While I am not a trauma surgeon, I worked as an EMT for a large, academic medical center that handled emergency response for a very densely populated and very violent urban area. In this medical center, any patient that is backboarded is treated as a trauma patient and seen in the dedicated trauma ED. To that end, a suburban soccer mom involved in a low speed fender-bend while heading home and complaining of mild neck and back pain could be sharing a trauma bay with a gang banger shot multiple times by "his boy" over something as stupid as a dime bag of dope. I always admired the work of the trauma surgeons in this situation because they had to quickly change their attitudes and demeanor when dealing with different patients in close spatial proximity. For those of you that have never worked EMS or in a urban ER, the way that you are viewed and the amount of respect that you receive as a healthcare provider varies vastly based on the patient. In my experience, the soccer moms obviously treat you with alot more respect and cooperation (most of the time) than the banger who tells you to go **** your mother when you ask him his name. Obviously, the level of respect that you show each of these patients will vary, even if its subconsciously. My attitude has always been to show every patient the utmost respect until they give me a reason not to and even when they give you a reason not to, I just simply refuse to engage the patient in confrontation. In that respect, ER docs, trauma surgeons, EMTs, and paramedics are on the front lines of medicine. Another situation for which I greatly admire the work of trauma surgeons is their composition during pediatric trauma codes. All pediatric codes are dramatic but I have noticed that trauma codes are especially dramatic and difficult and I have yet to see a trauma surgeon falther under such a situation. I have always imagined how difficult it is for the ER doc or the trauma surgeon to pronounce the infant/child after we bring them into the ER and after working them up to the point of exhaustion in the field; to know that we had failed when the doc pronounced is very difficult. In fact, it was a pediatric trauma patient that coded in my arms that eventually drove me out of urban EMS and made me concentrate more on research. For the surgeon or ER doc, it must be difficult to order resuscitation efforts to cease and essentially condemn any minute chance that the patient has of survival. Again, just my opinion but ER docs and trauma surgeons have some of the toughest jobs in medicine. To think that EMTs and paramedics often have to deal with the same level of stress and often see the most severe patients before a physician and that they are only paid $10/ hr in some states should make you raise an eyebrow.
