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Acute Care Surgery

Surgical Critical Care


 Emergency General Surgery


A New American Surgical Specialty for Emergency Surgical Diseases

Trauma, Emergency General Surgery, and Surgical Critical Care

Acute Care Surgery is a new tri-disciplinary surgical specialty that has evolved over the past twenty years in the United States.  The specialty addresses the concern highlighted by Dr. William Halstead, widely recognized as the father of American surgery, when he stated that “…every important hospital should have on its staff of surgeons at least one who is well trained and able to deal with any emergency.”  A number of forces have created an optimal environment for the birth and development of this new American surgical specialty.  These changing forces include a dramatic decline in the surgical workforce that is involved in the care of the emergencies noted by Dr. Halstead as well as the well-documented short supply of specialty support in the acute care setting.  An American College of Emergency Medicine survey in 2005 of emergency department medical directors noted that 75%  of leadership believe that they have inadequate specialty coverage.  The Institute of Medicine corroborated these findings in 2006 in a paper entitled  “The Future of Emergency Care”.   The new and unique specialty of Acute Care Surgery evolved specifically to address the changing needs for urgent surgical care in this country.  Although some controversy existed during the evolution of this new specialty, the true definition of “acute care surgery” now embodies three distinct specialty components – trauma surgery, emergency general surgery and surgical critical care (Figure 1).  The new specialty is now fully recognized through fellowships, certification (AAST) and support from senior American  surgical/medical leadership including such organizations such as the American College of Surgeons, the American Association for the Surgery of Trauma and the Society of Critical Care Medicine. 

Mountain States Health Alliance recognized the needs of its patients and made a commitment in 2009 to establish an Acute Care Surgery program based on the tenets of the new surgical specialty.  Surgeons have been recruited who are specifically fellowship trained and Board Certified/ Board Eligible in the three disciplines of Acute Care Surgery.  The overarching principle, that transcends each of these three components is early and expedient medical/surgical intervention by surgeons at Mountain States hospitals.  Adherence to evidence-based clinical guidelines and continued strong academic programs focused on Acute Care Surgery principles ensures the highest level of care for patients in need of emergency surgical care, whether it be a critically injured trauma patient with multiple gunshot wounds to the abdomen or a critically ill patient with peritonitis due to perforated intestines. 

The establishment of Acute Care Surgery at Johnson City Medical Center ensures  the optimal management of the sickest of patients in our region and meets the new national quality standards of care for surgical emergencies.    Please utilize this Acute Care Surgery website to learn more about this new specialty, meet our team of dedicated specialists and program staff and to access the resources that help us provide the highest level of care for our patients (see Tabs – Evidence-Based Clinical Guidelines, Education and Training, Research, Meet our Team, etc.).  


Tyler Putnam, MD, FACS, FCCM

Chief, Acute Care Surgery

Medical Director, Trauma Services