ADVANCED TRAUMA LIFE SUPPORT PROGRAM INCREASES EMERGENCY ROOM APPLICATION OF TRAUMA RESUSCITATIVE PROCEDURES IN A DEVELOPING COUNTRY

The Advanced Trauma Life Support program, or ATLS, is a trauma education system that has become the standard of care for initial management in emergent settings. Trauma is responsible for 10% of the world’s mortality, and comes at extensive cost, often with significant morbidity and rehabilitation1. ATLS provides an organized language and approach to the trauma patient that can be communicated globally and has been shown to significantly decrease mortality in the first hour post-admission2. It was originally designed for use in low resource settings after a devastating accident involving an orthopaedic surgeon’s family. The shortcomings in care that his family received spurred him to create an educational system that could be applied at any site.

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Should the ‘C’ in ‘ABCDE’ Be Altered to Reflect the Trend towards Hypotensive Resuscitation?

Scandinavian Journal of Surgery ◽

10.1177/145749690809700102 ◽

2008 ◽

Vol 97 (1) ◽

pp. 4-11 ◽

Cited By ~ 12

Author(s):

W. Sapsford

Keyword(s):

Emergency Room ◽

Life Support ◽

Penetrating Trauma ◽

Experimental Models ◽

Sufficient Evidence ◽

Advanced Trauma Life Support ◽

Hypotensive Resuscitation ◽

Prehospital Phase ◽

Clinical Scenarios ◽

Urban Rural

Background: Fluid resuscitation of trauma victims currently differs, depending on whether the Advanced Trauma Life Support (ATLS), Prehospital Trauma Life Support (PHTLS) or Battlefield Advanced Trauma Life Support (BATLS) algorithm is utilised. Resuscitation protocol depends on the situation of the patient before definitive surgical control of the haemorrhage can be achieved, that is, in the prehospital phase (the urban, rural or battlefield setting) or in the emergency room. The principle difference is between hypotensive (PHTLS and BATLS, in the prehospital phase) and normotensive (ATLS, in the emergency room) resuscitation. The aim of this review was to determine if there is sufficient evidence to consider altering the ATLS resuscitation algorithm to a hypotensive model prior to definitive surgical control of haemorrhage. Method: A literature review was conducted of the experimental and clinical evidence for hypotensive resuscitation. Results: Uncontrolled haemorrhage models are too severe. They do not realistically mimic — And their results cannot easily be extrapolated into — Clinical scenarios. One important clinical trial, inspired by these experimental models, has rightly influenced resuscitation of shocked prehospital patients towards a ‘scoop and run’ approach and permissive hypotension but it is specific to patients with penetrating trauma alone. Conclusion: There is insufficient evidence to alter the current ATLS algorithm in the emergency room in favour of hypotensive resuscitation. The future of resuscitation is considered.

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Teaching Effectiveness of the Advanced Trauma Life Support Program as Demonstrated by an Objective Structured Clinical Examination for Practicing Physicians

World Journal of Surgery ◽

10.1007/s002689900171 ◽

1996 ◽

Vol 20 (8) ◽

pp. 1121-1126 ◽

Cited By ~ 41

Author(s):

Jameel Ali ◽

Robert Cohen ◽

Rasheed Adam †, ‡ , Theophilus J. ◽

Ian Pierre ‡, †† , Henry ◽

Undine West ◽

...

Keyword(s):

Clinical Examination ◽

Teaching Effectiveness ◽

Life Support ◽

Support Program ◽

Objective Structured Clinical Examination ◽

Advanced Trauma Life Support ◽

Practicing Physicians

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Effect of team training on efficiency of trauma care in a Chinese hospital

Journal of International Medical Research ◽

10.1177/0300060517717401 ◽

2017 ◽

Vol 46 (1) ◽

pp. 357-367 ◽

Cited By ~ 1

Author(s):

Yucai Hong ◽

Xiujun Cai

Keyword(s):

Propensity Score ◽

Emergency Room ◽

Trauma Care ◽

Life Support ◽

Propensity Score Analysis ◽

Team Training ◽

Advanced Trauma Life Support ◽

Trauma Patients ◽

Traditional Practice ◽

Blood Routine

Objective Multidisciplinary trauma teams are the standard of care in the USA, but staffing differences and lack of advanced trauma life support training hinder replication of this system in Chinese hospitals. We investigated the effect of simulation team training on initial trauma care. Methods Over 15 months, we compared grade I trauma patients cared for by the trained team and those cared for using traditional practice on times from emergency room arrival to tests/procedures. Propensity-score analysis was performed to improve between-group comparisons. Results During the study, 144 grade I trauma patients were treated. Trained team patients showed shorter times from emergency room arrival to initiation of hemostasis (31.0 [13.5–58.5] vs. 113.5 [77–150.50] min), blood routine report (8 [5–10.25] vs. 13 [10–21] min), other blood tests (21 [14.75–25.75] vs. 31 [25–37] min), computed tomography scan (29.5 [20.25–65] vs. 58.5 [30.25–71.25] min) and tranexamic acid administration (31 [13–65] vs. 90 [65–200] min). Similar results were obtained for the propensity-score matched cohort. Conclusion Simulation team training could help reduce time to blood routine reports, scans and hemostasis. Assessment of available resources and development of targeted team training could improve care in resource-limited hospitals.

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