Dr. R Adams Cowley, the brilliant, combative surgeon who pioneered the shock-trauma medicine that has saved thousands severely injured emergency patients here and across the nation, died yesterday at his home in Baltimore. He was 74.
A spokesman at the Shock-Trauma Unit in Baltimore said coronary disease was the apparent cause of Dr. Cowley's death. Funeral arrangements were incomplete.
Dr. Cowley, already a superior cardiac surgeon involved in early open-heart operations, was one of the first to recognize that emergency medicine should be a separate medical discipline, demanding doctors, nurses and paramedics trained in the needs of people with multiple, massive injuries.
In early 1961, he opened a two-bed research unit at the then-University of Maryland Hospital, called the Clinical Shock-Trauma Unit. He had launched what has become the Maryland Institute for Emergency Medical Services Systems. He remained director of the emergency services system until his retirement last May.
Just before his retirement, a 138-bed, eight-story, $44 million emergency services building opened at the University of Maryland Medical Center complex in downtown Baltimore. It was named the R Adams Cowley Shock Trauma Center. Cowley Center was called the most technically advanced life-saving facility in the world.
"R Adams Cowley's efforts in the field of emergency medicine has made the state of Maryland first in the nation," said William J. Kinnard, acting president of the University of Maryland at Baltimore when the center was dedicated. "He has established a standard of excellence the world over."
Dr. Cowley's innovations and techniques were widely credited with reducing the death rate among Maryland's most critically injured patients from about 60 percent to fewer than 10. The accident survival rate in Maryland was 2 1/2 times better than the national average, according to a 1986 study.
Typically, Dr. Cowley was not satisfied.
"We've done a hell of a job," he said during a tour of the new center. "But we've not done enough. People are dying needlessly."
The emergency medical system he launched with his two beds today encompasses a 50-hospital network with 10 trauma centers, 450 ambulances, a $15 million communications system and a $35 million fleet of high-tech Med-Evac helicopters.
Early in his research into trauma, Dr. Cowley identified what he called "the golden hour."
"What we've discovered," he told Alan Doelp and Jon Franklin, who wrote about him in their book "Shocktrauma," "is that if you stay in shock for very long, you're dead . . .
"If I can get to you," he said, "and stop your bleeding, and restore your blood pressure, within an hour of your accident . . . then I can probably save you. I call that the golden hour."
He preached for innovative, aggressive treatment of massively injured patients. Speed, skill and decision were his watchwords. He could have added courage, which he had in abundance. He fought tenaciously for his beliefs. And he was often in dispute with more conservative doctors and their wait-and-see attitudes.
"Victorian surgeons," he snapped, according to Gerri Kobren, a writer who interviewed him for The Sun Magazine. "They would say: 'This is my patient. I'm in charge of him. If I decide he needs this or that, I'll do it.'
"Well, that's fine . . ." he said, "but not in a program where people are dying. Because by the time you finish deciding, the guy is dead.
"Our whole goal is to keep the patient alive. If you stop to diagnose, half your patients are dead. We treat before diagnosing. That's is just the opposite of what you're taught in medical school."
A stocky, jowly man with a pugnacious stance and direct blue-gray eyes, Dr. Cowley could take care of himself.
Cowley was politically adept. He had close relations with several governors of Maryland. Gov. Marvin Mandel launched the Maryland Institute for Emergency Medical Services Systems, named Dr. Cowley director, separated it from the medical school and gave it a line in the state budget.
Gov. Harry R. Hughes sponsored the bill that provided the
money for the new center and broke ground for it in 1985. Gov. William Donald Schaefer was a great good friend.
"We have lost not only a great Marylander," Schaefer said. "He made Maryland -- and the world --a safer place to live. I have seen few people as dedicated as Dr. Cowley to grasping life when it is most threatened."
Dr. Cowley was equally astute at public relations. He was a favorite of reporters, feature writers and editorialists. Doelp and Franklin's "Shocktrauma" was a best seller, and a TV docudrama was made from it. Shock-trauma medicine was, of course, the essence of drama.
All of which sometimes offended his colleagues outside the unit. In the hospital, according to one observer, there was the feeling that shock-trauma "grabbed all the media attention, the money and the prestige."
Elizabeth Scanlon, his longtime director of nurses at Shock-Trauma, told Kobren: "The people he likes and respects the most he'll have these yelling matches with. People he doesn't really respect he rarely raises his voice at or reprimands."
Scanlon was fresh from St. Agnes Hospital Nursing School when she joined Dr. Cowley's team in 1957.
"He can be very charming socially and in first impressions," she said. "Obviously he knows how to manipulate people. He couldn't have accomplished what he has otherwise."
Dr. Cowley already was a respected heart surgeon when he opened his first shock-trauma unit. He had been one of the first in America to do open-heart surgery. He pioneered electronic monitoring devices, the use of artificial materials and heart-lung machines. He helped develop a prototype pacemaker and a special surgical clamp that still bears his name.
"I can remember," he once said, "when we needed to replace a section of the aorta . . . I'd run over to the city morgue and get a replacement."
He recalled early use of nylon.
"A nurse would sit outside the operating room and sew the stuff to the dimensions I gave her after I made the incision and measured the part to be replaced."
Dr. Cowley liked to say he was "just a country boy." He was born July 25, 1917, at Layton, Utah, and, he said, raised on a ranch. His parents named him R Adams. R was his first name, not an abbreviation. Friends called him "R" or "RA."
The great-great-grandson of a woman who trekked the plains behind Brigham Young in the great Mormon migration of 1848, Dr. Cowley was an elder in the Church of Jesus Christ of Latter-day Saints.
He graduated from the University of Utah in 1940 and came east to the University of Maryland School of Medicine. He earned his medical degree in 1944 as World War II was ending and he had a year's internship and a year of surgical residency before he was sent to Europe in 1946 as a military surgeon.
Assigned to the operating rooms of an Army field hospital in France, he worked in almost wartime conditions, according to Doelp and Franklin. "He began to take pride in the quickness of his knife," they wrote.
Dr. Cowley became chief surgeon, then was transferred to the 98th Field Hospital in Munich. He was picked to go to the Allegemeines Krankenhaus, the famed general hospital in Vienna.
"Some of the Continent's greatest old-school surgeons were still alive and operating there," the authors of "Shocktrauma" said. "Cowley was spellbound.
" 'One swipe of the knife and the belly was open,' Cowley said. 'They were so good, and so clever, that what would take three hours in America would be over in 40 minutes.' "
He had learned a lesson that would stay with him through his medical life.
Dr. Cowley told Kobren that when he was in the Army, people would ask him where he was from.
"I'd say Baltimore and they'd say, 'Oh, from Johns Hopkins?' And I'd say 'No, from the University of Maryland.' They'd say, 'Oh,' and that stopped the conversation.
" 'Well,' I said to myself, 'if I can ever get back to the University of Maryland, I'm going to make something that's better than anything any place else.'
"And I think I did."
He remained at Maryland for the rest of his life. He was professor of thoracic surgery and cardiovascular surgery there and at the University of Pennsylvania. He was a founding member of the Society of Thoracic Surgeons and of the American Trauma Society, of which he had been president.
After leaving Shock-Trauma, he became director of the National Study Center for Trauma and Emergency Medical Systems in Baltimore. He received numerous awards and honors and served on a great many prestigious boards.
Dr. Cowley's survivors include his second wife, Roberta Schwartz Cowley, of Baltimore; a son, R Adams Cowley 2nd, just 3 weeks old; a daughter, Kay Cowley Pace, of Santa Cruz, Calif.; three grandchildren and 11 great-grandchildren.