Letters to the Editor

Editor’s note: 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 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.

Surgeons’ role in trauma health policy spans decades

The August issue of the Bulletin included an article regarding the American College of Surgeons’ (ACS) interactions with the U.S. Congress, which was timely given the cycle of legislation.1

In the late 1980s, trauma legislation was new to members of Congress. A few of us in the then-leadership of trauma systems development to the U.S. formed the Coalition for American Trauma Care, which was run by consultant Marcia Mabee, MPH, PhD, and funded by many members of the Committee on Trauma (COT), including Donald Trunkey, MD, FACS, then-Chair of the COT; Lenworth M. Jacobs, Jr., MD, MPH, FACS, now Medical Director, STOP THE BLEED®; myself; and others.

The purpose of the Coalition for American Trauma Care was to mobilize the leadership of the COT to attain federal support for trauma systems development in the U.S. It took approximately six years to accomplish this mission. The ACS and other coalition members engaged in hundreds of meetings on Capitol Hill, winning broad support for the trauma systems bill, as well as a bit of drama when a senator placed an anonymous hold on a bill at the last minute, effectively killing it for that session of Congress. Such “pocket vetoes” are prohibited now. This advocacy group put trauma on the map of many committees on Capitol Hill and in many states.

Ultimately, the Trauma Care Systems Planning and Development Acts of 1989 (H.R. 436) and of 1990 (H.R. 1602) were passed, became law (Public Law 101-590), and were funded, thus leading to trauma systems development in the U.S.

Notwithstanding the College’s current support of advocacy, these initial efforts by Dr. Trunkey, myself, and many others in the late 1980s should not go unchronicled. It was, I believe, the first major federal advocacy effort from an ACS-related team. Getting a bill through Congress and getting it funded takes a lot of hard work against lots of competition. Fortunately, the College now has a well-funded, competent advocacy team in play.

Howard Champion, MD, FACS, FRCS

Annapolis, MD


New tool measures hospitals’ climate impact and preparedness

We commend the authors of “The intersection of climate change and surgery,” published in the September issue of the Bulletin, for drawing attention to the incredibly important topic of climate change and for addressing surgery’s role in this field.2 We hope that there will be more work done in the surgical sphere to mitigate carbon emissions and prepare for the effects of climate change.

To best catalyze this effort, we have created the Surgical Providers Assessment and Response to Climate Change (SPARC2) Tool.3,4 This tool marks 22 key metrics to assess hospital systems on a scale of one to three to gauge their climate impact and preparedness for climate disaster and includes many of the factors highlighted by the authors of “The intersection of climate change and surgery.”

The SPARC2 tool is being prepared to assess hospital systems in South Sudan, Ecuador, Myanmar, Canada, Finland, and the U.S. to examine what surgical readiness for climate change will look like in drastically different contexts. The SPARC2 Team is in the process of expanding its application and forming long-term partnerships globally to work together in mitigating the effects of climate change. We invite other hospital systems to join this partnership and take the necessary steps in combating this looming crisis.

Kevin Gianaris

Indianapolis, IN

Adam Kushner, MD, MPH, FACS

New York, NY

Cliff Ewbank, MD

Oakland, CA


ACS should be part of the climate change consortium

The cover story of the September 2019 Bulletin was titled “Climate change and the future of surgery.” Two years later, the cover story is “The intersection of climate change and surgery.” Both articles mention organizations concerned about climate change, namely Health Care Without Harm and the Medical Society Consortium on Climate and Health. In 2019, the consortium included the American College of Physicians and the American Medical Association, among others, but not the ACS. The list of members of the consortium has grown to 37, adding such medical and surgical associations as the American College of Emergency Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Physical Medicine and Rehabilitation, and others.

Once again, the ACS is nowhere to be found. Why not? What is the problem? It seems to me that if our College is concerned about this existential problem, it would benefit our members and patients and hospitals and the planet to join the consortium to learn and share and bolster the effort. The April 2020 Bulletin printed my letter asking the same question. Will this one persuade the Regents to join in?

Edward Z. Walworth, MD, FACS

Lewiston, ME


  1. Ryan R, Collins C, Lee KB, Essig R, Marsh K, Saadat L. Surgeon advocacy in action: Challenges, accomplishments, and future direction. Bull Am Coll Surg. 2021;106(8):35-41. Available at: https://bulletin.facs.org/2021/08/surgeon-advocacy-in-action-challenges-accomplishments-and-future-direction/. Accessed November 4, 2021.
  2. Asfaw S, Dilger A, Tummala N, et al. The intersection of climate change and surgery. Bull Am Coll Surg. 2021;106(9):10-15. Available at: https://bulletin.facs.org/2021/09/the-intersection-of-climate-change-and-surgery/. Accessed November 4, 2021.
  3. Ewbank C, Stewart B, Bruns B, et al. Introduction of the Surgical Providers Assessment and Response to Climate Change (SPARC2) Tool: One small step toward reducing the carbon footprint of surgical care. Ann Surg. 2021;273(4):e135-e137.
  4. Ewbank C, Stewart B, Bruns B, et al. The development of a surgical care and climate change matrix: A tool to assist with prioritization and implementation strategies. Ann Surg. 2021;273(2):e50-e51.

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