Why the Advanced Trauma Life Support (ATLS) course is so relevant today
13 Sep 2018
Dr Simon Walton and Mr Guy Slater
Last month The Lancet published a report into survival outcomes in England for patients with major trauma, following changes that occurred in 2012 to trauma service provision. The study showed a 19% increase in the odds of survival since the introduction of these changes. 1,600 more trauma victims are alive today because of the developments that have been made in the management of trauma patients in England over the last six years.
The changes that occurred in 2012 were brought about by the NCEPD 2007 report ‘Trauma, who cares?” Followed by the National Audit Office recommending the development of regional trauma networks in England. At the heart of these regional trauma networks resides a Major Trauma Centre (MTC). Trauma service delivery is now developing along the lines of a hub and spoke model with a concentration of expertise and specialisation in the centre surrounded by smaller units which feed into the hub.
A typical trauma network in England now consists of a MTC based in a major teaching hospital with helipad, a well resourced emergency department and access to specialist trauma surgeons and other specialties such as cardiothoracic, neurosurgery and interventional radiology. Helicopter Emergency Medical Services (HEMS) bring patients from the surrounding network and ambulances increasingly will undertake longer journey times to deliver patients by road to the central unit. Surrounding the MTC are smaller Trauma Units (TU) and Local Emergency Hospitals (LEH) based in smaller DGH’s. These don’t provide the full range of services on offer in the MTC but can still receive trauma patients and refer on to the MTC. Not only is the role of the MTC to provide care, it also provides leadership throughout the network on the development of guidelines, governance, education and research.
At the same time as the results of these major changes to trauma delivery are being realised, this September the ATLS®programme reaches its 30th anniversary. Today, the course is delivered in over 75 countries and has trained well over one million providers worldwide. ATLS’s content is updated roughly every four years through an international collaborative process and we are now on the eve of the release of a new 10th edition which will bring ATLS up to date. However despite its huge success, the value of the course has come in for questioning from some quarters for its relevance particularly in a world of MTCs, trauma specialists and rapidly evolving treatments.
We believe ATLS is more relevant than ever in the UK because of the advances that are happening in trauma management outlined above. The changes that are occurring to Major Trauma Services make the teaching of this course more vital in those units that are now receiving fewer and fewer cases. Smaller units, such as those classed as an LEH, can lack immediate access to crucial specialties such as general surgery and orthopaedics to provide support to the trauma team. However, in our experience, these units still receive from time to time severely injured patients who have either been brought through the entrance by the general public or as a so called ‘hot drop’ by paramedics who feel the situation is too acute for them to pass by their local hospital and head for the MTC.
At its core, ATLS grew out of the experiences of American doctors concerned by the ability of rural hospitals to provide safe care to the infrequent major trauma victim that came through its front doors. Jim Styner developed and delivered a local trauma training programme through his own terrible experiences of the care in a remote hospital in Nebraska. He recognised that, although there were places that provided excellent trauma care, it was unacceptable that this was inconsistent; and it is this message of consistency that the ATLS® programme was and is designed to deliver.
Its core brief is to provide safe, goal-directed care to the greatest threat to life first, in situations where sometimes resources or expertise maybe limited. This makes it more relevant than ever to how we should manage major trauma patients in our Emergency Departments throughout the UK. So despite the radical changes in the organisation and management of major trauma we are currently witnessing, the ATLS® programme remains the central to the safe delivery of trauma services in this country.
Dr Simon Walton is a Consultant Anaesthetist at Eastbourne District General Hospital and Mr Guy Slater is a Consultant in Trauma and Orthopaedics at Tunbridge Wells Hospital. They are both members of the ATLS Steering Group.