Background

ATLS teaches inexperienced providers a systemic approach to trauma, with focus on stabilization and appropriate transfer of care. It is designed for providers who do not have much trauma exposure, not necessarily for providers who work in major trauma centers. This article reviews the scope of ATLS training and asks whether it is important or relevant for providers in major trauma centers.

Clinical Question

How should physicians in trauma centers use ATLS?

Primary Results

Critiques of ATLS

  • Cornerstones of ATLS teaching–such as the “golden hour” and classifications of shock–have been called into question. Battlefield resuscitation and advanced care delivered by first responders have stretched our understanding of the “golden hour” of resuscitation, and real-life data fails to reproduce the stages of shock as taught in ATLS.
  • Ignores some commonly used and validated methods of trauma resuscitation, including TXA and damage-control resuscitation, and continues to recommend DPL when this has been almost entirely been supllanted by CT and ultrasound.
  • Major trauma centers generally have dedicated trauma teams with center-specific protocols and thus may vary in their management of certain types of injuries based on center capabilities (i.e. interventional radiology vs operating room)

Suggestions

  • Reduce or eliminate needs for re-certification of physicians who work in major trauma centers. Use ATLS only as a teaching tool for junior physicians. Eliminate up-to-date ATLS certification as a requirement for faculty/consultant positions.
  • Emphasize team training and development of leadership skills for physicians in trauma centers.

Author's Conclusions

"When introduced almost 40 years ago, ATLS represented the cutting edge of trauma management; unfortunately, the course has failed to evolve at a pace that allows it to be relevant to the care delivered in modern MTCs (Major Trauma Centers). This course without doubt revolutionised trauma care, but it should now be reserved for use in isolated rural centres or environments where trauma is managed infrequently and with limited resources."

Our Conclusions

Take Home Points
▪ ATLS is a training program designed to provide inexperienced providers with a foundation of knowledge and management strategies for traumatically injured patients. In major trauma centers that take a multidisciplinary approach to trauma, the ATLS framework may have limited usefulness beyond introducing inexperienced physicians to the trauma approach.
▪ With a 4-5 year editing cycle, ATLS is "behind the times" regarding current data and practice, especially concerning the management of hemorrhagic shock.
▪ Trainees may benefit from high-fidelity simulation and teamwork/leadership training to deepen their trauma experience and advance their abilities in managing traumatically injured patients.

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ScanCrit: Archaic Trauma Life Support