ATLS 10th Edition Update The new course

Content Compendium of changes - minor Completely compliant with NICE Major Trauma Guidance 2016

Initial Assessment 1 litre of fluid, judicious approach Focus on massive transfusion protocols Tranexamic acid Coagulopathy Canadian C Spine Rule Trauma team

Airway and Ventilation RSI changed to Drug Assisted Intubation Videolaryngoscopy Trauma team

Shock Class of haemorrhage table amended Base excess Early use of blood and blood products Management of coagulopathy Massive transfusion defined >10U pRBC in 24 hours or 4U in one hour TXA Trauma team

Thoracic Trauma I Tension pneumothorax SV vs. IPPV Life Threatening Injuries Flail chest out Tracheobronchial injury now in 5th ICS MAL for needle thoracocentesis Open thoracostomy

Thoracic Trauma II Algorithm for circulatory arrest approach 28-32Fr chest drain for haemothorax (not 36-40Fr) Aortic rupture management with Beta Blocker Trauma team

Abdominal and Pelvic Trauma Palpation of prostate gland no longer recommended for urethral injury Flow chart for pelvic fracture with haemorrahge amended Trauma team

Head Trauma GCS changed – ‘pressure’ Detailed guidance on SBP management Classification – ‘mild’ head trauma Anticoagulation reversal guidance Seizure prophylaxis Trauma team

Spine and Spinal Cord Trauma New myotome diagram ‘Restriction of spinal motion’ Canadian C Spine Rule Trauma team

Musculoskeletal Trauma Weight based IV antibiotic regime Highlighting risk factor of bilateral femur fractures Trauma team

Thermal injuries 2ml/kg x weight x % burn adults 3ml/kg x weight x % burn children Fluid titrated to urine output Trauma team

Paediatric Trauma DOPE mnemonic Needle thoracocentesis UNCHANGED 2ndICS Limiting crystalloid resuscitation Trauma team

Geriatric Trauma Mortality / Morbidity Pelvic trauma Trauma Team COPD IHD DM Cirrhosis Coagulopathy Pelvic trauma 4x mortality Increased LOS Transfusion Trauma Team

Trauma in Pregnancy and Intimate Partner Violence Indication of amniotic fluid leak is vaginal pH of >4.5 Trauma Team

Transfer to Definitive Care Specific mention of avoiding CT in primary hospital SBAR template for communication Trauma Team

Trauma Team - RKR

Delivery mLearning only All materials available to everyone Hybrid course Mandatory completion prior to course All materials available to everyone One interactive discussion only Skills stations – completely redesigned

Skills stations Unfolding scenario Clarity of demo / 4 stage teaching UK specific guidance

Skills stations I Airway – basic, advanced, surgical Breathing Circulation – Local Haemorrhage Control Disability

Skills stations II Secondary Survey Adjuncts Trauma team

Skills stations - Airway Airway assessment - demo/discuss Jaw thrust - demo/discuss Nasal airway, Suction, Oral airway - 4 stage Bag valve mask ventilation (1 and 2 person) - 4 stage Discussion of paediatric basic airway Laryngeal mask (or tube) airway insertion - 4 stage LEMON assessment - demo/discuss Oral endotracheal intubation - demo/discuss Surgical Airway Basic airway (paediatric vs adults) - demo/discuss Surgical cricothyrotomy - 4 stage Needle cricothyrotomy - 4 stage

Skills stations - Breathing Breathing assessment - demo/discuss Chest drain (thoracostomy tube) insertion - 4 stage Needle decompression (child) - 4 stage Elderly chest injury - demo/discuss Sucking chest wound - demo/discuss Severe chest injury scenario - demo/discuss

Skills stations - Circulation Assessment of shock - demo/discuss Wound packing - demo/discuss Application of tourniquet - demo/discuss Insertion of intraosseous needle - 4 stage Application of pelvic binder - demo/discuss Femoral access - 4 stage Non haemorrhagic shock - demo/discuss

Skills stations - Disability Assessment of neurological status - demo/discuss Evaluation of cervical spine injury - demo/discuss Reassessment of changing neurological status - demo/discuss Referral process - demo/discuss Detailed neurological examination - demo/discuss Log roll - candidates and one faculty repeat it 5 times changing roles Elderly patient assessment of neurological status - demo/discuss Central cord syndrome assessment - demo/discuss

Skills stations – Secondary Survey Open fracture management - demo/discuss Perform secondary survey patient 1 - demo/discuss Perform secondary survey patient 2 - demo/discuss Application of hard collar - 4 stage

Skills stations - Adjuncts eFAST probe positioning - demo/discuss FAST scan - demo/discuss CXR interpretation - 4 stage Pelvic X-Ray interpretation - 4 stage Spine X-ray interpretation - 4 stage

Skills stations – Trauma Team Video Scripted interactive discussion

Electronic materials Mobile eLearning - demo to follow 13 chapters, each with 5-6 lessons PDF of each chapter eBook / iBook mATLS app

mLearning

Manual iBook eBook Hard copy

mATLS app – George Brighton >150,000 downloads in >120 countries (more than ATLS – 80). George Brighton

Not changing Principles and priorities Most of content Triage discussions Moulages – simulator use Assessment process Moulage MCQ

Will be changing Reverification course Instructor course Already well aligned Instructor course Microteaching Instructor recertification process No lecture

Day One 0800-0830 Welcome and Registration   0830-0850 Introduction and Course Overview 20 min - SB 0850-0950 Initial assessment interactive discussion 60 min - SB 0950-1000 Move to skill stations 10 min 1000-1200 Airway skill station 120 min   Group A NM, RO Group B HW, GS Group C SD, ACG Group D LZ, SM 1000-1030 Basic Airway 1030-1100 Advanced Airway 1100-1120 Break 1120-1150 Ped/Surg Airway

Day One Group A Group B Group C Group D 1210-1310 Breathing   Group A Group B Group C Group D 1210-1310 Breathing JF, ACG, RO SM, NM Circulation SB,GS, LZ SD, HW 1310-1400 Lunch 1400-1500 1500-1530 Post-test group discussion 30 min SB   1530-1550 Intro to afternoon skill stations/break 20 min SB   Group A Group B Group C Group D 1550-1650 Disability HW, ACG Secondary survey GS, RO SD, NM LZ, SM 1650-1750 HW ACG

Day Two 0800-0825 Group Question and Answer 25 min - SB Groups A & B   Groups A & B Groups C & D 0825-0910 Adjuncts ACG, NM, RO, LZ Trauma Team initial assessment SD, SM, HW, GS 0910-0955 0955 -1015 Break 20 min   1015 - 1045 Faculty demonstration of moulage 30 min 1045 - 1145 Practice moulage in groups 60 min Group A Group B Group C Group D SD, ACG HW, SM NM, RO LZ, GS 1145 - 1315 Triage Scenarios / Written test / Moulage 90 min 1315 - 1400 Lunch (including retests) 1400 - 1545 Triage Scenarios / Written Test / Moulage (incl. retests) 105 min 1545 - 1600 Wrap up and close 15 min

Hybrid course 0850-0910 Introduction and Course Overview 0910-0950   0910-0950 Initial Assessment Interactive Discussion Group A, B, C Or Basic Airway Group D, E, F Half of course doing initial assessment discussion and faculty demo. Other half doing basic and advanced airway 0950-1020 Faculty Demonstration of Moulage Group A, B, C Advanced Airway Group D, E, F 1020-1040 Tea/Coffee & set up 1040-1150 1040-1120 1120-1150 Initial Assessment Interactive Discussion and Faculty Demonstration of Moulage Group D, E, F Basic airway Group A, B, C Advanced Airway Group A, B, C 1150-1220 Surgical airway – 6 stations all candidates 1220-1310 Mentor Lunch & MCQ review 1310-1410 1410-1510 Breathing and Circulation Skills stations, 6 stations (3 Breathing and 3 Circulation), All Groups. Timetable on page 9. 1510-1525 Break & set up 1525-1625 1625-1725 Disability and Secondary Survey Skills stations, 6 stations (3 Disability and 3 Secondary Survey), All Groups. Timetable on page 9. 1725-1740 Close of Day 1 1740-1810 Faculty meeting Hybrid course

Hybrid course 0800-0810 Q & A session 0810-0855 Trauma Team video and discussion (discussion in 2 groups) 0855-0955 Adjuncts, groups D,E,F   Initial Assessment (Moulage) practice: Patient 1 – Group A Patient 2 – Group B Patient 3 – Group C 0955 - 1015 Break 1015–1115 Adjuncts, groups A,B,C Patient 1 – Group D Patient 2 – Group E Patient 3 – Group F 1115-1245 Triage scenarios/written test/moulage test Timetable for Groups A, B, C on page 11. Timetable for Groups D, E, F page 12. 1245-1330 Lunch and retests 1330 - 1515 1515- 1545 Faculty meeting 1645-1600 Summary, feedback and results Please ensure you have all your personal belongings with you before you leave Hybrid course

Impact on faculty No lectures Less exposure to candidates – IP / support reqd Less down time Less peer learning - tips and tricks New skills stations Little change in clinical approach

Impact on candidates Full on Less reflective time Less opportunity for catch up

Impact on coordinators New programme Equipment Skills stations changeover

Implementation Alpha Pilots Beta Pilot Refining model USA and Australia – January / Feb Beta Pilot London – May Refining model October x 2, November National roll out February 2018

Summary Changes Many benefits Careful roll out Minor content Huge delivery Many benefits Careful roll out