Reminiscences on Donald Trunkey From a Lifelong Friend, by Dr Dave Richardson

I first met Don Trunkey when I was a resident in Surgery in Texas.  He was a few years older than me, and was always very cordial and gracious.  Many aspects of our career were similar. We both did broad based surgery, but had a particular interest in the organization of trauma care.  I would not in any way want to infer that my impact in that regard is anywhere near that of Don, but it allowed me to understand the passion he felt for that cause.  Through the years, Don was a visitor in Kentucky on numerous occasions. He and Jane were always great friends, and my late wife, Suzanne, really enjoyed them both. She was particularly fond of Jane.  

One could look at a curriculum vitae of a person and glean certain things about their life.  In reviewing Don’s life accomplishments, there were certainly many. He was a recognized leader of surgical organizations, and I believe if one asked 100 well-informed surgeons with an interest in trauma, “Who was the most influential person in that field in the last 50 years?”, virtually all would have the similar response of Don Trunkey.  That is a tremendous legacy for any individual in any field of endeavor.

However, laudable Don’s accomplishments, they really paled beside the enormous personality that he’s always exhibited.  To know Don, even casually, was to never forget him. I can remember numerous dinners that we had informally at various meetings, where he would expound on the virtues of some wine he was making or some new food or beverage (usually the alcohol containing-type) that he had recently encountered.  This was always delivered with great gusto and bravado. Don and I have both shared an enormous love of learning beyond medicine throughout our lives. We were always sharing book titles with each other about a variety of topics and genres. Truly, Don’s larger than life persona made him, in my mind, even more remarkable than his many accomplishments in the field of surgery.  

It is my understanding that Don is not exactly himself today, but I certainly hope he realizes the great affection I have for him personally.  I know many of our mutual friends feel the same way. To have known Don through these many years is to have been blessed with his enormous charisma and charm.  

My Friendship with Jane and Don By Dr. Lew Flint

When I arrived to begin my trauma research fellowship at the University of Texas, Southwestern Medical Center in August of 1971, I was assigned to share laboratory space with another trauma fellow. Upon entering the lab, I noticed my new colleague concentrating on the electrical wave forms displayed on the screen of a very complicated piece of machinery. He turned, showed the grin that would become the defining characteristic of his personality, and welcomed me.

Don, my new lab-mate, proceeded to introduce me to all the research team members. I soon met Jane, Kristi and Derek; after my first son was born in February of 1972, Jane became his baby sitter. We had a wonderful professional and personal friendship during that year; fortunately for me, that relationship continued throughout our entire careers.

Don returned to San Francisco General Hospital and I stayed for a second year of research before finishing my training and joining the faculty at the University of Louisville. Don was making major contributions to the knowledge of trauma systems in the late 1970’s and early 1980’s; his advice and guidance were invaluable as I began to develop a trauma system for the state of Kentucky.

I loved watching Don use humor and intelligence to become a surgical leader and to work with him while he became, in my opinion, the foremost academic trauma surgeon of the last half of the 20th and the first two decades of the 21st century.

Most valuable, though, was the personal relationship with Jane and Don. For nearly two decades the “Sun-fun family”, our group of four trauma surgeon couples, vacationed each January on a select Carribean island. We cooked, ate, drank, told tall tales, made up funny names for one another, and laughed constantly. Jane and Don set the tone that guided the Sun-funs. To be able to live that experience was a joy, a privilege, and an honor that I will treasure forever.

One of my Heros, by Dr. John Mayberry

Don Trunkey, as my fellow surgical resident Brian Gilchrist liked to say, was Lincolnesque.  Always a calm demeanor, always a joke or an anecdote ready, and always leading others where they were afraid to go.  Like Lincoln he was tall, lanky, and folksy and was raised in a rural environment among family that favored hard work.  And like Lincoln, he rose to the top of his profession.  I never heard Don Trunkey character assassinate anyone.  The most negative thing, and it’s not even all that negative, I ever heard him say about another surgeon publicly or privately, was, ‘He’s an iconoclast’.  Some people might even say that’s a compliment!  And that attitude of acceptance permeated down from him into the surgery faculty at Oregon.  I consider myself very privileged to have trained with him.

From “Mayberry, John. Pioneers, Heroes, Brooders, Surgeons. American Journal of Surgery, 2019, Published Ahead of Print”

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.