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Recently, evidence-based guidelines for the management of multiply injured patients were released [1]. These guidelines were initiated by the German Trauma Society and developed in cooperation with all other subspecialties involved in trauma care (Table 1). The fact that 11 different societies were involved in the development of these guidelines demonstrates the high degree of specialization required for modern trauma care [2]. Distinct criteria were developed in order to define the responsibilities during initial management (Table 2). Interestingly, the information on guidelines for trauma patients is sparse. Apart from advanced trauma life support (ATLS) guidelines, or those well documented by EAST, most available treatment recommendations apply to certain injuries such as spinal fractures [3]. In view of the improvements in outcome, this is an unexpected finding [4]. Moreover, given the fact that the responsibilities of physicians dealing with multiply injured patients have changed substantially, this is even more surprising. When John Border published his experiences on the management of polytrauma, general surgeons and orthopaedic surgeons in many countries shared part of their education [5]. The care of severely injured patients was managed by only a few services. The diagnostic procedures available did not allow for a sophisticated differentiation of the major sources of hemorrhage. Abdominal injuries were judged on the basis of diagnostic peritoneal lavage (DPL), and clinical experience often guided decision making. Today, almost all diagnoses can be made early after admission, and the management of certain injuries has changed substantially. In several areas, exploratory surgeries have been replaced by CT scans. In fracture management, the timing of treatment and the type of orthopaedic stabilization has changed too. In the absence of adequate ICU care, many long bone fractures were left unstabilized. Early fixation became the major goal in the orthopaedic care of long bone fractures. With improvements in ventilation and the avoidance of secondary organ failure, sophisticated staged surgical management became achievable. Treatment was then guided by more complex

Physician involvement in the care of multiply injured patients: the role of guidelines and subspecialties