For the Care of the Underserved.

T you very much, and thank you Dr. Cioffi for that great introduction. I have to say, I did not expect in a million years to be standing up here, and it is an honor and rare privilege to be able to do so. The American Association for the Surgery of Trauma (AAST) has been part of my professional life and part of my culture since I was a young and very anxious junior resident presenting my first article here so many years ago. The title of an alternate subject that I had considered for this address was ‘‘The Company You Keep,’’ in reflection of the fact that there is not a day that goes by when I do not think about the value of the professional and personal relationships that exist among my colleagues and among so many people in this room. This community of surgeons that shares the same ideals, commitment, and dedication is extraordinary. I feel incredibly fortunate to have shared my professional life with so many special personsVthose who have been a source of great support, encouragement, and camaraderie over the years. As a young medical student, I landed a summer job working for a group of surgeons here in San Francisco that included Bill Blaisdell, Don Trunkey, Frank Lewis, George Sheldon, Bob Lim, Art Thomas, Jack McAninch, and others who were or were to become household names in American surgery. Don Trunkey, with his ‘‘love of the sport,’’ humor, and quick wit, and Frank Lewis, with his piercing intellect and analytic approach to problems, helped to convince me that surgery is where I wanted to be. My ‘‘Forrest Gump’’ experience continued when I accepted my first faculty position with two young surgeons, Steve Shackford and David Hoyt, joined 2 years later by Jim Davis. You are all probably tired of looking at this picture (Fig. 1), as it has been shown so many times on occasions such as this. To the young persons in the room, this is what happens to trauma surgeons after 23 years (Fig. 2), a little heavier perhaps (except for Shackford), a little grayer, but still sharing the same ideals and aspirations and still lifelong colleagues and friends. Trauma of course is a team sport. We share the thrill of victory and the agony of defeat on a daily basis with other members of our clinical family. Our ‘‘family’’ at the San Francisco General Hospital (SFGH) includes Drs. Bill Schecter, Andre Campbell, Peggy Knudson, Mike West, Jan Horn, Mitch Cohen, Rochelle Dicker, Rachael Callcut, and Art Hill. I value their partnership and friendship greatly and appreciate their support (and patience) over the years. My wife Katherine is sitting here in the front row. She is the most important person and the best thing in my life. The importance of most everything else in our lives pales by comparison with someone who provides the love, support, and encouragement that is truly sustaining over a career and over a lifetime. Thank you Katherine so very, very much. The focus of the talk this morning is on the care of the underserved in relation to their needs for emergency surgical care (ESC). We have seen amazing advances in clinical science, practice models, and the effectiveness of care of the critically ill and injured. At the same time however, access to this care for a significant proportion of patients, the underserved, continues to be threatened. The basic premise of this discourse today is that improving timely access to a system of optimal trauma and ESC may be one of the most effective means of reducing the overall ‘‘burden of disease’’ for critical surgical illness in the United States. The basic message is that we are uniquely qualified and positioned to do this and it is an integral part of our academic and clinical future. Before discussing the underserved and on the occasion of the AAST’s 75th anniversary, it is worth reflecting briefly on some of the major developments and milestones we have seen in this AAST 2013 PRESIDENTIAL ADDRESS