Tag: Army

Don Trunkey 1937–2019 from Injury Journal

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Nothing lasts forever. However, for most of us, Don Trunkey was the innovator of modern trauma care and it’s hard to imagine a world which he is not part of. As Ralph Waldo Emerson stated it is not length of life, but depth of life that matters. Indeed, his talent, passion for improvement, and vision to look into the future were unique and his contributions to the evolution of trauma care have been priceless.

Donald D Trunkey FACS, was born in Eastern Washington and went to medical school at University of Washington. He served in the US Army in the mid 60 s in Germany and completed his surgical training in San Francisco. It was from San Francisco that his seminal “Two Counties” [1] paper was published where he convincingly showed that where a trauma system existed the mortality was substantially lower than where it did not. It was this paper, more than any other in the contemporary literature which led to the drive to systematise trauma care around the world.

Another of Don’s seminal papers was that on the trimodal pattern of death after injury which was published in Scientific American in 1983 [2]. In that paper he outlined that death after trauma was either immediate, usually as a result of catastrophic brain or torso injury, in hours as a result of uncontrollable haemorrhage, or in 2–3 weeks as a result on multiple organ dysfunction itself, a long term consequence of poor initial control of haemorrhage. While true in 1983, the trimodal pattern of death no longer exists because, through the efforts of Don and other trauma surgeons, effective early trauma care, particularly consequent on near-universal uptake of ATLS/EMST teaching, has resulted in effective early haemorrhage treatment.

Noteworthy, he was also a leading figure in highlighting the challenges of managing multiple injured patients with associated head injuries what he described as a ‘crisis’ in trauma care [3]. He suggested that ‘neurosurgery should step up to the plate and provide coverage for Level I and Level II trauma centres at a reasonable cost, and went as far as to state that ‘If neurosurgery cannot or does not want to provide coverage, they should let other surgeons provide coverage’ [3].

Professor Trunkey also was one of the first clinicians to express his concerns about the omissions of the USA public policy in relation to recreational use of drugs such as heroin, cocaine, methamphetamines, and marijuana and reported a direct link between alcohol or drug use and crime, corruption, violence, and health problems, calling for the need of formulating a workable public policy [4].

Professor Trunkey’s academic record lists 317 publications and 10,118 citations but his only publication in Injury occurred in 2000 and was a comparative study looking at trauma outcomes in Oregon Health Sciences University and Stoke-on-Trent [5]. This paper, co-authored by John Templeton and Peter Oakley amongst others showed that although raw mortalities were different, when casemix was considered there were no significant differences between the centres. This highlighted how important it was to carefully consider casemix in any comparison of trauma outcome.

Don’s early military career was bookended by a role in the First Gulf War 1990–1991 where he served as an advisor to the US Forces in Saudi Arabia. He dealt with a number of operational and cultural obstacles that prompted him to publish a commentary in the March 1993 edition of Archives of Surgery called “Lessons Learned” [6]. This document paved the way for how the U.S. Department of Defence trained its trauma personnel.

Don was a giant on the US trauma stage but also a frequent traveller who spread his knowledge and influence around the world. Apart from his Honorary FRACS and FRCS(Eng) he was also an honorary fellow of the surgical colleges of Ireland, Edinburgh, Glasgow, South Africa and Brazil.

Don was inspirational, enigmatic, friendly and forceful all at the same time. He influenced generations of young doctors, in surgery and in other disciplines, to improve trauma outcomes and contribute to the teaching and delivery of optimal trauma care. At conferences and courses he was an enthusiastic teacher and a challenging mentor. He conveyed the absolute necessity of taking action when time critical injuries were present and was never afraid to do so.

Donald D. Trunkey was a legend in every aspect of the word and the trauma community will be much poorer with his passing. His legacy however, of improved trauma systems, trauma care and trauma outcomes, is very much alive and society as a whole will be grateful for the career long contribution of this trauma giant.

https://www.nattrauma.org/don-trunkey-giant-in-trauma-remembered/
https://www.injuryjournal.com/article/S0020-1383(19)30303-1/fulltext?dgcid=raven_jbs_etoc_email

References

  1. West, J.G., Trunkey, D.D., and Lim, R.C. Systems of trauma care: a study of two counties. Arch Surg. 1979; 114: 455–460
  2. Trunkey, Donald D. Trauma. Sci Am. 1983; 249: 28–35
  3. Trunkey, D.D. The emerging crisis in trauma care: a history and definition of the problem. Clin Neurosurg. 2007; 54: 200–205
  4. Trunkey, D.D. and Bonnono, C. A rational approach to formulating public policy on substance abuse. J Trauma Inj Infect Crit Care. 2005; 59: S61–S66
  5. Templeton, J., Oakley, P.A., MacKenzie, G., Cook, A., Brand, D., Mullins, R.J. et al. A comparison of patient characteristics and survival in two trauma centres located in different countries. Injury. 2000;31: 493–501
  6. Trunkey, D. Lessons learned. Arch Surg. 1993; 128: 261–264

Don Trunkey 1937-2019

Don Trunkey
1937 Born Oakesdale, Washington
1946 First Operation, Castration of pig
1955 Saint John HS
1958 Married Jane Henry
1959 Washing State College BS in Zoology, Also played basketball
1963 University of Washington MD
1964 Oregon Health Sciences University internship
1964 Drafted US Army, Nuernberg Germany
1966 University of California San Francisco, Residency
1971 Parkland Trauma Service, Trauma Fellowship
1972 University of California San Francisco, San Francisco General, Faculty
1978 University of California San Francisco, San Francisco, General Chief of Surgery
1985 Joined US Army Reserve
1986 Oregon Health Sciences University Chief of Surgery
1991 Desert Storm 50th General Hospital and After Action
2001 Oregon Health Sciences University Professor Emeritus
2006 Rotations to Landsthul Germany to relieve Army surgeons so they could visit home
2018 Moved to Idaho

Not commonly known about Don:
As a teenager Don shot squirrels for farmers and was paid 5 cents per tail. 22 ammo cost 2 cents so he became a good shot.
In High School he worked at a machine shop welding farm equipment and as a projectionist where he often fell asleep and had to be woken to change the reels.
He met my mom by repeatedly breaking his nose in HS sports which was set by Jane’s father. They also saw each other when St. John played Colfax in basketball and at barn dances.
He worked in mines in Montana during the summer in college to make money. He saw his first death on the first day of the job after a minor cave in.
He caught the biggest trout of his life fly fishing in New Zealand (about 24 inches).
He was an excellent cook.
His mom played college tennis and was 5’11”. Her family goes back to the Mayflower.
His 5th time great grandfather fought in the French artillery at Yorktown and deserted rather than go back to France.
He made his own wine with cousins and doctors and won a silver metal in the Oregon State Fair for Piot Noir (a competitive category)
He was in Tiananmen square the night before the 1989 incident talking to the protesters.
He also did historical research of surgery including Presidential assassinations and the Lewis and Clark Expedition

References
https://en.wikipedia.org/wiki/Donald_Trunkey
https://dontrunkey.com/
https://www.youtube.com/watch?v=vVN0laPGF24
https://kingfaisalprize.org/professor-donald-d-trunkey/
https://www.ohsu.edu/…/surgery/about/donald-trunkey-lecture…
http://archiveswest.orbiscascade.org/ark:/80444/xv64010
https://sfgh.surgery.ucsf.edu/…/234…/history%20of%20sfgh.pdf

50th General Hospital, by Dr. Tom Hutchinson, COL USA (Ret)

As the Commander of the 50th General hospital during Operation Desert Shield/Desert Storm (1991), I got to know Col. Don Trunkey pretty well.  He was our Chief of Professional Services and was always busy keeping the medical/surgical side of things on a straight and narrow path.  He presided over our M and M (Morbidity and Mortality) Conferences, and tolerated no nonsense in professional performance or behavior.  This was accomplished in the company of a splendid sense of humor.

When LTG Yeosock, our 3rd Army Commander, developed a gallbladder infection and needed surgery, I asked Don to manage the situation as I knew if I were to get involved, I would end up as a middleman which would create a problem-prone situation, not to mention adding unnecessary delays .  Don met with GEN Schwarzkopf (the Central Command Commander-and LTG Yeosock’s boss) to advise him how medical treatment for LTG Yeosock could be managed; and a decision was made to evacuate the general from the theater of operations and have him treated in Germany. Don and Col. Dan Cavanaugh, one of our General Surgeons, went to Germany with their patient, and performed the surgery.  A quick recovery and return to duty followed; setting the stage for the initiation of the Allied ground offensive.

As one of the nation’s leading trauma surgeons, Don was always an advocate for documenting wound management and preserving this data for analysis; so that any information that could be identified as ‘lessons learned’ would be on record.  He was particularly interested in seeing that this was done during Operation Desert Storm.

I remember sitting down with Don at Fort Lewis as we were being out-processed for discharge from active duty, and together working on a large stack of Officer Efficiency Reports which were due at that time.  Misery does love company.

Don was recognized by the AMEDD (Army Medical Department) for his distinguished career and his contribution to military medicine by induction into the Order of Military Merit.  Recognition he justly warranted.

After the first Gulf War, Don joined with us in the 50th General hospital Association.  In spite of the considerable distance between Seattle and Portland he and Jane were able to make several of our reunions, and enjoyed seeing old friends and visiting the Fort Lewis area.

Tom Hutchinson, MD,

COL, USA (RET)

Orthopedic Surgeon

The Best of the Best by Dr. Susan Briggs

Don has been my close friend and mentor for 50 years. I first met Don as a nurse in the Mission Emergency Room, San Francisco General Hospital, while pursing my premedical studies. His commitment to patient care and advocacy for the underserved populations in the city was incredible. He is the reason I, and many others, found trauma surgery such a gratifying pathway in our surgical careers.

He has been a phenomenal mentor to scores of young surgeons throughout the world, both with his enthusiasm for and experience in trauma surgery. He has set the gold standard for excellence in trauma care- both the art and the science of trauma care. He is the ultimate educator, always willing to take time to share his expertise with all levels of medical providers, prehospital and hospital.

He has been a relentless patient advocate. He has never been afraid to confront the ethical challenges of delivering the highest quality of trauma care, such as “the issue of “preventable trauma deaths”. His publications on the many challenging areas of trauma surgery are held in high regard by surgeons worldwide.

Don is the “grandfather “of global surgery, taking his surgical expertise to vulnerable populations throughout the world, both through his role in the US Army Medical Corp and as a consultant to numerous international trauma communities. He loved to travel and share stories, both personal and professional, with his many international friends.

All of us will always cherish our times with Don, and the impact he has had on the trauma careers of so many of his friends and colleagues.

Briggs, Susan,M.D.

Learning from Dr. Trunkey by Dr Schreiber

I first met Dr. Trunkey as an intern at Madigan Army Medical Center in 1988.  Dr. Trunkey was doing his active duty training there and he was a Colonel in the US Army Reserve.  He spent a significant part of a day teaching in educational conferences and meeting with the residents.  As an iconic figure in trauma, I did not expect Dr. Trunkey to take the time to personally get to know each of the residents but this is exactly what he did.  I was immediately impressed with his breadth of knowledge and his ability to impart it. I still remember many of the topics we discussed that day and the words of wisdom he imparted

During the time Dr. Trunkey was at Madigan, I was assigned the first case of my career as an operating surgeon, a needle localized breast biopsy and I was shocked to find out that Dr. Trunkey, the famous trauma surgeon, was assigned as the attending.  So, essentially, right out of medical school, I was doing a case with 1 of the top 5 trauma surgeons in the country. But it was a breast biopsy, not a GSW to the heart but Dr. Trunkey was very patient with me and even with a breast biopsy, he was able to teach surgical concepts I carried with me for the rest of my career.  I considered the case to be a success because a trauma surgeon and a future trauma surgeon completed the case without massive bleeding!

That very brief exposure to Dr. Trunkey at the beginning of my career played a huge role in my decision to become a trauma surgeon in the future.  As the Chief of Trauma at OHSU, following in Dr. Trunkey’s footsteps, I feel honored to have learned from Dr. Trunkey and then later to have served as a colleague.

Martin A. Schreiber, MD FACS

Icon in Surgery by Karen Deveney, M.D., F.A.C.S.

Don Trunkey is being honored by the American College of Surgeons (ACS) this month at their annual Clinical Congress as an “Icon in Surgery”, an honor which he richly deserves. Don was the leader among a small cohort of surgeons who played a major role in improving the care of the injured not just in the U.S., but across the world, by advocating for the development of standards of care for trauma patients and defining what specific expertise, resources, and personnel needed to be in place for a hospital to provide optimal care to those patients.

After a rotating internship under Dr. J. Englebert Dunphy at the University of Oregon followed by two years in the U.S. Army in Germany, Dr. Trunkey travelled to the University of California, San Francisco (UCSF) to train in surgery, where Dr. Dunphy had assumed the chairmanship. He developed an interest in a career in trauma during his rotations at the San Francisco General Hospital (SFGH), which was then developing a reputation as a leader in the new specialty of trauma surgery under the direction of the skilled and charismatic chief of surgery, Dr. F. William Blaisdell.

Don heeded Dr. Blaisdell’s advice to study with Dr. Tom Shires at Parkland Hospital in Dallas, one of the most prestigious centers for both care of the injured and trauma research. At Parkland, Don learned research techniques for studying cellular mechanisms in shock and fluid resuscitation. He returned to San Francisco and joined the staff at SFGH, continuing his basic research under an NIH Program Project Grant in 1972, at the exact time that Federal recognition of Trauma Centers was beginning. SFGH was one of the first such centers recognized. At that time, however, most injured patients across the U.S. were taken to the nearest hospital for care, without regard for their preparedness to care for traumatic injuries.

The network of young surgeons who had trained at UCSF extended up and down the state of California, and among them was John West, a surgeon in private practice in Orange County who had completed the surgery residency at UCSF in 1973, just two years after Don. John was distressed at what he felt were unnecessary deaths from basic traumatic injuries such as splenic rupture due to delays in recognition and prompt treatment of their condition. He and Don co-authored a landmark study comparing mortality from equivalent injuries in community hospitals to that at SFGH, a well-equipped and well-staffed trauma center. The study demonstrated the superiority of the trauma center in saving lives.

Throughout the U.S. were hospitals such as SFGH that had also demonstrated their expertise in trauma care. Surgeons at these hospitals were the major members of the Committee on Trauma of the ACS, a committee that had been originally formed as the Committee on Fractures in 1922, but formally reorganized as the Committee on Trauma in 1950. At about this time, trauma was being recognized as a major public health issue, with increased highway accidents due to the development of higher speed automobiles and the interstate highway system as well as inner city violence from knife and gunshot wounds.

Don Trunkey had been appointed to the ACS Committee on Trauma where he served as its chair from 1982 – 1986, joining a small group of like-minded “rabble-rousers” to lobby the ACS for designating hospitals according to a system of standards of trauma care, described first in 1976 in a manual called Optimal Hospital Resources for the Injured Patient. It set standards for what resources, personnel, and policies a facility need to have to render ideal care and divided hospitals into Levels I, II, III, or IV based on minimum standards at each level. They also advocated for providers to be taught and tested in a rigorous course, the Advanced Trauma Life Support (ATLS) course, now in its 9th edition, but a hard-fought battle for acceptance in its earliest days. Don Trunkey was a key leader in development of all of the elements of effective trauma care. These now well-accepted principles, processes, and programs were not initially so readily embraced by the power structure in American surgery, because they represented radical new ideas in the staid, traditional field of surgery. They were, in a word, disruptive to the status quo.

Don went on to lead the American Association for the Surgery of Trauma as its President in 1986, disseminate trauma systems standards, verification, and ATLS teaching throughout the world.

He also served in the U.S. Army as a reservist since his days on active duty in the early 1960’s, and was deployed to Saudi Arabia during the first Gulf war in 1991, where he served as commander of the U.S. army hospital based in Riyadh. In the aftermath of that experience, he issued a white paper that suggested necessary changes in military combat care to improve outcomes. Again, this report was met with resistance by those in positions of authority, but all of his recommendations have subsequently been adopted : most specifically, for improved pre-combat training of military surgeons for combat and standardized protocols of care, with damage control care near the combat lines and air evacuation as soon as possible to progressively higher levels of care.

Don Trunkey was, more than any other single person, responsible for the development of sophisticated, state-of-the-art trauma programs in the U.S. His promotion of systematic, sound trauma care worldwide has saved countless lives. He has been tireless in his devotion to the cause and is a larger-than-life figure to all who know and love him. He is the perfect individual for the ACS to honor as an Icon in Surgery.

Karen Deveney, M.D., F.A.C.S.

The above remarks are drawn from both personal recollection as well as from the excellent account contained in the book, The History of the Surgical Service at San Francisco General Hospital authored by Drs. William Schecter, Robert Lim, George Sheldon, Norman Christensen, and F. William Blaisdell.

Influential Champion for Optimal Care of Injured Patients by Richard J Mullins

Dr. Donald Trunkey’s skill, judgment and indefatigable determination as a trauma surgeon has saved the lives of thousands of patients. In addition, his leadership in the development of trauma systems has saved the lives of millions around the world. In the late 1960s Don was trained as a trauma surgeon at San Francisco General Hospital, a busy urban trauma center. Don recognized that a reason for the success of San Francisco General Hospital was that a surgical team capable of managing a wide range of injuries was always available in the hospital and ready to respond immediately when an ambulance delivered an injured patient to the emergency department.

The team approach was essential to prevent immediate death in injured patients from obstructed airway, impaired breathing and shock. As Don Trunkey pointed out in his manuscript Trauma published in Scientific American (1983; Vol. 249:28-35) a coordinated team was able to establish quickly a list of the patient’s injuries, and with prompt treatment prevent death during the “golden hour” following injury. The foundation of Don Trunkey’s advocacy for trauma systems was based upon lessons he had learned in the care of individual injured patients.

Don Trunkey has been a prolific scholar. He has written over 100 manuscripts and book chapters in which he described the optimal treatment of a wide range of specific traumatic injuries. Additionally, Don Trunkey has authored over forty manuscripts that examined the influence of implementation of trauma systems of the survival of injured patients. His influential scholarship in support of trauma systems are evidence of his strategic vision regarding optimal health care.

A seminal paper published by Don Trunkey with co-authors John West and Robert Lim entitled: Systems of trauma care. A study of two counties (Arch Surg. 1979 Apr;114(4):455-60.) had an enduring influence. The authors studied the patients who died of injury in Orange County, California, which did not have a trauma system, and patients who died of injury in San Francisco, California, which did have a trauma system. These authors determined that in Orange County many injured patients died preventable deaths, while it was a rare event in San Francisco. This study was used to convince the Orange County government officials to implement a trauma system.

After the trauma system was established, and injured patients were taken to designated trauma centers, the outcome study was then repeated; preventable deaths had declined substantially in Orange County. This classic paper has been praised as a model of a process that could bring about implementation of a trauma system. The West, Trunkey and Lim study of preventable deaths in injured patients was duplicated by researchers around the United States who made similar observations of high rates of death among seriously injured patients treated in a hospital that is not a trauma center. These preventable death rates became the incentive for implementation of multiple other trauma systems.

Don Trunkey has been an influential leader in Academic surgical organizations around the world. From the leadership podiums of these organizations Don Trunkey advocated for these organizations to make optimal trauma care of injured patients a priority. His influence on public understanding of medical issues has been enhanced by his persuasive style of presentation and articulate speeches. On one occasion he was featured on a documentary television show (Operation Lifeline. 1978-79) demonstrating the fulltime commitment that surgeons needed to make to treat seriously traumatized patients in those first critical minutes following injury.

In the time period 1978 to 1985 Don Trunkey was an active participant and then leader of the Committee on Trauma of the American College of Surgeons. Don Trunkey described that he and his colleagues on the Committee were “busy trauma surgeons, and we wanted to change the care of trauma patients in the United States.” Don worked with the other members of the Committee on Trauma to establish programs that delivered enduring improvements to the care of injured patients. These programs include the Advanced Trauma Life Support course that has subsequently achieved worldwide distribution.

The Committee members published a book that described what trauma centers needed to provide optimal care-i.e. Resources for Optimal Care of Injured Patients. During Dr Trunkey’s leadership of the Committee on Trauma that organization established a program that verified hospitals had the resources needed to function as trauma centers. There were critics of the process to provide oversight of trauma centers. Undeterred, Don persisted as a candid advocate for having seriously injured patients treated in trauma centers where an experienced team was continually ready.

During his military service also called for optimal of casualties of war.
From 1962 to 1964 Captain Don Trunkey, US Army Medical Corps, Reserves, served in Germany as a general medical officer. He returned to a military in service 1985. He was 48 years old, Professor and Chair of Surgery at Oregon Health & Sciences University and decided to apply for a commission as a surgeon the US Army reserves, explaining that he was “concerned there were not enough surgeons in the Army”. He would later say his only regret was that he did not return to the Army reserves sooner.

Colonel Trunkey and his hospital unit was called to duty for Desert Shield and Desert Storm in the fall of 1990. His military hospital was in Riyad, Saudi Arabia and treated injured form the SCUD missile attacks, and wounded soldiers evacuated from the battlefield. At the end of what was a brief war, when others were proclaiming success with a low death rates, Colonel Trunkey wrote an after-action report that was critical of several aspects of the Army Medical Corps response to casualties. He provided several recommendations for how the care of casualty could be improved.

One enduring influence of Colonel Trunkey on the care of casualties of war was implementation of training programs in busy civilian trauma centers where military surgeons could acquire experience in the care of seriously injured patients. Multiple training programs were implemented and substantially improved the care provided to wounded soldiers, sailors and Marines during the war on terror following September 11, 2001 attack.

Thousands of surgeons have met Don Trunkey and been inspired by his wisdom and dedication to the care of injured patient. Many young surgeons have vivid memories of Professor Trunkey taking an interest in their work. His ability to inspire surgeons has meant that Don Trunkey will have an enduring influence on the optimal care of injured patients long after his retirement through the work of subsequent trauma surgeons who perpetuate his commitment to the optimal care of injured patients.
October 8, 2018
Richard J Mullins, MD, FACS.

My Dad

My father is Don Trunkey.  He was a renowned trauma surgeon and is finally retired to Idaho.  This web site will be about his life and achievements.

Basic Biography from OHSU:

Donald Dean Trunkey was born, raised, and educated in the state of Washington. He graduated with an M.D. from University of Washington in 1963 in the hope of becoming a General Practitioner. He interned under J. Englebert Dunphy at the University of Oregon Medical School, who became his mentor and turned his focus to surgery. When Trunkey was drafted into the Army, Dunphy went to San Francisco to begin one of the first trauma centers. He brought Trunkey in to join him after his service, and also got him a surgical Fellowship in Texas. On his return Trunkey rose to become chief of surgery for San Francisco General Hospital for 8 years. He then came back to Oregon to build a trauma system as Dept. Chairman over the next 15 years. An important interlude saw him as chief of surgery in an army hospital in Saudi Arabia during Desert Storm. After the chairmanship he returned to teaching and lecturing on a global scale as a Professor and Professor Emeritus.

His varied experiences influenced his thoughts and actions on trauma care. In the Army rampant alcoholism led him to institute A.A. programs. In San Francisco the drug wars of the ‘60s made him both an expert in gunshot wounds, and an advocate for controversial measures like gun control and drug legalization. Work with traffic accident victims led him to lobby for seat-belt and helmet laws. Likewise, exposure to the Texas Burn Unit not only led him to replicate one in San Francisco, but also to research fire-retardant clothing and self-extinguishing cigarettes. His wartime service likewise gave him an up-close look at the current state and problems of combat medicine.

Trunkey’s decades-long involvement with trauma and trauma systems led to new surgical protocols of both invasive and non-operative types; the authorship of hundreds of articles and book chapters; the delivery of innumerable lectures; and participation in over 30 professional organizations.