Letters to the Editor

Editor’s note: The following comments were received regarding recent articles published in the Bulletin.

Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to dschneidman@facs.org, or via mail to Diane S. Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.

Words of appreciation for Dr. Basil Pruitt’s service to the ACS Surgical History Group

From the first days of the Surgical History Group (SHG), Basil A. Pruitt, Jr., MD, FACS, planned one of its most successful activities, the educational sessions at the Clinical Congress of the American College of Surgeons (ACS). As chair of the SHG Program Committee, he helped to select the themes for the Panel Sessions and ensured that the program satisfied the requirements for courses presented at the Clinical Congress. The approval process is sometimes arcane, involving reviewing applications, meeting deadlines, and securing approvals, but Dr. Pruitt handled it all with ease, making sure the Panel Sessions met the standards for excellence in content, while addressing topics of interest to surgeons.

The other major activity was the annual SHG Poster Competition, which now routinely attracts nearly 100 applicants each year. Directed at residents and medical students, the competition reflects a lively interest in history among young trainees and students and their mentors. The Panel Session and Poster Competition became the signature activities of the SHG, successes that came from Dr. Pruitt’s committee and his leadership.

Less visible but equally significant were Dr. Pruitt’s contributions as a member of the SHG Executive Committee—the group’s governing body. He made sure the SHG remained true to its mission to preserve the history of the College and promote an appreciation of history among its members. His experience as chief of surgery at the busiest evacuation hospital during the Vietnam War and Commander of the U.S. Army Institute for Surgical Research benefitted the far more modest SHG enterprise. The SHG is honored to have Dr. Pruitt as one of its guiding members and expresses its appreciation for his contributions.

Don K. Nakayama, MD, FACS
Chair, ACS Surgical History Group
Pensacola, FL

It is time to mandate bleeding control training in medical schools

Hemorrhage is the leading cause of preventable death in the U.S. for individuals ages 46 and younger.1 Efforts to address this issue started in 2013 with the Hartford Consensus,2 which led to the establishment of the Stop the Bleed® (STB) campaign, which has made great strides in providing bleeding control (B-Con) training to civilians.3 Continuously, the www.bleedingcontrol.org website highlights various public B-Con classes that are enabling an already willing public to act when needed.4,5

Unfortunately, efforts to mentor and teach these valuable skills to future physicians are lagging behind. Some medical schools have made the effort to implement STB, but many have not yet had the opportunity. Although all health care professionals are mandated to know how to perform cardiopulmonary resuscitation, the ability to provide hemorrhage control techniques is not required as a condition of employment.6

As leaders in medicine, it is time to change the culture of health care. The Association of American Medical Colleges (AAMC) mandates in its entrustable professional activities for entering residency that all medical students know how to respond to an emergent situation and initiate care.7 Few conditions require more time-sensitive care than life-threatening hemorrhage. It would be prudent to ensure all graduating medical students are B-Con certified and able to teach these critical, lifesaving skills to other medical students and the surrounding community.

At a time of ever-expanding curricular requirements and decreased calendar space, the logistics of adding yet another mandatory component may seem daunting. The B-Con course, however, is flexible and can be easily implemented into medical school curricula. Several key opportunities exist to add this training for all medical students. The first-year orientation period is optimal. To a new medical student, this hands-on course is exciting and provides a skill that they can use immediately. A second opportunity to teach B-Con is during the surgery clerkship, providing an active learning opportunity directly related to surgery and complementing other didactic requirements. However, because the surgery clerkship can occur late in the medical school curriculum, some students may demonstrate less interest and will lack these lifesaving skills throughout most of medical school.

Several medical students have come together to close the gap by assisting other medical schools to incorporate B-Con classes into their curriculum. This grassroots committee has worked together to develop a turnkey solution for medical schools interested in incorporating B-Con training into their curriculums. We have extensive experience teaching B-Con and have advocated and implemented STB as a curricular activity. We would like to offer our assistance to anyone who is interested in implementing B-Con training at their institution.

Brad Chernock, MS, PA-C, MS-4
Rutgers New Jersey Medical School
Newark, NJ

Andrew Fisher, MPAS, PA-C, MS-3
Texas A&M College of Medicine
Temple, TX

Kathleen Gallagher, MS-4
Vanderbilt University School of Medicine
Nashville, TN

Adam Engberg, MS-3
Case Western Reserve School of Medicine
Cleveland, OH

Brian Moriarty, NRP, MS-1
Rutgers New Jersey Medical School
Newark, NJ

Jeremy Fridling, MS-2
Frank H. Netter MD School of Medicine at Quinnipiac University
North Haven, CT


References

  1. National Academies of Science, Engineering, and Medicine. National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press; 2016.
  2. Jacobs LM, McSwain NE, Jr., Rotondo MF, et al. Improving survival from active shooter events: The Hartford Consensus. J Trauma Acute Care Surg. 2013;74(6):1399-1400.
  3. American College of Surgeons. 2018 Progress Report. www.bleedingcontrol.org/~/media/bleedingcontrol/files/2018_stb_progressreport.ashx. Accessed October 10, 2018.
  4. Jacobs LM, Burns KJ, Langer G, Jonge CKD. The Hartford Consensus: A National Survey of the Public Regarding Bleeding Control. J Am Coll Surg. 2016;222(5):948-955.
  5. American College of Surgeons. News updates. Available at: www.bleedingcontrol.org/news-updates. Accessed October 30, 2018.
  6. Fisher AD. Letters to the editor: Hemorrhage control training should be mandatory for health care professionals. Bull Am Coll Surg. 2018;103(2):68-69.
  7. Core Entrustable Activities for Entering Residency: Toolkits for 13 Core EPAs. Available at: www.aamc.org/download/484778/data/epa13toolkit.pdf. Accessed on January 4, 2019.

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