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Dr. Cowley was pioneer in shock trauma medicine

August 03, 2008

Dr. R Adams Cowley, considered a pioneer in emergency medicine and shock trauma treatment, established the Shock Trauma Center in Baltimore, the nation's first and only trauma hospital, in 1969.

Cowley was one of the first people to experiment with open-heart surgery in the U.S., performing operations before the heart-lung machine was widely used, according to the Shock Trauma Web site.

Despite his expertise and success, some of his patients died from shock, not always immediately, but sometimes within days or weeks.

"Cowley later called shock 'a momentary pause in the act of death,' a process that once set in motion was irreversible," according to the Web site. "Dr. Cowley's goal was to make it reversible."

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After years of research and discussion, Cowley received a $100,000 contract from the Army to study shock in people. He developed the first clinical shock-trauma unit in the nation, which consisted of two beds, according to the site.

Gradually, the "Golden Hour" theory emerged and was based on the importance of speed in beginning treatment as well as skill in operating procedures, according to the site.

"There is a golden hour between life and death," Cowley said before his death in 1991. "If you are critically injured, you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later - but something has happened in your body that is irreparable."

Using what he had observed in the military, where wounded soldiers were transported by helicopter, Cowley applied to use military helicopters to transport his patients to the shock-trauma unit more quickly. After much discussion with the Maryland State Police, the agency's aviation command in 1970 became the first civilian agency in the U.S. to transport critically injured patients by helicopter.

The first medevac transport occurred after the five-story, 32-bed Center for the Study of Trauma opened, according to the Web site.

"In 1970, Cowley expanded his dream, feeling that not a single patient should be denied the state-of-the-art treatment available at his trauma center in Baltimore," according to the site. "He envisioned a statewide system of care funded by the state of Maryland available to anyone who needed it."

By that point, the center had grown to 138 beds and now is the centerpiece of an emergency care system that includes 11 trauma centers, a fleet of 12 state police helicopters, and volunteer and paid emergency medical personnel across the state.

In 1973, then-Gov. Marvin Mandel issued an executive order establishing the Center for the Study of Trauma as the Maryland Institute for Emergency Medicine. The order also created the Division of Emergency Medical Services, and Cowley was appointed director.

After Cowley's death in 1991, William Metcalf, the former associate executive director of the American College of Emergency Physicians, called Cowley "the father of many of the things we do today."

The R Adams Cowley Shock Trauma Center in Baltimore treated more than 6,200 patients between June 2006 and May 2007.

As a part of the trauma system, there also are two pediatric care centers in the area - the Johns Hopkins Children's Center in Baltimore and the Children's National Medical Center in Washington, D.C.

In addition to these primary care centers, there are three levels of trauma centers and numerous specialty centers across the state. The Johns Hopkins Hospital Adult Trauma Center is a Level I, and offers more patient services than Level II and Level III centers. Washington County Hospital is a Level II trauma center.

There are special centers for patients suffering from burns, hand and extremity trauma, eye trauma and neurotrauma (head and spinal cord injuries).

· More information on R Adams Cowley or the Shock Trauma Center can be obtained at www.umm.edu/shocktrauma.

· More information about Maryland's trauma system can be found at the Maryland Institute for Emergency Medical Services Systems' Web site at www.miemss.org.

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