Sir George Bedbrook
As noted in the Chapter on the History of Spinal Cord Medicine in a recent text, (1) many nations and regions of the world have now been fortunate to have developed a comprehensive system for providing optimum care to people with spinal cord injury (SCI). Usually such systems have come about as a result of the dedication and resourcefulness of one or two individuals. (1) In that part of the globe called Oceania, the one name that stands out as the major force behind the creation of spinal cord centers providing comprehensive care is Sir George Bedbrook. (1921- 1991)
Following the lead and impetus of Sir Ludwig Guttmann (1899-1980 (2), Bedbrook established the first Australian SCI center at the city of Perth in Western Australia (WA). Like Guttmann, he was not satisfied with just his own center of excellence for SCI but took on the added responsibility of proselytizing the need for SCI centers throughout Oceania including the other Australian states, New Zealand, the pacific islands and Indonesia. At each location, he encouraged key physicians to take up the banner and direct their own SCI centers.
In Perth, itself, a city in a state somewhat isolated from the rest of Australia, with a desert to the East and the Indian Ocean to the west, he was able to implement a regional system of care where all SCI injuries in WA were referred to Bedbrook’s unit, dedicated and operational in 1954. From distances, sometimes considerable, patients were transported by helicopter or fixed wing courtesy of the Royal Flying Doctor Service. Thus, by mid-century, after World War II, his unit and system of care offered all the elements that have come to be accepted as providing comprehensive care: rescue, transport, emergency evaluation and treatment, acute care, rehabilitation and long-term care and follow up. In the US, these elements were later codified by John Young (1919-1990) and incorporated into legislation that defined what services a system must have to be considered a “Model System “, in 1980. (2) (3)
An orthopedic spine surgeon, he also was a strong advocate of conservative management of the spine except when deformity or instability were refractive to closed realignment and reduction. His unit was known for the assiduous attention to cross infection control and overall cleanliness to which all disciplines adhered. As a rehabilitationist, he was just as concerned over whether the patient got the right wheelchair as to a successful surgical outcome. Post discharge planning was also comprehensive with options of assisted living for those who could not return home, visiting nurse services, home modifications, assistance with transportation, sports and re-employment. Overall, a model system was functioning in Perth and providing an example, well before John Young pioneered the concept in the US and other leaders did so in other countries (1).
The nations in Oceania, particularly those mentioned, have much to thank Sir George Bedbrook for the leadership he provided and the example he set as to how to provide excellent care to persons with SCI.
He died in 1991 and left a legacy which prevails in his nation and region to this day.
Ditunno JF, Donovan WH, Oleson CV. History of Spinal Cord Medicine in: Spinal Cord Medicine. Kirshblum S, Lin V ed. New York. Springer Publishing Company LLC. 2018
Donovan WH. Donald Munro Lecture. Spinal Cord Injury - Past, Present and Future. J Spinal Cord Med. 2007, 30: 85 – 100.
Donovan WH, A look at Spinal Cord Injury Down Under. SCI Digest, Fall 1980, 15-17.
This profile of Sir George Bedbrook was written by William Donovan
John Young, inspired by a visit to Sir Ludwig Guttmann at Stoke-Mandeville in 1962, embraced Guttmann’s model of creating a system of care from “injury to grave”. As he applied this concept of comprehensive rehabilitation to spinal cord injury (SCI) at Craig Hospital, he envisioned a program in the future that would address the problem of the fragmented care for SCI in the Western Hemisphere. In 1970 he was afforded the opportunity to begin the greatest challenge of his career: establish a model SCI Center at Phoenix, AZ., which illustrated a team concept, physician led, continuity of life-time care at lower costs and better outcomes. His demonstration grant was so successful that after 3 years 6 centers were funded which eventually grew to 14 centers in 2018, which has collected data prospectively on course of recovery, complications, service delivery and costs. From 1975 to 2017 over 32,000 cases have been collected at the National Statistical Center (uab.edu/NSCISC).
In addition, Young’s leadership together with members of ASIA and the support of ISCoS, the International Standards for the Classification of Spinal Cord Injury were established. This classification system serves as the current gold standard for research studies in recovery and regeneration of SCI.
Ditunno JF, Jr., Donovan WH and Oleson CV. History of Spinal Cord Injury (SCI) Medicine. In: Kirshblum S and Lin VW, (eds.). Spinal Cord Medicine. Third ed. New York, New York: Demos Medical Publishing 2019.
This profile of John Young was written by John Ditunno