Trauma in the Time of COVID

10 May 2020

By Jeff Claridge and Lillian Kao

As trauma surgeons and acute care surgeons, we are available 24/7 for all types of emergencies and crises. We often find ourselves at the epicenter of disasters, such as mass casualty incidents. As part of disaster preparedness training, we are instructed in utilizing and running an incident command center, working locally and regionally to coordinate care between services and institutions, managing units and multiple patients, triaging patients to those centers with the right resources, and dealing with extraordinary life and death decisions.  However, few if any disasters have tested trauma surgeons and health care professionals to the scale of the COVID-19 pandemic. Rarely, outside of war, have we had to simultaneously manage a disaster of such large magnitude across the country and the world. Now, health care professionals are  soldiers and are among those who are putting their lives on the line.

In trauma care, there are tried and true algorithms for the recognition and diagnosis of injuries, and there are proven management strategies. We are classic “doers and fixers”, but our instruments are often most effective in the operating room and involve surgically tackling catastrophic injuries.  This is different!  We are very limited in our treatment options, and surgical solutions are not apparent and may carry extra complications to the patients and risks to the surgical team.  In this pandemic, much is unknown.  We continue to struggle with COVID testing and with assessing the prevalence of asymptomatic carriers. Defined treatment strategies are unproven and fraught with controversy.  Furthermore, most mass casualty incidents are short-lived and affect only a segment of the population at one time. Despite multiple models for predicting COVID spread, it is unknown when life will return to some sort of “normalcy”.  There is also a tremendous amount of uncertainty as we go to work every day and as we move forward in our profession.

Amidst the uncertainty, however, we find comfort and solace where we can. We are still an integral part of healthcare today. Our ability to continue to maintain our routines and contribute helps to lessen our feelings of helplessness incurred by the pandemic.  Despite stay at home orders and social distancing, people are still being injured in motor vehicle collisions and by other mechanisms; there is still a need for trauma care! There is something oddly soothing about going through the A-B-Cs of trauma resuscitation. Nonetheless, even trauma care has been affected by the pandemic, from the types of injuries being seen to the way that trauma patients are being evaluated to the kinds of specialists  now caring for trauma patients.

As everyone is being asked to play an important role in this fight, there are countless stories of sacrifice, ingenuity, and resilience. Perhaps, most importantly, we have seen how despite “social distancing”, the pandemic has also united us in a fight against a common enemy.  Thus, we would like to use this forum and to encourage the use of the term “physical distancing” instead of “social distancing”.

In the words of Gabriel Garcia Marquez, author of Love in the Time of Cholera: “The heart’s memory eliminates the bad and magnifies the good, and that thanks to this artifice we manage to endure the burden of the past.” Although it is hard to see the light at the end of the tunnel, this too shall pass. We will get through this together. We may even come out of this stronger and more resilient! #StrongerTogether

In keeping with the motto that we are “stronger together”, we hope that the upcoming combined AWS/AAST Tweetchat will bring together our collective experiences and help us to weather this pandemic.  Many of us wonder if we are doing enough.  The feelings and emotions this current pandemic evokes in our hearts and minds are difficult to put into words and worthy of talking about for years.  We will be discussing the following topics during the tweetchat that may help us get stronger together:

  1. Has your trauma center seen a difference in the number and types of injuries since stay-at-home and physical distancing mandates have been put into place (i.e. more intimate partner violence or child abuse)? 
  2. What has your role been during the pandemic? Do you worry that you have not been able to do enough?
  3. What has your hospital done to ensure capacity for COVID positive patients? What has your trauma center done to ensure its ability to continue to care for both injured and COVID positive patients?
  4. How can we ensure learners are educated safely and effectively during physical distancing? If you are a learner, do you feel education is safe and/or effective? How we can do better)?
  5. How have you addressed your personal wellness in this time of uncertainty?
  6. Do you have concerns about future job opportunities, job security, or salary as a result of the pandemic?


Join the Association of Women Surgeons in a tweetchat to discuss trauma in the time of COVID-19. This #AWSchat will be hosted on Monday May 18th, 8pm Eastern Time. To participate, follow @womensurgeons along with our blog authors Dr. Lillian Kao (@LillianKao1) and Dr. Jeffrey Claridge (@ClaridgeJeffrey), as well as moderators Dr. Stepheny Berry (@Dr_Stepheny) and Dr. Bryce Robinson (@traumabryce). The questions will be posted directly from the @WomenSurgeons twitter account and you can also find them following the hashtag #AWSchat. If you haven’t participated in a tweetchat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more.


Jeffrey A Claridge, MD, MS is the Service Line and Division Director of Trauma, Burns, Critical Care and Acute Care Surgery at MetroHealth Medical Center in Cleveland, OH.   He is a Professor at Case Western Reserve University School of Medicine.  He is the current state chair of the Committee of Trauma for Ohio and is the President Elect for both the Surgical Infection Society (SIS) and the Eastern Association for the Surgery of Trauma (EAST).  He went to medical school at the University of Rochester and did his surgical residency at the University of Virginia.  Dr. Claridge did his critical care and trauma fellowship at University of Tennessee in Memphis and moved to his current location in Cleveland in 2005.  His twitter handle is @ClaridgeJeffrey.


Lillian S. Kao, MD, MS is Professor and Division Chief of Acute Care Surgery at McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth). The division staffs the Red Duke Trauma Institute at Memorial Hermann Hospital-Texas Medical Center which admits over 5,000 adult trauma patients per year. She is also Vice Chair of Research and Faculty Development and one of two Vice Chairs of Quality in the Department of Surgery. She is the co-founder and co-director of the Center for Surgical Trials and Evidence-based Practice (C-STEP). She is a past president of the Association for Academic Surgery. Her twitter handle is @LillianKao1.




Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the authors and are not necessarily the opinions of the Association of Women Surgeons or the American Association for the Surgery of Trauma.

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