David R. Boyd

Osmometry: A New Bedside laboratory Aid for the Management of Surgical Patients

The osmometer (cryoscope) measures the tonicity of body fluids accurately and rapidly, even when operated by a relatively untrained technician or house physician, and provides specific information necessary for physiologic monitoring of solute disturbances.

A trauma surgeon's journey.

T modern era of improved civilian trauma care occurred in the two decades after 1966. The introduction of designated trauma centers (TCs) with supporting prehospital components was new and essential to the organized regionalized systems that were developed in this period. In 1966, the National Academy of Sciences National Research Council published Accidental Death and Disability: The Neglected Disease of Modern Society with 23 recommendations. At this time, the USCongress also enacted theHighwaySafetyActwith technical standards for emergency medical services (EMS) including prehospital ambulances, emergency medical technician (EMT) training, and radio equipment. Drs. Robert J. Baker and Robert J. Freeark established the first civilian trauma unit (TU) at the CookCountyHospital (CCH) inChicago.Dr. FrankPantridge, a cardiologist in Belfast, North Ireland, initiated out-of-hospital emergency cardiac care, which was soon emulated in the United States. Dr. Eugene Nagel, a Miami anesthesiologist, taught his advanced EMTs how to intubate patients in the field and called them paramedics. Early in this period, I started my general surgery residency with an interest in trauma, and these events caught my attention and helped define my career. I soon recognized that there was no cohesive plan to bring these clinical advances and the EMS technical components into one coordinated system or how to replicate them in variable sociogeographic settings. This was a complex problem worth fixing. It would require a ‘‘systems approach.’’ All history has ironic twists and developmental surges that emanate from a single but seminal act, conversation, or technical adaptation. These are rarely documented and tend to emerge later in memoirs and oral histories. My personal observations and experiences became the basis of important and at times critical decisions that affected trauma care and EMS systems (trauma/EMSS) development in the United States. I was fortunate to get interested and involved in solving this problem at such an opportune time. Our proven military casualty care and evacuation system of World War II (WWII) and Korea, which many practicing surgeons had experienced, had not been transferred to the civilian community. This article describes some of the seminal events, opportunities, and options I encountered as well as the logic and rationale that I used in key decisions. Many of these important seminal events and technical advances are publishedbut have not been explained. Some have been misinterpreted. The energy that fueled this transformative period was desire for change. The civilian trauma/EMSS required the participation of established surgical, medical, and health care organizations and institutions and the government. The comprehensive systems approach concept that I envisioned required all participants to change. I thought these changes were reasonable and moderate. Others did not. My journey described here was not planned. It is inconceivable that it could have been predicted. I trust the readership will find it interesting. I was born in Seattle in 1937 and grew up during the Great Depression andWWII. This was a period of commitment to public service, community volunteerism, and national duty. My early reward system was through athletics, which started with my father, Gene Boyd. He was the recreation director at an inner-city gymnasium, park, and swimming beach. He was an iconic teacher and could successfully coach anyone from youth to semiprofessional levels. He was an advocate for the Japanese-American community. During the internment period enacted by Executive Order 9066, I can remember him passing ‘‘expropriated’’ sports equipment to ‘‘his playground kids’’ through a barbed wire fence at the relocation station in Puyallup, Washington, before their removal to the internment camp in Idaho. I worked for the Seattle Parks Department as a teacher, coach, and lifeguard and learned public safety responsibility. After graduating from the Theodore Roosevelt High School, I went to Central Washington College of Education in Ellensburg, Washington, planning to become a high school teacher and athletics coach. I progressed through education, psychology, and science with enough credits for medical school. An emphasis at Central was not only course content but also how to teach it to others. This has been valuable in my life work. One short conversation with Dr. William Hutchinson, the senior surgeon of the Swedish Hospital in Seattle, convinced me that his almamater,McGillUniversity Faculty ofMedicine in Montreal, Canada, was the place for me.