as an ideal trauma care model. Interestingly, it has been reported that only a small percentage of trauma victims require operations by trauma surgeons in the United States. Due to the decreased incidence of penetrating trauma in the United States, most trauma surgeons perform relatively few trauma-related operations per year.9,10 In the United States, trauma system development and establishment of the Advanced Trauma Life Support (ATLS®) courses was prompted by the increased awareness of medical care professionals.1 In 1998, Travma Resusitasyon Kursu (TRK) training was implemented in Turkey. Since then, 10,186 doctors have been trained and certified by TRK courses.11 However, 75% of the doctors in our study stated that they were not certified by any of the national or international trauma training courses. Despite the national prominence of the American College of Surgeons and the American College of Surgeons Committee on Trauma and the need for more trauma surgeons in the United States, Green10 has documented a decline in the number of medical students interested in pursuing a surgical career and even more importantly, a career as trauma surgeons. Ciesla et al12 and Rodriguez et al13 have defined trauma surgeons as an “endangered species” and “gasping for air” in their reports respectively. Our data corroborate the declining interest of doctors in becoming trauma surgeons. Residents’ lower response rates to this survey may also be a reflection of their low interest levels toward trauma surgery. In our study, only 25% of all doctors would pursue a trauma surgery fellowship program. To put in the way they say it, Why should we work harder and risk more to earn the same money? Despite the aversion to choose trauma surgery as a profession, 95% of all doctors surveyed were in agreement that they would wish to have one of their family members or close relatives to be treated at a trauma center by a trauma surgeon. Of note, general practitioners were more likely to want this choice. Respondents displayed awareness that to decrease trauma-related morbidity and mortality rates, attention should be directed at prioritizing injury prevention, establishing trauma centers, and increasing legal enforcements. In order to improve the Turkish system for trauma care, research is required. The key component of trauma research is the development of a dedicated trauma database. Unfortunately, Turkey and other developing countries have rudimentary and incomplete trauma databases.14,15 These findings transpire from the fact that 91% of our respondents were unaware of a database in their hospitals. Of note, 97% of all doctors were in agreement that a national trauma database should be established. In 1982, the trimodal distribution of deaths was described. The second peak occurs within minutes to hours and can be addressed by emergency medical systems, as mortality may significantly be decreased by rapid assessment and resuscitation.15 Despite this known paradigm, only 19% of all doctors accurately selected the Table 4: Answers to critical findings Finding1 General practitioner Surgical residents Surgeons Academic surgical specialties Aytekin Ünlü et al 58 second period for decreasing trauma-related deaths by performing rapid life-saving interventions, implying a possible knowledge gap. Casualty data from recent military conflicts showed that most of the deaths (78%) have occurred in the prehospital period, and 18% of these are potentially survivable if the victims were triaged appropriately.16,17 Same principles may apply to terrorist bombings in civilian settings. Eighty-one percent of the doctors surveyed in our study were unable to triage mass casualty victims correctly. The most alarming result was that only 13% of general practitioners, 8% of surgical residents, 12% of surgical specialists, and 6% of academic personnel succeeded in selecting the right order of triage in a complicated threecasualty scenario. The ability to diagnose life-threatening thoracic injuries and the use of simple techniques, such as needle or tube thoracostomy performed expeditiously to alleviate tension pneumothorax have reduced mortality.18,19 In the present study, a single case scenario of thoracic trauma was presented, and the identification of tracheal deviation as the most critical finding to select the right treatment was missed by the majority of the respondents. The ATLS® classification of hemorrhagic shock is based on the estimated blood loss.15 However, it is criticized as not being sensitive and specific enough, estimation may not be accurate and it may be unhelpful and difficult to apply.20 However, there is no disagreement that a 30% of loss of blood volume causes hypotension.21 Only 30% of respondents were able to identify correctly class III hemorrhagic shock. This finding raises major concerns regarding the ability of the doctors who were surveyed to treat appropriately patients in hemorrhagic shock. Obviously,