May 07, 2022
A high level of organization at regional, national and international levels has helped trauma professionals coordinate traumatic injury management and also dramatically decrease death and disability worldwide for the 100 years of existence of the American College of Surgeons (ACS) Committee on Trauma (COT). According to Scott P. Zietlow, M.D., a trauma surgeon at Mayo Clinic's campus in Rochester, Minnesota, commitments by altruistic trauma professionals unpaid for their work with the COT have helped the organization realize this impact.
Dr. Zietlow has been part of the COT for most of his trauma career, serving at the organization's regional and national levels. He served as regional vice chair from 1996 to 2002 and regional chair from 2002 to 2008, focusing on Minnesota trauma. From 2011 to 2018, Dr. Zietlow served the national COT on the membership committee, focusing his work on prehospital and rural trauma care.
The COT, originally known as the Committee on Fractures, started in 1922 with a prehospital and emergency department care focus. Later, the organization expanded to encompass all traumatic injury. The COT encompasses 12 regions plus one military and one international region. Each U.S. state has at least two representatives, with state and national committee membership totalling about 250 members.
The four COT pillars
The COT's work is divided into four pillars:
Education
The COT oversees U.S. and international trauma education. Two well-known COT education efforts include Stop the Bleed and Advanced Trauma Life Support (ATLS) courses. The ATLS program began in 1980, offering injury-management training. The course covers assessment, resuscitation, stabilization and needs determination, which establishes the appropriate facility for a patient's care.
A plane crash involving an orthopedic surgeon and his family in which a family member died prompted the inception of ATLS. There was no consistent nationwide approach to traumatic injury at the time. The events that transpired after the crash prompted trauma community members to work toward consistency in trauma management from the field to the medical center. ATLS called for care performed to a determined quality standard, while recognizing timing as crucial to trauma patient morbidity and mortality. Mayo Clinic began using ATLS in 1981; certification is mandatory for all general surgery residents.
A COT-appointed task force revises the ATLS curriculum, now in its 10th edition, every four years. The curriculum also includes companion courses for nurses, prehospital providers, physician assistants and advanced practice nurses. Dr. Zietlow, who has been involved in each ATLS version and taught approximately 250 ATLS courses, notes that it's an outstanding course for training and continuing professional education. Currently, more professionals teach ATLS courses outside North America than within the continent.
Similar to other specialty ATLS courses, the Rural Trauma Team Development Course (RTTDC) is an ATLS training for trauma professionals at resource-limited facilities. The RTTDC encourages rural trauma professionals to examine the capabilities of their centers to determine if a given patient would be best served there or elsewhere.
Quality
Another COT pillar is quality. ACS involvement in reviewing medical centers' trauma care quality evolved into The Joint Commission, which reviews trauma and all medical institution care. Dr. Zietlow indicates that the COT is well organized for trauma assessment and known for its emphasis on transparency regarding patient treatment and any complications, including defining how care might be improved in similar encounters in the future.
COT developed the Trauma Quality Improvement Project (TQIP), assessing facilities' data and providing performance and potential improvement feedback. TQIP also requires Level I or II trauma centers such as Mayo Clinic to submit all trauma-related data to a national databank. In turn, TQIP provides performance input for these centers compared to others nationwide. Each high-ranking center agrees to serve as a resource for other institutions.
Systems
The COT systems pillar focuses on how a trauma system in a given area, such as Southern Minnesota, or an entire state, is performing.
"We need to look at those in our own backyard, but also at the whole state — a systemic approach to care," says Dr. Zietlow.
The systems pillar affects factors such as triage guidelines and injuries mandated for direct referral to a Level I or Level II Trauma Center.
"The COT addresses getting the right patient to the right location in the most cost-efficient manner," says Dr. Zietlow.
Additionally, the COT systems pillar has helped solve challenges such as how to offer all blood and blood products in every trauma center, prompting the development of a mobile unit to make these available. The COT also standardized trauma center imaging requirements to ensure consistency among all of a patient's care providers.
Injury prevention
The COT's injury prevention pillar involves advocacy at state, regional and national levels to decrease prevalence of traumatic injury. Dr. Zietlow calls this aspect of the COT's work crucial, as about 50% of U.S. deaths due to trauma occur in the field, before trauma professionals can intervene. The COT's injury prevention pillar also addresses prevention of leading factors in traumatic injury, such as distracted or drunk driving, and advocates for change such as improvements to poor road design.
"If you can prevent a disease with a vaccine, it's much better," he says. "Likewise, in trauma, it's better to prevent death and disability."
All of the COT's pillars are intended to build more robust trauma systems, from the local level to the international.
Impact for local trauma centers
Dr. Zietlow says that the COT's work has had a significant impact for all trauma centers.
"It isn't just doing a bunch of things without any outcome," he says. "The COT has brought trauma centers from having no trauma system to now having an optimally functioning system. Looking at trauma systems before and after the COT's efforts were in place, there is a 25% decrease in mortality. One out of four people injured in traumatic incidents didn't need to die."
Dr. Zietlow feels confident that the COT will continue to examine other crucial trauma care issues, assessing how trauma professionals can serve most effectively.
"There are more good things to come," he says.
For more information
Advanced Trauma Life Support. American College of Surgeons.
Refer a patient to Mayo Clinic.