R. Adams Cowley, MD (1917-1991) was a pioneer in the field of open-heart surgery in the United States. Dr. Cowley performed operations before the heart-lung machine was widely used; unfortunately, patients would die from shock within days or weeks of surgery. He referred to shock as “a momentary pause in the act of death,” a process that, once set in motion, was irreversible. Cowley developed of the concept of the “golden hour,” which recognized that if a trauma victim could get appropriate care before that point, the patient was more likely to survive.
In 1960, the Baltimore Shock Trauma Center was born with the “golden hour” concept in mind. The Baltimore Shock Trauma Center encouraged trauma patients everywhere to be transported to trauma centers, while Cowley pushed the Maryland State Police’s Aviation Division to become one of the first ALS medevac transport systems in the world.
By 1973, he convinced Maryland’s governor to issue an executive order establishing the Maryland Institute for Emergency Medicine, which later absorbed emergency medical services and became the Maryland Institute for Emergency Medical Services Systems (MIEMSS), the first statewide EMS system with Dr. Cowley appointed as director. Over 30 years later, MIEMSS is still recognized as one of the world’s best EMS oversight systems.
Submitted to NEMSM October 2009 by R. Adams