Shock Trauma founder is dead R Adams Cowley had single vision that changed care

Dr. R Adams Cowley, the visionary and sometimes abrasive surgeon at the University of Maryland who established a world renowned shock trauma center to treat severely injured people, died yesterday at his Baltimore home. He was 74.

Dr. Cowley, who suffered from heart disease for years, died of apparent coronary failure at 2:17 p.m.


Dr. Cowley was native of Utah who received his medical degree from the University of Maryland in 1944. He propounded the theory that there was a "golden hour" in the ebbing lives of accident victims when they could be saved if specially trained doctors and nurses could exercise their skills in a properly equipped surgical setting.

Statistics proved his point.


The University of Maryland opened its first Shock Trauma Center under Dr. Cowley's leadership in 1962 when the survival rate of accident victims was 40 percent. Today, the survival rate is nearly 90 percent, and Maryland's accident survival rate, a 1986 study reported, is 2 1/2 times higher than the national average.

For years, Dr. Cowley insisted that the traditional hospital emergency room was not the proper place for treating potentially fatal injuries, a line of reasoning that ruffled some feathers in medical circles.

"There is no way for [medical] people to take care of the critically ill in the hospital today," he told a committee of the American College of Surgeons at a conference at Johns Hopkins Hospital in 1956, adding that "the emergency patient really interferes with the hospital's day."

The remark was the kind of comment that occasionally got the Maryland surgeon in hot water with some of his peers, as well as hospital administrators who did not want their institutions bypassed in serious-injury cases.

But it was also part of a plan of action Dr. Cowley doggedly pursued for the next three decades, culminating in a monument to his perseverance, the eight-story, state-of-the-art structure at Redwood and Penn streets that opened in February 1989 in the university's complex of downtown professional schools.

The building, named the R Adams Cowley Shock Trauma Center, is the hub of the state's emergency medical system which, in close cooperation with the state and county police, fire departments, paramedics and volunteer agencies, rushes seriously injured people there from all parts of Maryland by helicopter and ambulance. The system's success has made it a model for systems throughout the world.

The $45 million building is also a reminder of what a singled-minded, dedicated and sometimes abrasive human +V being can achieve.

On the last point, Dr. Cowley freely admitted that he was no diplomat, and he laughed about it.


A visiting reporter once spotted a small sign on the wall of the director of nurses' office at Shock Trauma, which read:

"Yea, though I walk through the valley of the shadow of death I will fear no evil.

"For I'm the meanest son of a bitch in the valley."

Dr. James P. G. Flynn, the current director of the state's shock trauma system, said Dr. Cowley was "a remarkable surgeon" and "a remarkable organizer" who had little patience for bad ideas.

"He certainly did intimidate," Dr. Flynn said. "If you had doubts about what you were doing, you thought twice about going to him with something half-baked."

Despite his demands, Dr. Cowley's admirers -- among them the nurses and physicians who worked for him -- outnumbered his detractors. Even those he offended couldn't argue with the results of his work.


"He has left Maryland with the finest emergency care system in the world," Dr. Ameen Ramzy, a trauma surgeon and the state director of emergency medical services, said last night.

Gov. William Donald Schaefer described Dr. Cowley last night as a medical giant "who touched so many lives and who put so many lives and dreams back together. He will be greatly missed."

R Adams Cowley (the R is his first name, not an initial) had learned the elements of desperation surgery in the operating rooms of Army field hospitals in France and Germany shortly after the end of World War II.

Although the war was over, he found himself tending a continuous stream of battered people who been injured when bombed-out buildings collapsed or forgotten ordnance exploded on abandoned battlefields.

Under these conditions, the young surgeon concluded that speed with a knife was often essential if a life was to be saved. His reputation in the operating rooms of the field hospitals grew, and he was rewarded with a transfer to the Allgemeine Krankenhaus in Vienna, Austria, where some of Europe's top-flight surgeons worked with astonishing quickness.

"These men . . . one swipe of the knife and the belly was open," Dr. Cowley recalled in the 1980 book "Shock-Trauma," written by two former Evening Sun reporters, Jon Franklin and Alan Doelp. "Not like us, going through layers at a time and stopping the bleeding as we go. They'd slap on towels, do it barehanded.


"Quick as they would get down to the guts they'd put on a pair of cotton gloves so that they could hold the bowel without slipping and sliding. They'd do their stuff, and they were finished. They were so good and so clever, that what would take three hours in America would be over in 40 minutes."

The Vienna surgeons' work made a lasting impression on the visiting American and set the stage for the launching of a remarkable career in emergency medicine.

Dr. Cowley had grown up on a ranch in Layton, Utah, the great-great grandson of a woman who crossed the Plains behind Brigham Young in the historic Mormon migration of 1848.

As a mischievous youth, he broke wild mustangs and became a problem student in high school, where he was suspended five times. He also was expelled from college and found himself earning $37 a week cleaning spittoons, trundling cement and wrestling tires, according to a 1982 profile published in The Sun.

He decided to find a better way to make a living and returned to college a more serious individual.

Working his way through the University of Utah, he graduated eighth in his class and won acceptance to the medical schools of Stanford, Tulane, Johns Hopkins and Maryland. He chose Maryland simply because he knew two doctors in Utah who were graduates.


He came East with his life's savings, $750 for the first year's tuition; survived a serious case of homesickness, and was drafted into the Army Students Training Program.

"And that was a lifesaver," he recalled. "It paid for everything, the tuition and the clothes I wore."

He paid the Army back with his postwar service in Europe.

By then committed to the concept of quick treatment for the severely injured, he returned to the University of Maryland Hospital and pursued research in this branch of emergency medicine, as well as in the burgeoning field of open heart surgery.

Finally, with the help of an Army grant, he was able to open a two-bed trauma research unit in 1961 and, eight years later, a greatly expanded five-story shock trauma center where the Cowley team's repeated successes with seriously injured people made the facility famous.

In May 1989, Governor Schaefer announced at a fund raiser for Shock Trauma that Dr. Cowley would retire as head of the state's shock trauma system and become director of the Mathias National Study Center for Trauma and Emergency Medical Systems at the university's Baltimore campus.


Dr. Cowley is survived by his second wife, Roberta Schwartz Cowley of Baltimore; a 3-week-old son, R Adams Cowley II; and a daughter, Kay Cowley Pace of Santa Cruz, Calif.

Funeral arrangements were incomplete last night.