Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting and normally focuses on the abdominal area along with any given ‘Emergency’ field they may be required to serve upon. Trauma surgeons generally complete residency training in general surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals.
Most United States (U.S.) trauma surgeons practice in larger centers and complete a 1-2 year trauma surgery fellowship, which often includes a surgical critical care fellowship. They may therefore sit for the American Board of Surgery (ABS) or the American Osteopathic Board of Surgery (AOBS) certifying examination in Surgical Critical Care.
National surgical boards usually supervise European training programs; they also certify for subspecialism as trauma surgery. An official European trauma surgical exam exists.
Training for trauma surgeons is sometimes difficult to obtain. In the United Kingdom, the Royal College of Surgeons of England is responsible for training consultants via the Definitive Surgical Trauma Skills course (DSTS). It remains the only course of its kind in the United Kingdom. The course was originally designed to teach the military and now trains both military and civilian surgeons.
The broad scope of their surgical critical care training enables the trauma surgeon to address most injuries to the neck, chest, abdomen, and extremities. In large parts of Europe trauma surgeons treat most of the musculoskeletal trauma, whereas injuries to the central nervous system are generally treated by neurosurgeons. In the US and Britain skeletal injuries are treated by trauma orthopedic surgeons. Facial injuries are often treated by maxillofacial surgeons. There is significant variation across hospitals in the degree to which other specialists, such as cardiothoracic surgeons, plastic surgeons, vascular surgeons, and intervention radiologists are involved in treating trauma patients.
Trauma surgeons must be familiar with a large variety of general surgical, thoracic, and vascular procedures and must be able to make complex decisions, often with little time and incomplete information. Proficiency in all aspects of intensive care medicine/critical care is required. Hours are irregular and there is a considerable amount of night, weekend, and holiday work. Salaries for trauma surgeons are comparable to that of general surgeons.
Most patients presenting to trauma centers have multiple injuries involving different organ systems, and so the care of such patients often requires a significant number of diagnostic studies and operative procedures. The trauma surgeon is responsible for prioritizing such procedures and for designing the overall treatment plan. This process starts as soon as the patient arrives in the emergency department and continues to the operating room, intensive care unit, and hospital floor. In most settings, patients are evaluated according to a set of predetermined protocols (triage) designed to detect and treat life-threatening conditions as soon as possible. After such conditions have been addressed (or ruled out), non-life-threatening injuries are addressed.
Acute Care Surgery
Over the last few decades, a large number of advances in trauma and critical care have led to an increasing frequency of non-operative care for injuries to the neck, chest, and abdomen. Most injuries requiring operative treatment are musculoskeletal. For this reason, part of US trauma surgeons devote at least some of their practice to general surgery. In most American university hospitals and medical centers, a significant portion of the emergency general surgery calls are taken by trauma surgeons. The field combining trauma surgery and emergency general surgery is often called acute care surgery.