Dr. Michael DeBakey's Contributions to Emergency Medicine and Trauma Care
Article Outline
When Michael E. DeBakey, MD, died in July at the age of 99, more than one obituary described him as the greatest surgeon ever, emphasizing his path-breaking work in open-heart surgery, coronary bypasses, the artificial heart and heart-lung machine.
In a career of astonishing breadth, depth and length (about 75 years), he made contributions in fields beyond his specialty of cardiovascular surgery, such as the link he and his mentor, Alton Ochsner, MD, postulated between smoking and lung carcinoma—in 1939.
And emergency medicine? “So many of the contributions that Dr. DeBakey made sort of set the stage,” said Norman Rich, MD, chairman emeritus of the Uniformed Services University for the Health Sciences in Bethesda, MD. “It's not possible to say that Dr. DeBakey contributed that much in his early years to emergency medicine, because it didn't exist.”
It may not have existed as a specialty, or even a quasi-formal medical regime, but the treatment of traumatic emergencies certainly did, and Dr. DeBakey was at the forefront in developing ways to improve it. Perhaps his first and most notable contribution came in World War II when, as a consultant to the Army surgeon general, he surveyed medical facilities across the European Theater.
The system then in place was a network of battalion aid stations, field hospitals in the rear and general hospitals in the cities. “He felt that moving a patient across Europe to a surgical field hospital was incorrect so he helped develop (the concept of) soldiers being operated on near the scene of their injury,” said Kenneth Mattox, MD, vice chairman of surgery at Baylor College of Medicine and chief of staff at Ben Taub General Hospital in Houston.
Father of the MASH Unit
“He had the idea of the MASH, or mobile auxiliary surgical hospital,” said John Ochsner, MD, 81, who studied under Dr. DeBakey at Baylor College of Medicine in Houston. “His idea was that you give what little aid as you can in the field—what they call an ‘orbit’—and then they'd go to a battalion aid station for stabilization and then send them to a MASH unit for extensive therapy.”
A simple idea, but making it a reality took extensive research, documentation and organization, much of it driven by Dr. DeBakey. “That goes back more than 50 years ago,” said Dr. Rich. “I'm sure other people had thought about it, but nobody really put in the time and effort that he did.”
The first MASH was commissioned in August 1945, too late for World War II, but not for the next conflict. “The statistics in the Korean War,” said Dr. Ochsner, “showed your chances of surviving were almost 95% if you could get to the MASH unit.”
The last MASH unit was decommissioned in October 2006. The Army replaced them with Combat Support Hospitals, though the mission remains much the same.
In 1948, Dr. DeBakey left the Army but Dr. Rich said he “never stopped supporting the military mission and the management of injured patients on the battlefield, and he remained a very valued consultant over all this essentially up until the time that he died.”
Back in Houston, teaching and practicing at Baylor, Dr. DeBakey in 1949 established a trauma research center at Jefferson Davis Hospital.
“It was recognized regionally as a place to go for trauma,” said Dr. Mattox. “ Cook County (Ill.) usually credits itself as being the first organized trauma center-- in 1962. Dr. DeBakey predated that, and it's in his articles back then that they established a trauma center at Jefferson Davis Hospital in 1949. That makes what Dr. DeBakey did in 1949 the first civilian trauma center in the history of medicine.”
Dr. Ochsner trained under Dr. DeBakey at Jefferson Davis Hospital. “And almost every paper I wrote when I was young was devoted to trauma because that was what we did. I would say 90% of what we did was trauma, because we didn't have time for elective surgery.”
Before EM Existed
“His foundational contributions occurred before the words ‘emergency medicine’ even existed,” said Dr. Mattox, “and the only thing that existed back then was the words ‘emergency room,' which was at the back of the hospital, an outgrowth of the old accident room.”
Dr. DeBakey pressed for a more formal environment for the treatment of emergencies, at least traumatic emergencies. And that extended to out-of-hospital treatment.
In the early 1960s, the ambulance services in Houston were owned by funeral parlors and other businesses, who raced to the scene of accidents so they could get the body in the event of death or earn a transport fee if the person survived. But in 1962, Dr. Mattox said, Dr. DeBakey worked with the Houston Medical Society, the city fire department and the surgery department at Baylor to establish the Houston Emergency Medical Service, one of the first in the country.
Paul Pepe, MD, who came to head the Houston EMS in 1982, said Dr. DeBakey was always supportive of his “efforts to launch sort of a sub-specialty of emergency medicine, which is emergency medical services, the pre-hospital care system.”
“We actually instituted a fairly sophisticated system of care,” said Dr. Pepe, now chairman of emergency medicine at the University of Texas Southwestern Medical Center in Dallas. “The dispatch office, the emergency responders, the paramedics, the emergency departments, the ICU. We actually launched some of the first critical care trials in the world in terms of trauma care.
“Not only did we improve trauma care, we improved the cardiac arrest system there as well. And Houston has today, without a doubt, one of the best—if not the best—emergency medical service systems in the country. It saves lives, literally I suspect, on a daily basis. And that really has its roots in Dr. DeBakey and his vision.”
None of this is to say that Dr. DeBakey was one of the Ur-founders of the practice of emergency medicine. Peter Rosen, MD, senior lecturer at the Harvard Medical School, said Dr. DeBakey might even have shared the opposition of many surgeons to emergency medicine becoming a specialty. “I never heard him say a word about any aspect of emergency medicine.
“I'm sure that Dr. DeBakey was interested in trauma and was interested in surgical emergencies, but only from the vantage point of how they were managed surgically. That's actually significant because not many people in the country at the time were interested even at that level.”
Dr. Rosen said Dr. DeBakey had made “enormous contributions” to surgery and even deserved a Nobel Prize—“though they don't seem to give them out for clinical genius.” Dr. DeBakey, he said, deserves the highest respect for creating the field of vascular surgery “almost single-handed” and developing techniques for the management of complex wounds, “but I think he basically preceded any public awareness of emergency medicine in this country, and I'm not sure what his position on emergency medicine would have been….”
Dr. Mattox, asked if Dr. DeBakey ever said anything in opposition to the establishment of emergency medicine as a specialty, replied, “I can tell you that Dr. DeBakey never said that. Dr. DeBakey always encouraged cutting-edge new information, new technology and the broadening of medicine.”
His contributions to medicine were perhaps best described by Dr. Ochsner: “It was an emergency to him, I don't care what it was.”
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The author has stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
PII: S0196-0644(08)02006-4
doi:10.1016/j.annemergmed.2008.11.006
