Trauma surgery

Trauma surgery is a surgical specialty involved in the invasive treatment of physical injuries, typically in an emergency setting. Trauma surgeons generally complete residency training in general surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for the initial resuscitation and stabilization of the patient, as well as ongoing evaluation. The attending trauma surgeon also leads the trauma team, which typically includes nurses, resident physicians, and support staff.

Training
In the US, the majority of trauma surgeons practice in larger centers and complete a 1-2 year fellowship in surgical critical care. This allows them to sit for the American Board of Surgery (ABS) certifying examination in Surgical Critical Care. There is no separate board or examination specifically for "trauma surgery".

In Europe training programs usually take place under supervision of the national surgical boards, who also certify for subspecialism as trauma surgery. There is also an official European trauma surgical exam.

Training for trauma surgeons is sometimes difficult to obtain. In the United Kingdom, the Royal College of Surgeons of England is responsible for training consultants via the Definitive Surgical Trauma Skills course (DSTS). It remains the only course of its kind in the United Kingdom. Originally designed to teach the military, the course now trains both military as well as civilian surgeons.

Responsibilities
The broad scope of their surgical critical care training enables the trauma surgeon to address most injuries to the neck, chest, abdomen, and extremities. In large parts of Europe trauma surgeons treat most of the musculoskeletal trauma. Whereas in injuries to the central nervous system are generally treated by neurosurgeons. In the US and Britain skeletal injuries are treated by trauma orthopedic surgeons. Facial injuries are often treated by maxillofacial surgeons. There is significant variation across hospitals in the degree to which other specialists, such as cardiothoracic surgeons, plastic surgeons, vascular surgeons, and interventional radiologists are involved in treating trauma patients.

Trauma surgeons must be familiar with a large variety of general surgical, thoracic, and vascular procedures and must be able to make complex decisions, often with little time and incomplete information. Proficiency in all aspects of intensive care medicine/critical care is required. Hours are irregular and there is a considerable amount of night, weekend, and holiday work. Salaries for trauma surgeons are comparable to that of general surgeons. Most patients presenting to trauma centers have multiple injuries involving different organ systems, and so the care of such patients often requires a significant number of diagnostic studies and operative procedures. The trauma surgeon is responsible for prioritizing such procedures and for designing the overall treatment plan. This process starts as soon as the patient arrives in the emergency department and continues to the operating room, intensive care unit, and hospital floor. In most settings, patients are evaluated according to a set of predetermined protocols (triage) designed to detect and treat life-threatening conditions as soon as possible. After such conditions have been addressed (or ruled out), non-life-threatening injuries are addressed.

General Surgery
Over the last few decades, a large number of advances in trauma and critical care have led to an increasing frequency of non-operative care for injuries to the neck, chest, and abdomen. Most injuries requiring operative treatment are musculoskeletal. For this reason, part of US trauma surgeons devote at least some of their practice to general surgery. In most American university hospitals and medical centers, a significant portion of the emergency general surgery calls are taken by trauma surgeons. This increases the operative case load for trauma surgeons and allows other general surgical specialists (such as gastrointestinal surgeons, surgical oncologists, and vascular surgeons) to focus on their own respective areas.