How can trauma surgeons approach urgent decisions responsibly?

Trauma changes a life in a fraction of a second, whether by injuring organs, fracturing bones, or causing bleeding. A trauma professional’s decisions can also change a life forever. In trauma bays, physicians often need to make high-stakes, split-second clinical and ethical decisions without knowledge of a patient’s name, age, history, goals, or values. Action frequently must outpace deliberation.

The May issue of AMA Journal of Ethics® (@JournalofEthics) explores the ethics of urgent decision making in trauma care settings, what it means for clinicians to approach decisions responsibly, and what it means for patients and their loved ones to have the consequences of those decisions communicated with clarity and compassion.

Take a moment to consider this question: Should a patient’s family members be allowed in the trauma bay during resuscitation?

• Yes, for any family members who request it.
• Yes, for family members who have been assessed to ensure they won’t cause a disruption and are accompanied by a chaperone.
• No, this is never acceptable.

Give your answer and find responses to this question in the May issue of the AMA Journal of Ethics, which also explores what trauma care policies can mean for public health, community planning and resource allocation.

Articles include:

“What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence?” Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context. These programs, with their multipronged, community-based approach, have shown great potential in reducing trauma recidivism by leveraging the acute experience of violence as an opportunity to introduce services and assess risk of re-injury.

“The Evolving Surgeon Image.” The stereotype of the abrasive, technically gifted white male surgeon is ubiquitous among members of the public and the medical profession. Yet today’s surgeons are far more diverse and socially adept than the stereotype suggests. While the stereotype is largely a relic of days gone by, it continues to influence patients’ expectations and surgeons’ interactions with their clinical colleagues.

“Does Family Presence in the Trauma Bay Help or Hinder Care?” Family presence during a pediatric resuscitation remains somewhat controversial. Opponents express concern that family presence would be detrimental to team performance and that exposure to such a traumatic event could put family members at risk of post-traumatic stress. Proponents argue that family presence affords families a sense of closure, by easing their anxieties and assuring them that everything was done for their loved ones, in addition to improving clinicians’ professional behavior by humanizing the patient.

“How Should Trauma Patients’ Informed Consent or Refusal Be Regarded in a Trauma Bay or Other Emergency Settings?” The urgency of treatment for trauma patients, who frequently have temporary alterations in their abilities to make autonomous and competent decisions, often results in presumed consent for medically necessary treatment. Academic trauma centers use protocol-based management of injuries to facilitate their simultaneous evaluation by multiple clinicians and to avoid delays in treatment, ensuring that trauma patients receive the best possible care.

In the journal’s May podcast, experts David Hoyt, MD, executive director of the American College of Surgeons, and Karen Brasel, MD, professor of surgery at Oregon Health and Science University, discuss how the specialty has evolved over the years and how trauma surgeons can address the needs of changing communities. Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other podcast-distribution platforms.

Meanwhile, the AMA Journal of Ethics Discussion Forum will explore confronting racial and gender stereotypes in medicine, drawing lessons from the #ILookLikeASurgeon movement. The online discussion runs May 17–24. Join the discussion to learn from experts on the topic and ask your questions.

The Conley Art of Medicine contest for medical students, residents, and fellows is now open through 25 September 2018, with a $5,000 prize for the winning art entry.

The Conley Ethics Essay contest for medical students, residents, and fellows is now open through 25 September 2018, with a $5000 prize for the winning essay.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on ethics in burn care, and religion and spirituality in health care practice. Sign up to receive email alerts when new issues are published.