Seismology and Advances in Trauma Resuscitation

Christopher Hicks, MD, MEd, FRCPC, Editor

Andrew Petrosoniak, MD, MSc (MedEd), FRCPC, Editor

Trauma is a disease that imparts an almost unspeakable burden of illness on a global population of patients. Over the past decade, advances in the science of trauma resuscitation have changed the landscape of trauma resuscitation dramatically. Trauma is a team sport, and the science of teams has greatly advanced our ability to deliver rapid, effective multidisciplinary trauma care. Traumatic cardiac arrest, once believed to be a terminal event, is now believed to contain a population of patients with excellent survival, provided a thoughtful approach is followed. The primacy of the ABCDE approach has been called into question, prompting calls for a “resequencing” of trauma resuscitation to better align with physiologic priorities. Trauma resuscitation has moved well beyond the 2-L crystalloid challenge: trauma coagulopathy is a well-described killer, one that front-line providers can either help or hinder. Technologic and procedural advances can improve the early bedside management of the traumatic airway, facilitate neuro-resuscitation, and temporize catastrophic abdominal injuries.

The demographic of trauma is changing. Extremes of age pose unique challenges and considerations that demand thoughtful variation in practice. By 2050, the prototypical trauma patient may not be a 22-year-old healthy man, but rather a 77-year-old woman with multiple comorbid diseases and serious injuries despite a relatively “minor” mechanism.

Importantly, the bulk of the “new science” in trauma resuscitation is applicable in a broad number of practice settings, from the prehospital environment to fully equipped trauma centers, and every point in between. Much of what is known will be most useful in the hands of front-line providers rendering care within the first few minutes to hours following injury.

Prevention and public awareness will always be the cornerstones of minimizing the trauma disease burden worldwide. But while injury is pervasive, so too has resuscitation science advanced our ability to care for those injuries. This issue, in thirteen parts, will highlight the practical ways in which trauma care has evolved, and how our practice as emergency care providers should evolve along with it.

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