Graduate Profiles
Michael Rotondo, MD
By Alison Rooney, April 17, 2008
Since his time as a Jefferson resident, Michael Rotondo, MD, has built an impressive career as an innovator, educator, and national leader in trauma and surgical critical care. Now Professor and Chairman of the Department of Surgery at The Brody School of Medicine at East Carolina University, his work has led him to improve the standard of surgical care in arenas far and wide.
A Strong Jefferson Foundation
Having served as chief resident in 1988–89, Dr. Rotondo still recalls that “Jefferson was one of my dream schools—it was at the top of my match list.” He is extremely proud of his Jefferson training at the hands of the “consummate Jefferson surgeons,” who he feels carried on the American surgical tradition of Dr. Samuel D. Gross. He describes his Jefferson mentors as meticulous, saying they “operated off the end of their instruments” (meaning they prided themselves on their gentle handling of the tissues ) and were fastidious about controlling hemeostasis (tolerated very little blood loss). “Those meticulous techniques were the standard for operative care in that period,” he recalls.
“There was a tremendous esprit de corps and pride that was handed down from that exceptional team,” says Dr. Rotondo. This cadre of strong clinical faculty had a very high surgical volume. “This was in the late 1980s—a time before ambulatory surgery centers, so all the patients were admitted as inpatients and had longer lengths of stay.. This was great for us as residents because the patients were much more accessible in terms of increased clinical learning opportunities,” he says. “I was very much aware that I had signed up for an immersive apprenticeship. Frequent every-other-night call was the order of the day.”
In 1990 he left Jefferson for a fellowship in Traumatology and Surgical Critical Care at Hospital of the University of Pennsylvania, where he distinguished himself in the management of complex injury. In 1993 he and his colleagues introduced the groundbreaking concept of “damage control” surgery—an entirely different approach to injury care that is now common practice. In 1995, he was named Vice Chief of the Division of Trauma and Surgical Critical Care at Penn’s internationally renowned academic Level I trauma center, and two years later he was appointed Trauma Program Director.
Care for Rural Populations
In 1999 Dr. Rotondo moved to rural eastern North Carolina to become Professor and Vice Chair of the Department of Surgery at the Brody School of Medicine. There he established the Center of Excellence for Trauma and Surgical Critical Care for the University Health Systems of Eastern Carolina, where he also served as Chief of Trauma and Surgical Critical Care. This rural system has more than 760 beds and a surgical staff of 100, performing 30,000 operations each year and serving some 1.4 million people in 29 eastern counties of the state—many of them in tiny regional hospitals with only a handful of beds.
When he became Vice Chair in 1999, Dr. Rotondo set about recruiting a cadre of young, dynamic trauma and critical care surgeons “to bring world-class trauma and critical care experience to this vastly underserved region at a large, high-volume, high-acuity institution,” he says. He notes that this is especially critical for rural areas, given that areas with smaller populations prove to have higher fatality rates and, “that violence has increased steadily in rural areas in recent decades,” with some 15 percent of the over 2500 injured patients admitted each year suffering from either stab wounds or gunshots. He has created dramatic improvement in clinical outcomes for the citizens of eastern North Carolina that in turn brought national attention.
“My first job was to create a trauma center that would reduce mortality as well as use the hospital’s resources more efficiently,” says Dr. Rotondo. The strides he made over the next four years included saving an estimated 200 lives. These successes were reported in the Wall Street Journal in October 2007.
Dr. Rotondo has also carried forward the tradition of his Jefferson mentors’ commitment to education. In 2003, when he was named Chairman of the Department of Surgery at East Carolina University, he oversaw the creation of a new Division of Surgical Education within the Department of Surgery, “to focus on an integrated curriculum and a clear, evaluative approach to learning,” according to Dr. Rotondo. In 2005 he established the first Trauma and Critical Care Fellowship at East Carolina, to build upon what he describes as “a foundation of outstanding clinical care, a zealous commitment to teaching, and leading-edge outcomes research.” Moreover, he has turned his efforts towards building other much needed services such as Pediatric Surgery, Transplantation, and Surgical Oncology.
The Brody School of Medicine is ranked 6th (tied with Duke University) in the nation among medical schools that emphasize primary care, according to U.S. News & World Report. “The development of outstanding surgical services, focused on research and education is completely compatible and complimentary to our primary care mission,” says Dr. Rotondo. He also notes the particularly gratifying aspect this work in an underserved region, “where patients are so genuinely appreciative of your efforts.”
National Advocacy
Dr. Rotondo has become a consistent advocate at the national level to improve care of this patient population through systems development and policy reform. As President of the Eastern Association for the Surgery of Trauma (EAST) in 2005, he focused the organization on the needs of the rural patient, which he notes accounts for only 25 percent of the U.S. population and but 60 percent of the nation’s injury-related deaths—from motor vehicle accidents, falls, and farming accidents—for some 60 thousand lost lives each year. He also established a Rural Trauma Committee to conduct collaborative outcomes research specific to the rural environment.
With the American Association for the Surgery of Trauma (AAST), he was one of the principal architects of the Acute Care Surgery curriculum, which offers an integrated approach to trauma, surgical critical care, and emergency surgery to respond most effectively to time-dependent surgical disease.
As Chair of the Trauma Systems and Planning Committee of the American College of Surgeons’ (ACS) Committee on Trauma, he has recently worked aggressively for healthcare policy reform and to develop regional healthcare systems across the U.S. and impact grant funding in an effort to maximize resources devoted to rural injury populations.
New Frontiers of Trauma Care
A recent experience took Dr. Rotondo beyond rural and urban populations with which he has had experience. In January of this year he was invited by the American College of Surgeons (ACS) and the AAST to treat soldiers wounded in Iraq as a Distinguished Senior Visiting Surgeon in Combat Casualty Care at Landstuhl Regional Medical Center (LRMC) and Ramstein Air Force Base (AFB) in Southwest Germany—the only ACS verified Level II Trauma Center in Europe offering definitive care for combat casualties from Iraq and Afghanistan. Dr. Rotondo spent two weeks sharing his trauma experience with the younger military surgeons.
The contributions that span one’s career rarely come full circle, but more than a decade after Dr. Rotondo and his colleagues at Penn contributed to the “damage control” model of injury management, he had the moving experience seeing it first hand applied across the entire theater of combat on a daily basis for the benefit of our U.S. Soldiers.
Dr. Rotondo explains that “The United States military has adopted and modified the Damage Control approach in a way that it can be applied across the echelons of care in the theater of combat. They have effectively bridged gaps in continuity of care by uploading patient care information onto a secure Website.” He continues, “Surgeons can access the information along the continuum of care from the forward surgical unit, the combat surgical hospital, there at LRMC, or stateside at Walter Reed.” But it was clear that the concept of doing surgical care of injuries in stages in order to reduce civilian mortality rates had a significant impact on reducing battlefield death, and that this contribution was much more pervasive than he had imagined. Dr. Rotondo says it was extraordinary “to see what was once only the kernel of an idea early in my career” become the cornerstone of combat casualty care across the entire Department of Defense System.”
Despite decades of experience treating victims of violence, Dr. Rotondo found treating soldiers to be profoundly humbling. These 19- and 20-year-old soldiers not only volunteer to put their lives one the line for our security and freedom—they’re also eager to return to combat after they’re wounded out of loyalty to their fellow soldiers. It’s both amazing and moving,” he says.
