The Loss of a Trauma Legend: Remembering Norman E. McSwain, Jr., MD, FACS

On July 28, the EMS and trauma care communities lost a brilliant surgeon, author, teacher, mentor and collaborator. We also lost a very dear friend who cared about everyone he met and was loyal to a fault. He was driven to excel in all that he did, but he was also a gentleman and would send handwritten notes and flowers when things happened to you or your loved ones, good or bad. He fully expected us to share his passion to serve our patients. Whenever he saw you or called you on the phone, he would start with “What have you done for the good of mankind today?”and he expected you to have something to report.

Dr. Norman E. McSwain, Jr., MD, FACS, has made so many contributions to the prehospital profession it is impossible to capture his impact in a single essay. His passion for our work, his fellow practitioners and collaborators, and the patients we treat was so great that those he touched could not help but be changed, inspired and swept up into service.

The EMS community got its first look at what McSwain could do when he joined the faculty of the University of Kansas School of Medicine. He became the medical director of the Kansas Paramedic program and developed a statewide EMS system that provided paramedic coverage to 90% of the population of Kansas. Work that he did while there also contributed to what would become the National Standard Curriculum.

McSwain was always a strong supporter and participant in the National Registry and continued to proudly carry his National Registry EMT card throughout his life. He felt strongly that EMS providers needed a national voice and was one of the founders of the National Association of EMTs. Over the course of his life, his contributions provided the financial support that enabled NAEMT to become a vibrant representative for all EMS providers.

McSwain published prolifically across multiple platforms from scientific papers to textbooks and video. Anyone trained in EMS in the United States or anywhere in the world for that matter has read his work or watched him speak, either live or on film.

The most lasting impact on the EMS and trauma communities though is clearly the development of the Prehospital Trauma Life Support Program (PHTLS). In the late 1970s, McSwain was one of the first faculty members of the Advanced Trauma Life Support (ATLS) course. This course was designed to standardize care and train emergency physicians and trauma surgeons in how to provide the first critical minutes of care to trauma patients. McSwain immediately saw that an even larger impact on trauma patients could be achieved if this information was provided to EMS providers. He obtained approval from the American College of Surgeons Committee on Trauma to develop a prehospital version of the course and he brought it to NAEMT. A committee was formed and, by the early 1980s, pilot courses were being conducted. By 1984, regional faculty courses were run across the United States and the course began to take off. Eight textbook editions and almost four decades later, somewhere around 1 million providers have taken a PHTLS course in over 60 countries.

The effect of PHTLS has been profound. An example was described in a paper published in the Journal of Trauma in 1997. Dr. Ali described the difference in trauma patient care before and after the entire EMS workforce took the PHTLS course. What he found was that there was a 1/3 improvement in mortality and skills compliance, which was less than 10% in some areas before PHTLS, was nearly 100% across all of the measurements post course.

Trinidad and Tobago entered the program in 1988. The courses in Trinidad, conducted under the guidance of Jameel Ali, MD, M Med Ed, FACS, also initiated the first scientific study on the effectiveness of the program in improving patient outcomes. Ali reported that a mortality rate of 15.7% improved to 10.6% after the PHTLS course.

Years later, while delivering the Scott Frame memorial lecture, Dr. Ali shared a story that I think is fitting to remember here. He said that if a PHTLS instructor teaches 16 students per course in four courses per year, over four years he or she has trained 64 students. If each of these students saves five lives per year because they are able to stop a life-threatening bleed or open an airway, adds up to 320 lives saved per year. Over four years, that’s 1,280 lives saved per instructor. Once you change that to thousands of instructors in over 60 countries all over the world, who, in addition to offering PHTLS, are now teaching Bleeding Control (BCon), TCCC and TECC (Tactical Trauma Care), LEFR (the law enforcement Trauma course), you begin to see the millions of lives touched over the last 30 years because of McSwain’s work.

I think the most important contribution though is not represented by books, courses or video. It’s the passion that McSwain had for his work and his patients and how he shared that with all of us. Whether you were a doctor, nurse, EMT, police officer or firefighter, he treated you like an equal with something to contribute. McSwain’ s legacy is vast and rich, but the most lasting will be that those of us who were touched by him will remember that he expects us to be able to report to him on what we did for the good of mankind today.

Godspeed, Norman.

A Life Devoted to Patient Care

Dr. Norman E. McSwain, Jr., MD, FACS, attended The University of The South in Sewanee, Tenn., and then returned to his birthplace of Alabama to learn medicine under Dr. Tinsley Harrison (of Harrison’s Textbook of Medicine fame) and surgery from Dr. Champ Lyons at the University of Alabama School of Medicine.

After completing two years of surgical training at Bowman-Gray School of Medicine in Winston-Salem, NC, McSwain then joined the Air Force. There, he performed more than a thousand surgical procedures. After his service, he went to Grady Memorial Hospital in Atlanta to finish his initial education as a surgeon.

Over the next three years, he learned more about true patient care as a partner in private practice with Dr. Harrison Rogers in Atlanta before he joined the clinical and academic faculty at the University of Kansas in Kansas City.

While there, he was given the responsibility of EMS education and system development for the State of Kansas. When he was recruited four years later to Tulane University School of Medicine, Department of Surgery, and Charity Hospital, New Orleans, he left behind 90% of the population of Kansas covered by paramedic quality care within ten minutes of home, and one out of every 500 Kansans (including the entire Kansas Highway Patrol) trained as an EMT-Basic.

Serving as academic and clinical faculty at Tulane, McSwain’s main interest was in prehospital patient care through Charity Hospital, considered to be one of the three most important trauma centers in the U.S. at the time. Through his work there, he was recruited by the City of New Orleans to develop an EMS system for the city. He initiated both the EMT-Basic and EMT-Paramedic training within the New Orleans Police Department as well as a citywide EMS system.

McSwain also was recruited to the American College of Surgeons Committee on Trauma to assist in the development of the Advanced Trauma Life Support program. He worked with the ACS/COT and NAEMT to develop the PHTLS program.

McSwain worked with the military and the Department of Defense to develop the Tactical Combat Casualty Care program for military medics. For the past 30 years, he provided care to severely injured police officers at Charity Hospital and authored or revised more than 25 textbooks, published more than 360 articles and traveled throughout the world giving 800 presentations. McSwain lectured in each of the U.S.’s 50 states and in all of Canada’s provinces, most of the countries in Europe and in Central America, and in the upper part of South America, as well as in Japan, China, Australia, and New Zealand.

For more on Dr. McSwain's life and legacy, see www.naemt.org/education/PHTLS/McSwainTribute.