Evolving Roles of the Surgeon in the Management of Pediatric Trauma Resuscitation

The traditional paradigm for trauma resuscitations was that a surgeon was always required for leadership. However many changes such as resident work-hour limitations, a shift toward non-operative management, improved trauma triage, and advanced imaging have raised questions about the necessity of a member of the surgical team at all resuscitations. The requirement for surgeon presence is based mostly on opinion rather than data. Our institution has over a decade of experience with pediatric emergency medicine physicians managing minor trauma resuscitations and requiring surgeon presence specifically for the major resuscitations. This has resulted in more appropriate resource allocation without sacrificing patient care in our institution. Other institutions have similarly shifted the focus away from early surgeon involvement while preserving patient safety. We recommend a critical re-evaluation of trauma protocols and systems in requiring surgeon presence as a novel mechanism to improve surgical resource utilization without compromising patient care.