Nothing lasts forever. However for most of us, Don Trunkey was the innovator of modern trauma care and its hard to imagine a world which he not part of. Donald D Trunkey FACS, was born in Eastern Washington and went to medical school at University of Washington. He served in the US Army in the mid 60s in Germany and completed his surgical training in San Francisco. Its was from San Francisco that his seminal “Two Counties” paper(1)was published where he convincingly showed that where a trauma system existed the mortality was substantial lower than where it did not. It was this paper, more than any other in the contemporary literature which led to the drive to systematised trauma care everywhere around the world.
Another of Don’s seminal papers was the that on the trimodal pattern of death after injury which was published in Nature in 1983(2). In that paper he outlined that death after trauma was either immediate, usually as a result of catastrophic brain or torso injury, in hours as a result of uncontrollable haemorrhage, or in 2-3 weeks as a result on multiple organ dysfunction itself a long term consequence of poor initial control of haemorrhage. While true in 1983 the pattern of death after trauma is now unimodal because, through the efforts of Don and other trauma surgeons, effective early trauma care, particularly consequent to near universal uptake of ATLS/EMST teaching, has resulted in effective early haemorrhage treatment.
Professor Trunkey’s academic record lists 317 publications and 10,118 citations and although he never published in the ANZ Journal of Surgery he was on the Editorial Board for many years.
Don’s early military career was bookended by a role in the First Gulf War 1990-1991 where he served as an advisor to the US Forces in Saudi Arabia. He dealt with a number of operational and cultural obstacles that prompted him to publish a commentary in the March 1993 edition of Archives of Surgery called “Lessons Learned.”(3) This document paved the way for how the U.S. Department of Defence trained its trauma personnel.
Don was a giant on the US trauma stage but also a frequent traveller who spread his knowledge and influence around the world. Apart from his Honorary FRACS he was also an honorary fellow of the surgical colleges of England, Ireland, Edinburgh, Glasgow, South Africa and Brazil. Locally he first came to Australasia in the early 80s for meetings in Brisbane and Auckland. At that time he also spent a number weeks in Dunedin and Southland interacting with local clinicians and spreading the trauma system message. He was a highly sought-after speaker at conferences around the world and over the years spoke many times in Australasia and taught on a number of Definitive Surgical Trauma Care courses. His last visit was as energetic as his first, flying from Portland to Perth to contribute to a Definitive Surgical Trauma Care course and speak at the annual conference of the Australasian Trauma Society.
Don and his wife Jane, enjoyed wine and spent many wonderful times, visiting vineyards in California, the Granite Belt in Queensland, the Hunter Valley in New South Wales, the Barossa and McLaren Vale in South Australia and the Margaret River in Western Australia. He was even an expert on the Tokaji wines of Hungary and had his own label Pinot Noir from grapes grown in Washington State. He was also an excellent cook.
Don was inspirational, enigmatic, friendly and forceful all at the same time. He had a great sense of humour. If ever anyone has made and left a mark on trauma management, it was Don Trunkey. He influenced generations of young doctors, in surgery and in other disciplines, to improve trauma outcomes and contribute to the teaching and delivery of optimal trauma careDonald D Trunkey was a legend in every aspect of the word and the trauma community will be much poorer with his passing. His legacy however, of improved trauma systems, trauma care and trauma outcomes is very much alive and society as a whole will be grateful for the career-long contribution of this trauma giant.
- Systems of Trauma Care: A Study of Two Counties West, J.G., Trunkey, D.D., Lim, R.C. Archives of Surgery 1979:114(4), pp. 455-460
- TRAUMA. Trunkey, Donald D. Scientific American 1983:249(2), pp. 28-35
- Trunkey D. Lessons learned. Arch Surg. 1993 Mar;128(3):261-4.
Mr Ian Civil, President, ANZAST.