Dr Matt Wiles Sheffield Teaching Hospitals NHS Trust

@STHJournalClub http://sthjournalclub.wordpress.com

To examine how the Advance Trauma Life Support (ATLS) course meets the challenges of modern trauma management, with a focus on:

The background to the development of ATLS

The impact of ATLS training on trauma related morbidity & mortality

The weaknesses of ATLS, especially in the context of UK trauma management

To look at how training in trauma management in the UK could be developed in the future

"When I can provide better care in the field with limited resources than my children and I received at the primary facility, there is something wrong with the system and the system has to be changed.“

James K. Styner

“With great power comes great responsibility....”

“So let it be written, so let it be done..”

“False principles or rules handed down through generations of medical providers and accepted without serious challenge or investigation”

Dr Chris Nickson (@precordialthump)

Rapid Sequence Induction

[Can J Anesth 2007; 54: 748-764]

Manual in-line stabilisation

[Br J Anaesth 2000; 84: 705-709]

Trauma nasopharyngeal airways

[Emerg Med J 2005; 22: 394-396]

Permissive hypotension

[Anaes 2013; 68: 445-452]

GCS as a trigger for intubation

[Trauma 2003; 54: 671-680]

[Emerg Med J 2007; 24: 139-141]

Guly et al. Resuscitation 2011; 82: 556-559

Mutschler et al. Resuscitation 2013; 84: 309-313

Demetriades et al. J Am Coll Surgeons 2005; 201: 343-348

De Knegt et al. Injury 2008; 39: 993-1000

“Rules are for the obedience of fools and the guidance of wise men”

Douglas Bader

Sequential assessment Permissive hypotension Haemostatic resuscitation Etomidate Importance of CT

Advanced Trauma Life Support program increases emergency room application of trauma resuscitative procedures in a developing country. Ali et al. Trauma 1994; 36: 391-394

Trauma outcome improves following the Advanced Trauma Life Support Program in a developing country. Ali et al. Trauma 1993; 34: 890-899

Clinical Impact of Advanced Trauma Life Support. Van Olden et al. Am J Emerg Med 2004; 22: 522-525

“If I had an hour to solve a problem I'd spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.”

Albert Einstein

“Everything is awesome. Everything is cool when you’re part of a team”

President Business

[Trauma Team Performance. Barach & Weimger; http://www.academia.edu/5270549/ITTACS_Team_Performance]

[Capella et al. J Surg 2010; 67: 439-443]

[Capella et al. J Surg 2010; 67: 439-443]

28 hospitals, 2860 trauma team members 1 day course

[Wisborg et al. Educ Health 2006; 19: 85-95]

Treat ATLS as BTLS Stop routine recertification Focus on non-technical skills Institution specific training

Protocols

Team working

Debriefs