The Cradle of Trauma Care: University of Louisville Hospital Trauma Center Celebrates 100 Years

Since opening its doors as the nation’s first “accident service” in 1911 at Louisville City Hospital (presently University of Louisville Hospital), the Trauma Center has served as either the innovator behind, or a forerunner in adopting, most of emergency medicine’s groundbreaking procedures.

“If anybody were going to list trauma centers in terms of contributions made over almost any period of time, I think we’d make the Top 5,” said Dr. J. David Richardson, University Hospital’s Chief of Surgery and Director of Emergency Surgical Services. “And it’s continued to be a very productive unit in terms of taking care of patients – we’re one of the busiest in the country.”

Not only is it one of the busiest, it’s one of the best. The quality of service provided at the center has earned it an American College of Surgeons’ Level I designation, the highest stamp of approval. The benefits to patients are enormous.

While a typical emergency department is prepared to treat a broad scope of minor to mild medical emergencies from heart attacks to general injuries, it usually does not handle major procedures. Instead, it stabilizes patients before transferring them to a trauma center, where the focused scope of practice is more suited to coping with severe injuries. Trauma centers also perform operations and follow up with long-term care.

The Level I designation, up for review every three years, means University Hospital’s Trauma Center meets the rigid criteria of having the full range of specialists and equipment in-house 24-hours a day, plus it has a robust research program and is a leader in injury prevention activities within the community.

“We were one of the four original ACS-designated trauma centers in the country, beginning more than 30 years ago and maintaining it since,” Richardson noted. “This means we can take care of any kind of patient who comes in, to the extent humanly possible given the state of knowledge today. If you have a head injury, heart injury, broken bone, eyeball injury — whatever — we have the capability of managing it.”

So much so that many of the leaders of the top trauma centers countrywide got their starts here.

“They used to talk about Miami University of Ohio being the cradle of coaches — well, we’re the cradle of trauma surgeons and chiefs,” Richardson said. “The chief of trauma at UCLA trained here, as did the ones at Stanford, the New Jersey College of Medicine & Dentistry in Newark, Hollywood Memorial Hospital in Ft. Lauderdale, SUNY at Buffalo, Loyola in Chicago and many more.”

“We’ve also been thought leaders and consistently turned out good people. I think that really speaks well for what this place has done.”

Dr. Kelly McMasters, Chair of the UofL Department of Surgery, agrees.

“University of Louisville Hospital has a long and proud tradition as not only the oldest trauma center in the nation, but one of the finest,” he said. “Our trauma program has contributed many advances in the treatment of injured patients, starting with innovative care of penetrating chest trauma and fractures by Dr. Arnold Griswold in the early 20th century, followed by pioneering advances in the treatment of pelvic fractures, liver and spleen injuries, to name a few.”

Along with quality and scope of treatment, the Trauma Center strives for compassionate treatment, too. The focus is totally on the patient.

McMasters explained, “We treat all patients regardless of ability to pay. Unlike some other centers, the University Hospital Trauma Center is open 24/7, 365 days per year. We never go on diversion or close our doors because we are too busy.”

Early Innovators

Turn-of-the-century surgeon, Dr. William O. Roberts, famous for performing the first successful operation on a human abdominal stab wound, is credited with starting the accident service when he assigned four UofL medical students to be on hand at Louisville City Hospital at all times. Their mission was to provide accident victims instant attention. While a far cry from the services offered by the Trauma Center today, in 1911 having medical professionals available around-the-clock to treat anyone in need of immediate care was a radical idea.

The next great leader of the service would appear in 1932 when Dr. R. Arnold Griswold, a 1925 graduate of the UofL medical school, returned to his alma mater after training in surgery at a hospital in Cleveland. The impact he would make in trauma care over the next several decades is still felt today.

Among them are establishing a new protocol for treating penetrating heart wounds, promoting auto transfusion, establishing the city’s first blood bank and radicalizing how broken bones were set. He also revolutionized emergency response services by equipping police cars and fire trucks with medical supplies and training police officers in emergency care. In fact, Louisville’s police-run emergency response ambulance service would earn national recognition in 1965 after instituting many of Griswold’s ideas.

Griswold had a major influence on automobile safety standards, too. Ford designed the first collapsible steering column in response to Griswold’s challenge for a safer design and he was one of the first — and possibly the most outspoken — advocates for seat belts in cars.

When Griswold left the department in 1952 to return to private practice, Dr. Rudolf Noer took over as director of surgery at what was now known as Louisville General Hospital. Through the ensuing years, his leadership role in several national trauma organizations would keep the center in the spotlight.

Then, in 1971, Dr. Hiram Polk came on board to head up surgery. Just 35 years old, he was soon widely regarded as one of the top administrators in the country, helping shepherd the Trauma Center into international prominence. He also is considered a pioneer in surgical procedure, in the late 1960s introducing the concept of using preoperative antibiotics to minimize infection during surgery. His work in treating burn patients also set standards in medical care.

One of the first things Polk did after arriving in Louisville became what he believes is his legacy to the Trauma Center:  separating the surgical service into distinct trauma and elective surgeries.

Polk credits the idea to Dr. George Shires, famous as chief of surgery at Parkland Memorial Hospital in Dallas when President Kennedy was assassinated. When Polk arrived in Louisville, Shires was serving as a consultant to the UofL medical school dean.

“Dr. Shires was doing a lot at Parkland, much like Griswold had done 20 years before,” Polk recalled. “I spent a couple of days with him and he advised me to segregate the surgical services. What this meant was that trauma service would have its team ready at all times and then your elective surgery schedules didn’t get interrupted.

“He was absolutely right. It was a simple thing that I did, but it worked out extremely well.”

It was also under Polk’s tenure that Dr. Don Thomas began the region’s first emergency residency program — only the nation’s fifth — at Louisville General. Thomas was one of the first physicians to specialize in emergency medicine and was instrumental in creating the Louisville EMS and the hospital’s STAT Flight helicopter ambulance service.

Delivering the Best Care Possible

While they may be some of the better-known names associated with the Trauma Center, the fact is that Roberts, Polk, Griswold, Noer, Thomas and McMasters represent just a few among many dedicated men and women who have made the center into a world-class facility.

Through the years, the staff has helped the region cope with killer epidemics that plagued the area and treated victims of natural disasters, from the 1937 flood to the 1974 super tornado outbreak and the recent ice storms. They also aided those who endured the rage of their fellow citizens, including the incident Richardson recalls as his most taxing — treating 13 victims from the Standard Gravure shooting in 1989.

Most patients aren’t the victims of a high-profile incident, and thus, don’t receive any media attention. But they all deserve and receive the highest quality of care.

And that’s just what they get at University Hospital’s Trauma Center, Richardson said.

“In terms of being able to guarantee that the care you get equals the best you can get from anybody anyplace in the world, that’s pretty hard to say. But I can tell you, in the Trauma Center that’s true.”