Wounds of the abdomen. Part 2: In peace.

Until the mid 1960s in the United States, penetrating abdominal wounds in civilians were badly handled and often fatal. Little attention was paid to the methods used and results reported by military surgeons in previous wars such as those in Korea and Vietnam. In 1966 the National Academy of Sciences, National Research Council Committee on Shock pointed out that there was an increasing incidence of severe civilian injuries associated with unacceptably high morbidity and mortality and that this was because of lack of organized civilian community care. As a result the Trauma/Emergency Medical Service (T/EMS) was formed. The initiators based the organization on the remarkable success of military concepts and techniques. The improvement in the evacuation and treatment of penetrating abdominal wounds in peace from the inception of the T/EMS to the present is described in this paper. The methods used and results obtained through the T/EMS have made an important contribution to both civilian and military surgery--a unique event in peacetime.