TRAUMA: The Unrecognized Epidemic

Abstract

Trauma is an integral part of human existence. From the time that Cain slew Abel, humans have learned that the most effective way to end a disagreement and silence an opponent is to bring the controversy to a traumatic ending, quieting rancor and anger with the never-ending stillness of death. The limitations of stones, clubs, and fists impelled humans to develop more efficient means of destruction—knives, spears, guns, and finally, atomic weapons. More arguments are terminated, and ever-increasing numbers of people are silenced, but violence and trauma remain. The development of high-speed methods of transportation has facilitated travel and the movement of goods but, at the same time, has increased the risk of serious injury. Manufacturing and the use of heavy machinery also have added risk factors, while the use of intoxicants adds risks by releasing inhibitions and obscuring judgment. The recent development and wide use of psychotropic drugs and their ready availability further complicate the issue of traumatic injury. Reading newspapers and magazines in the United States might lead one to conclude that trauma is essentially an American affair, 23 with other nations too civilized to indulge themselves in the violent orgies so characteristic of large American cities. Wars elsewhere are looked upon as character aberrations and not truly representative of popular mores. This concept is untrue, because violence and trauma appear to be characteristic of humankind and not a special trait of any race, nationality, religion, ethnic grouping, or gender. Trauma is a global phenomenon and a major cause of morbidity and mortality throughout the world. The anesthesiologist is a physician-citizen whose interest in trauma must be multifaceted. As an anesthesiologist, one is immersed in the daily clinical care problems of the injured. As a physician, one recognizes the totality of injury, with the alterations in anatomy and physiology attendant upon trauma, and the mechanical and pharmacologic manipulations necessary to restore the patient to his or her prior state of well-being. As an informed citizen, the physician must seek to know the causes of trauma and develop preventive safeguards via education and, when appropriate, legislation. The physician must lead the way in developing trauma care teams and trauma hospitals with adequately trained personnel who possess the latest knowledge and equipment.