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June 1992

Surgical Critical CareThe Next Challenge in Regionalized Trauma Systems

Author Affiliations

From the Surgical Critical Care Unit (Dr F. Moore) and the Department of Surgery (Dr E. Moore), Denver (Colo) General Hospital.

Arch Surg. 1992;127(6):665-667. doi:10.1001/archsurg.1992.01420060031005

Regionalized trauma centers were developed to provide optimal care for patients with high injury-severity and have, in fact, resulted in improved survival by ensuring early appropriate intervention.1-3 However, to further reduce preventable deaths, these centers must now focus on the later phases of therapy that is delivered in the intensive care unit (ICU). Historically, trauma surgeons have been effective leaders in this arena, but now a variety of nonsurgeons (eg, anesthesiologists, pulmonologists, and pediatricians) with special interest in critical care believe they can best manage the severely injured.4-10 They argue that trauma surgeons do not possess the necessary skills nor can devote the time needed to effectively care for the critically ill patient. Trauma surgeons, however, are best positioned to be critical care experts and have implicit responsibilities to comprehensively manage their patients. Abdicating ICU responsibilities to nonsurgeons will clearly fragment patient management and render this costly, advanced

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