In memoriam: Dr. Norman McSwain, a pioneer in comprehensive trauma care

Dr. McSwain

Dr. McSwain

Norman E. McSwain, Jr., MD, FACS—surgeon, teacher, mentor, collaborator, and internationally recognized visionary leader in trauma care—died July 28 in his New Orleans, LA, home, surrounded by family and friends. Dr. McSwain was 78. The dynamism, positivity, and warmth Dr. McSwain brought to all he did is greatly missed by surgeons and patients alike. He is survived by his daughter Merry Johnston McSwain; his sister Ann McSwain Kightlinger, and her husband Neal; and his niece and nephew, Janelle Eason and David Kightlinger.

Dr. McSwain was an exemplar in each professional role he undertook, which included trauma surgeon, professor, registered emergency medical technician (EMT), and leader of numerous health care organizations and initiatives. As founder and medical director of the Prehospital Trauma Life Support (PHTLS) program, he forever changed the education and training of emergency medical services (EMS) personnel and gave them the necessary tools for optimal treatment immediately following injury.

He was fond of beginning his conversations with colleagues and staff with a simple but penetrating question: “What have you done for the good of mankind today?” This query represented the core of Dr. McSwain’s motivation for practicing medicine and is indicative of his humanitarian spirit.

Early years

Born in northern Alabama in 1937, Dr. McSwain earned his bachelor of science degree from Sewanee: The University of the South, TN, and in 1963 began his medical education at the University of Alabama School of Medicine, Birmingham. There he trained under Champ Lyons, MD, FACS, a prominent surgeon from the early years of the Ochsner Clinic Foundation (now the Ochsner Medical Health System), New Orleans. Dr. McSwain completed his internship at the Bowman Gray School of Medicine (now Wake Forest School of Medicine), Winston-Salem, NC. He then joined the U.S. Air Force where, under the tutelage of Major General Kermit Vandenbos, MD, FACS, he completed more than 1,000 surgical procedures before completing his residency at Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA. Dr. McSwain then became a partner in private practice with Harrison Rogers, MD, FACS, in Atlanta.

As medical director of the Road Atlanta race track, he developed an interest in emergency medicine and trauma care, and in 1973, Dr. McSwain joined the faculty of the University of Kansas School of Medicine (KUMC), Kansas City, where he developed a statewide EMS system and served as its medical director. He met this challenge with what would become familiar dedication and success, establishing a standardized EMT curriculum and training program.

In 1977, Dr. McSwain was recruited by Tulane University School of Medicine and Charity Hospital, New Orleans, where he brought his tireless enthusiasm to bear in developing EMS protocols for the city. He was instrumental in developing Charity Hospital into an ACS Verified Level I Trauma Center, partnering with his colleagues at Louisiana State University. Dr. McSwain would continue to work at Tulane until the final weeks before his passing.

COT and revolutionizing emergency trauma care

Dr. McSwain

Clinical Congress 2012: Dr. McSwain and Donald D. Trunkey, MD, FACS (center left and right, respectively), were accepted into the Order of Military Medical Merit during the annual COT dinner. Drs. McSwain and Trunkey are pictured with Brian Eastridge, MD, FACS (far left), and Stephen Flaherty, MD, FACS (far right). The Order recognizes excellence and promotes fellowship and esprit de corps among U.S. Army Medical Department (AMEDD) personnel, and membership in the organization denotes distinguished service that is recognized by the senior leadership of the AMEDD.

Dr. McSwain became a Fellow of the American College of Surgeons (ACS) in 1973 and began working with the Kansas Committee on Trauma (COT) in 1975. He subsequently joined the national COT, where he led the Prehospital Care Committee and the Advanced Trauma Life Support® (ATLS®) Committee. He also worked in what is now known as the COT Verification, Review, and Consultation Program for hospitals. He would serve on the Louisiana COT for the next three decades. In time, Dr. McSwain would become the only Fellow in ACS history to receive all major trauma awards, including the Meritorious Service Award from ATLS in 1989; the National Safety Council’s Surgeons’ Award for Service to Safety in 1998; the COT Millennium Commitment Award in 2000; and the COT’s Meritorious Achievement Award. He also delivered the Scudder Oration at the ACS Clinical Congress in 2001.

Through his service on the COT, Dr. McSwain helped lead revolutionary changes in how trauma care was taught and practiced. He believed that the principles of the ATLS course—which was designed to train emergency physicians and trauma surgeons to provide standardized treatment in the so-called golden hour following an injury—could have an even more significant effect if the same techniques were taught to EMS professionals. After receiving approval from the COT to create and share a prehospital version of the course, he collaborated with the National Association of Emergency Medical Technicians to bring it to fruition. By the mid-1980s, regional faculty courses had been established and the program began to proliferate. The PHTLS course had been born with Dr. McSwain serving as medical director. Since then, the course’s impact in trauma and emergency care has been profound.

More than 1 million EMTs in more than 60 countries have participated in PHTLS—impressive numbers in and of themselves. But if this training led each of these EMS-providers to rescue even two or three trauma victims from a life-threatening hemorrhage or a blocked airway, you begin to understand that Dr. McSwain’s passion to educate and train all trauma care practitioners has likely saved millions of lives around the world. The effect becomes even more staggering if you add in the effect of training derived from PHTLS, which includes Tactical Combat Casualty Care and law enforcement, first responder, and lay-person bleeding control courses.

Dr. McSwain’s commitment to provide optimal treatment to trauma victims as quickly as possible never waned. Following the 2012 shooting at Sandy Hook Elementary School, Newtown, CT, Dr. McSwain collaborated with ACS Regent Lenworth H. Jacobs, Jr., MD, MPH, FACS, to form the Joint Committee to Develop a National Policy to Increase Survival from Active Shooter and Intentional Mass Casualty Events. All of the characteristics for which he had become known throughout his career—his dedication, passion, and intellect—were brought to bear in the Hartford Consensus meetings that followed. He advocated for coordinated, standardized, and improved hemorrhage control training for law enforcement and EMS professionals, and he advocated for extending this training to include the lay public responders on the scene. His goal, and the goal of his colleagues, was to empower and convert bystanders into effective and trained doers, aimed at immediate control of life-threatening bleeding. Dr. McSwain contributed to Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium, which mailed with the September Bulletin. He died shortly before its publication, but Dr. Jacobs dedicated the publication to his friend and colleague, Dr. McSwain.

The good of mankind

As a surgical educator, Dr. McSwain was a patient, thoughtful teacher. In 2009, he received Tulane’s School of Medicine Teaching Scholar Award, in part for “McSwain’s Rules of Patient Care,” a list of 18 rules that guided his professional philosophy and that he offered to medical students and colleagues. He was an able and willing mentor, offering advice and guidance to all who sought it—surgeons, police, EMTs, even civilians—so that they would be better able to treat the trauma victim. He served as U.S. Navy Captain in the Persian Gulf as a general surgeon; volunteered as medical director of numerous New Orleans events; was the police surgeon for injured New Orleans Police Department officers for more than 35 years; served as editor or contributor to multiple surgery journals; lectured throughout the U.S. and the rest of the world; and worked in many other roles throughout his career.

“What have you done for the good of mankind today?” Looking back at a life and career dedicated to improving the lives of people around the world, we know that, for Dr. McSwain, that question has been soundly answered.

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