Dr Matt Wiles Sheffield Teaching Hospitals NHS

 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..”

“The greater the ignorance, the greater the dogmatism” William Osler

“False principles or rules handed down through generations of medical providers and accepted without serious challenge or investigation” [Newman. J Emerg Med 2007; 50: ]

Rapid Sequence Induction [Can J Anesth 2007; 54: ] Psuedoaxioms in Trauma Anaesthesia Manual in-line stabilisation [Br J Anaesth 2000; 84: ] Trauma nasopharyngeal airways [Emerg Med J 2005; 22: ] Permissive hypotension [Anaes 2013; 68: ]

GCS as a trigger for intubation [Trauma 2003; 54: ] [Emerg Med J 2007; 24: ] Psuedoaxioms in Trauma Anaesthesia Cervical Collars [J Neurotrauma 2014; 31: ]

[Guly et al. Resuscitation 2011; 82: ]

[Mutschler et al. Resuscitation 2013; 84: ]

[Demetriades et al. J Am Coll Surgeons 2005; 201: ] [De Knegt et al. Injury 2008; 39: ]

“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

Impact in Developing World Advanced Trauma Life Support program increases emergency room application of trauma resuscitative procedures in a developing country. Ali et al. Trauma 1994; 36: Trauma outcome improves following the Advanced Trauma Life Support Program in a developing country. Ali et al. Trauma 1993; 34: Clinical Impact of Advanced Trauma Life Support. Van Olden et al. Am J Emerg Med 2004; 22:

ATLS is a dogmatic approach to trauma resuscitation in the civilian hospital setting. It would be naïve to apply the same model to each echelon of care within the conventional military evacuation chain. BATLS 2008 is a stepwise approach to trauma resuscitation that acknowledges the tactical constraints at point of wounding, together with the incremental enhancement of interventional skills, diagnostic equipment, experience-based judgement and trauma team sophistication at successive echelons of care.

“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;

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

 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

 All trauma team training should take place as a multidisciplinary team and should be undertaken within the usual working environment of that team  Train as a team in order to perform and deliver as a team