATLS, which was originally the brainchild of orthopaedic surgeon James K. Styner, MD, FACS, also includes insights into orthopaedic surgical care.

Building an Ocular Trauma Roadmap

The ACS Committee on Trauma (COT) connects with ophthalmologists on challenges in ocular trauma treatment as well. This past year, the COT created a position paper with recommendations for addressing systems-level gaps in ocular trauma care in the US. Collaborations between the COT and American Society of Ophthalmic Trauma are ongoing.

Improving TBI Care across Surgical Disciplines

Traumatic brain injury (TBI), which has a lifetime prevalence of 18.2% in US adults, is also highly relevant for multidisciplinary efforts.

In October 2024, the COT released a new edition of Best Practices Guidelines for the Management of Traumatic Brain Injury. More than 20 neurosurgeons, along with dozens of other healthcare professionals, contributed to the creation of these guidelines. A previous edition, in 2015, has led to improvements in some aspects of TBI care; the aim of this new edition is to continue that success by providing comprehensive best practices.

Similarly, we have created the “Fundamentals in the Management of Traumatic Brain Injury” course as a joint initiative of the Brain Trauma Foundation and the COT, using Brain Trauma Foundation guidelines that have been shown to reduce TBI mortality by 50%.

Uniting Surgical Disciplines at Conferences

ACS conferences, particularly Clinical Congress and the Trauma Quality Improvement Program (TQIP) Conference, include sessions on multidisciplinary trauma care. For example, Clinical Congress 2024 featured neurosurgery-related panels on TBI and domestic violence and guidelines for TBI.

For ophthalmologists, a panel on assessing and managing ocular, orbital, and skull-based injuries is relevant, while a session called “Damage Control Ophthalmology for the Non-Ophthalmologist” addressed ophthalmological trauma surgery. Sessions suited to orthopaedic surgeons included ones on combat trauma and postinjury sports participation.

Leadership and Collaboration

Surgical disciplines also mesh in ACS leadership. Our Board of Regents includes Regents and officers from many surgical disciplines, and our Advisory Councils cover surgical specialties comprehensively, including the neurological, ophthalmic, otolaryngology–head and neck, orthopaedic, oral and maxillofacial, and plastic surgery disciplines I have mentioned in this column.

Succeeding Together

The ACS—The House of Surgery™—strives to include surgeons of all kinds. In many ways, our mission, to heal all with skill and trust, cannot be realized without multidisciplinary efforts—and the ongoing effort to connect across disciplines for the good of all patients is a practice as ancient and as eternal as medicine itself.