American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

What Happens After the Mortality & Morbidity Conference?

Generations of surgeons have grown up with the sometimes dreaded Mortality & Morbidity (M&M) Conference as a part of their work week. Beginning as residents, despite heavy clinical responsibilities, there was the constant need to prepare for the conference. Organizing the case reviews was necessary, but the more important activity was the self-education component. Even the staff did their homework to avoid being one-upped by the resident with the latest literature. Most of the time, the value was the largely personal growth of both knowledge and clinical judgment.

Fifty odd years ago, one M&M conference was rather unique. At Parkland Hospital, Dallas, TX, Dr. Shires’ Chief’s Conference convened as usual on Thursday afternoon. More than an M&M conference, it held something for everyone, sometimes lasting for hours. Over the prior week, several gunshot wound victims had been treated with mixed results. The President of the United States had arrived with non-survivable injuries and died, the Governor of Texas had survived after a combined surgery by three of the surgical services, and the accused assassin had died during surgery.

The last patient provoked the greatest discussion. As the world knew from a press conference, he had died from intractable shock. At the Chief’s Conference, a major factor in what would now be termed “root cause analysis” was the more than 20-minute transport time to a hospital less than three miles away. Today, we would call the paramedics (which did not exist until 1969), and they would arrive from the fire station in a well-equipped civilian ambulance (which also did not exist for almost another decade).

In 1963 ambulances were usually off duty hearses driven by funeral home employees with little training. The economic incentive was to deliver the dead to the funeral home for burial services, while the living were dropped off at the nearest hospital. The chief of surgery and the chief of the Dallas Fire Department delegated to their junior staff, including Dr. Ronald C. Jones, a Governor of the College, and Captain Bill Roberts of the Dallas Fire Department, the “process improvement” charge. All agreed that they needed proper vehicles, strategically positioned in the community, and manned by a professional workforce.

General Motors was approached to create one of the first “box on box” ambulances, modeled after a Norwegian troop carrier. These vehicles were placed in the Dallas fire stations, which had been built to follow the suburban growth of the population. Firemen were the perfect ambulance drivers, comprising a stable work force of selfless members of the community.

This story is ancient history to most Americans born long after these events. We now take for granted a robust emergency medical services system, fostered a decade later by the Federal EMS Act of 1973. There is perhaps heartwarming irony that the violent, tragic events in Dallas played a role in changing how we care for and transport injured patients across the globe. And, maybe now you might just think twice before you question the burden of preparing for Chief’s a Conference.