Specialty staff versus generalists: How do ORs strike the balance?

In the middle of the night, a patient arrives with a leaking abdominal aortic aneurysm, and the surgeon wants to insert an endograft. Or a patient arrives with a major pelvic fracture. Another patient needs an image-guided craniotomy. Who will answer the call? In an ideal world, specialized teams for these cases would be available 24/7. But in the real world, for most ORs, the on-call staff must be generalists, able to handle any type of case that comes through the doors. But with today's technology, general skills may not be enough.