Introduction: although the term “polytrauma” has been in use for decades, no generally accepted definition exists. Our definition has been until 2010: a combination of injuries where one, or the combination where one, or the combination of injuries himself is directly life threatening, in detail is meant: injury to two body cavities, or injury to one cavity committed by two long bone fractures, where spine and unstable pelvis has counted similarly as an injury to a cavity organ. Since 2013 a new definition has been established, the so-called Berlin definition.
"A polytrauma means significant injuries of three or more points (AIS) in two or more different anatomic AIS regions in conjunction with one or more additional variables from 5 physiologic parameters: Hypotension (SBP - Systolic Blood Pressure <= 90 mm Hg); Level of consciousness (GCS - Glasgow Coma Scale) ≤ 8; Acidosis (BE - Base Excess ≤ - 5.0); Coagulopathy (INR - International Normalized Ratio ≥ 1.4; PTT - Partial Thromboplastin Time ≥ 40 seconds, and Age ≥ 70 years).
This definition fits the reality perfectly. The role of the surgeon in the trauma team is essential. It should provide multidisciplinary care to reduce diagnostic time and optimize therapeutic procedures.
As Medicine adapts to the 21st century, new specialties arise. In the management of trauma, two models have been opposed in the past: on one side, a Trauma Surgeon based system, with specialists fully devoted to trauma care, often able to fix skeletal trauma too; on the other hand, blended systems with General Surgeons dealing with both elective and emergency surgery and trauma patients.
The evolution of technology, of the epidemiology of trauma, and of the trauma systems and networks entailed the emerging of the concept of Acute Care Surgery. In the vast majority of Countries, this new specialist seems to better fit with the needs of both patients and health organization.
Who is the Acute Care Surgeon? What is his minimal educational and technical background? How can interact with the other medical specialists playing around a trauma patient?
Keywords: Polytrauma, Trauma surgeon, general surgery, Acute Care Surgeon, Anesthesia, surgery, emergency medicine, education,