TRAUMA MANAGEMENT IN THE 21ST-CENTURY

Predicting the future can be interesting but difficult, particularly b ecause of the exciting developments in the science of injury, inflamma tion, sepsis, and shock. Considering what has happened between 1895-19 95, it is difficult to contemplate what will happen in the next 100 ye ars. Will change accelerate in the 21st century? So far, our scientifi c knowledge and capability have exceeded the ability to care for injur ed and operated patients. Much of the future will depend upon society' s ability to control violence and prevent injury. Most of the factors resulting in death after injury are beyond the control of those caring for patients or those studying patient problems. Thus the major risk factors for death after trauma are injury severity, the age of the pat ient, the problems of shock, and end-stage organ injury. If we are to decrease mortality from injury, we must work to prevent injury and dec rease the severity of injury while improving our capabilities to care for the injured. New rapid diagnostic procedures, immediate therapy at the scene of the injury, portable or flying resuscitative and therape utic units, and better understanding of the need for the inflammatory response in contrast to the disaster produced by an overwhelming infla mmatory response will help. The major hazard for predicting the future in the management of injured patients could be predicting that someth ing cannot be done. We recognize now that almost anything can be done if we learn enough and understand the problems sufficiently well. The Shock Society is dedicated to that purpose.