A History in Trauma

It was 1972, and Houston was a boomtown of economic development. Many of the city's most recognizable buildings such as the Galleria and the massive skyscrapers of downtown were constructed in the early 70's, and the city was becoming more and more urbanized with the completion of a massive infrastructure of freeways. The landscape of the Greater Houston area was changing rapidly, both literally and figuratively, and the city leaders were moving at breakneck speed to meet the ever-changing needs of a community under the strains of such development. It was a time of remarkable opportunity and growth in the Texas Medical Center as well. The first class of medical students had been under way for only two years at The University of Texas Health Science Center at Houston (UT Health) Medical School, and administrators from the medical school and the hospital were working closely together to build several new programs, including a much needed trauma service.

It was that same year that James "Red" Duke, Jr., MD arrived in Houston at the behest of his long-time friend and the newly appointed chairman of the medical school, Stan Dudrick. Dr. Duke had completed his residency in general surgery at Parkland Hospital in Dallas in 1965, and during his time there he famously attended to Governor John Connally's injuries after the assassination of President John F. Kennedy. After his residency, he spent four years at Columbia University Medical Center in New York studying the metabolic effects of traumatic injury and TPN (total parenteral nutrition, which is used for patients who cannot or should not get their nutrition through eating).

Just before coming to Houston, Dr. Duke served for two years as chairman of surgery for the Nangarhar University in Afghanistan, where he and his team were known for their resourcefulness while working in near-primitive conditions - it was not uncommon for him to use his carpentry skills to make his own orthopedic beds and shape pulleys out of tin to use for patients in traction. As much as he loved the Afghan people and his work there, his family was eager to return to the States.

"I thought if I was going to play the academic game, I needed to come back. I was doing work on TPN when they asked me to help start a trauma program here. I trained at Parkland, and I'd done a lot of it," said Dr. Duke. "I thought they were crazy."

The year before, in 1971, the Houston Fire Department had taken over the operation of emergency ambulances, which until that point had been run by local undertakers. As was the case across the country, the development of formalized Emergency Medical Services (EMS) was still in its infancy, but a growing priority for the city. Houston was one of the early pioneers, and District Chief L. O. "Whitey" Martin was assigned to put together the new service. Houston's EMS started with 126 personnel and 21 light van-type ambulances. Today, the City of Houston's EMS is still recognized as a global leader in emergency medical care.

"The first time I ever saw a modular ambulance or an EMT was when I got to Houston in '72. Before that, people came to the hospital in their own cars or by taxi. Taxis used to have thick plastic covers on the back seats in those days - I've delivered babies in the back of a taxi, treated gunshot wounds. Ambulances changed the whole picture, because then they just started hauling people in who got care on the scene. I was on service when they brought Lee Harvey Oswald to Parkland after he got shot, and I bet he would've survived had there been a decent ambulance."

During these first several years in Houston, Dr. Duke and his colleagues threw themselves into building trauma services from the ground up, caring for the ever-growing number of critical patients that came as a result of a burgeoning EMS, all while tirelessly working on research projects and writing white papers about their findings.

"Hermann was basically a surgical hospital at the time, and we were true general surgeons back then. We did everything - trauma, gall bladders, cancer. We just kept growing, kept on getting a little bigger and bigger with trauma, writing a few more papers." According to Dr. Duke, that era was when the medical community first became interested in preventing "unnecessary deaths," and the trauma team began building upon groundbreaking research from the 1960s regarding missed spleen lacerations on wounded soldiers in the battlefield. It was the beginning of what would become one of the most renowned trauma research programs in the world.