1. ATLS 10th Edition Update
The new course

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

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

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

8. 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

10. 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

11. 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

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

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

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

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

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

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

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

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

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

31. Trauma Team - RKR

32. 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

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

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

35. Skills stations II
Secondary Survey
Adjuncts
Trauma team

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. Skills stations – Trauma Team
Video
Scripted interactive discussion

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

44. mLearning

49. Manual
iBook
eBook
Hard copy

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

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

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

57. Day One 0800-0830 Welcome and Registration
Introduction and Course Overview 20 min - SB
Initial assessment interactive discussion 60 min - SB
Move to skill stations min
Airway skill station min
Group A
NM, RO
Group B
HW, GS
Group C
SD, ACG
Group D
LZ, SM
Basic Airway
Advanced Airway
Break
Ped/Surg Airway

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

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

60. Hybrid course 0850-0910 Introduction and Course Overview 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
Faculty Demonstration of Moulage Group A, B, C
Advanced Airway Group D, E, F
Tea/Coffee & set up
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
Surgical airway – 6 stations all candidates
Mentor Lunch & MCQ review
Breathing and Circulation Skills stations, 6 stations (3 Breathing and 3 Circulation), All Groups. Timetable on page 9.
Break & set up
Disability and Secondary Survey Skills stations, 6 stations (3 Disability and 3 Secondary Survey), All Groups. Timetable on page 9.
Close of Day 1
Faculty meeting
Hybrid course

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

62. 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

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

64. Impact on coordinators
New programme
Equipment
Skills stations changeover

65. 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

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