CHICAGO -- Surgeons from Bay Area hospitals that treated the victims of the July 2013 Asiana Airlines accident came together to share the successes and challenges in trauma and emergency care delivery in the days and weeks after the mass casualty response. Presenters offered new solutions to improve the quality of patient care and strengthen emergency medical response through regionalization, coordination, and enhanced communication between hospitals and on-site responders.

The American College of Surgeons (ACS) hosted the ACS Surgical Health Care Quality Forum Northern California on January 14 at the University of California San Francisco, the 15th program in a series of events to drive national discussions on effective quality improvement methods that surgeons, physicians and hospitals are using to improve patient safety and quality outcomes.

"That a major airliner crashed with a less than one percent fatality rate, is a tribute to safety advances in aviation and the strength and importance of our emergency medical system, particularly in its capacity to absorb a massive surge in patient volume and complexity," said forum co-host John Maa, MD, FACS, President, Northern California Chapter, American College of Surgeons; Chair, University of California Office of the President Tobacco Related Disease Research Program SAC. "The successful medical outcome after the Asiana accident demonstrates to our nation what hospitals can accomplish working collaboratively in a region." 

"The infrastructure that allowed San Francisco to respond so effectively to this major mass causality event is really based upon principles put forth in the ACS book Resources for Optimal Care of the Injured Patient and includes an organized response to injury for things like pre-hospital medical education, setting up pre-hospital systems, 911 communications systems, triage and transport protocol," said David B. Hoyt, MD, FACS, ACS Executive Director. "It's amazing when you look at a map of the area and realize that casualties were distributed to 12 different hospitals in a little over an hour or so – that would not have been possible 30 years ago." 

The forum was also hosted by Shelley A. Marks, MD, FACS, general surgeon, Palo Alto Medical Foundation; President-Elect, Northern California Chapter, American College of Surgeons. Forum hosts proposed the following areas that should be the focus of future efforts to strengthen emergency care:

1. Preparedness and coordination – across the continuum from the site of the accident to acute in-hospital care to expedite patient access to life saving treatments through search and rescue, rapid transport and helipads, translators, and coordination of operating room resources.
2. Federal Trauma Funding – appropriation of the $224 million to fully fund trauma and emergency medical services programs (authorized under the Public Health Service Act of the Affordable Care Act) to provide adequate support of existing programs and a financial investment in future research in emergency care coordination, trauma systems and regionalization to sustain emergency departments nationwide.
3. Leverage the American College of Surgeons Committee on Trauma (COT) – utilize the leadership and expertise of the ACS COT to engage surgeons in implementing meaningful new efforts to improve trauma care locally, regionally, nationally and internationally.

Keynote speaker, Fiona Ma, CPA, Former Speaker Pro Tempore, California State Assembly, provided her perspective on strengthening California's emergency response stating, "Looking forward, I believe greater regional cooperation and communication is needed between all stakeholders involved in response, including EMS, The Coast Guard, The American Red Cross and hospitals. In addition, translation services at the scene of the accident could help to alleviate future incidents where medical providers face challenging language barriers."

"Preparations and verification of a trauma center through the American College of Surgeons assures the public that we have the resources we need to take care of injured patients," said M. Margaret Knudson, MD, FACS, Professor and Interim Chief of Surgery, San Francisco General Hospital and Trauma Center, UCSF Division of General Surgery. She said that the ACS Committee on Trauma developed a disaster preparedness course designed by the Navy surgeon who responded to the Beirut bombings that gives surgeons background on what to expect from a mass causality event. "Another thing that helps us prepare is programs that allow civilian trauma surgeons to treat causalities coming off the battlefield in Iraq and Afghanistan. These are some of the most severe injuries you will ever see in your career and in Iraq there is a mass causally event almost every day so you get an idea of what you need to do and respond as a surgeon."