NIMS ​

Advanced Trauma Life Support (ATLS)

 

INTRODUCTION

Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Originally designed for emergency situations where only one doctor and one nurse are present, ATLS is now widely accepted as the standard of care for initial assessment and treatment in trauma centres. The premise of the ATLS program is to treat the greatest threat to life first. It also advocates that the lack of a definitive diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury, with the most time-critical interventions performed early.

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HISTORY

The ATLS course was established after a tragic plane crash in 1976, which devastated an entire family. The pilot, an orthopaedic surgeon named James Styner, was seriously injured while his wife was killed and three of his children sustained critical injuries. He was horrified at the treatment his family received at a local hospital in rural Nebraska and decided that the established system for managing the severely injured was wrong. A group of local surgeons and physicians, the Lincoln Medical Education Foundation, together with the University of Nebraska founded local courses aiming at teaching advanced trauma life support skills. These courses served as a framework for the national ATLS courses adopted by the American College of Surgeons’ Committee on Trauma.

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The original aims of the ATLS courses were to train those doctors who do not manage trauma on a regular basis, such as rural general practitioners, in the initial management of the severely injured patient. The pilot courses were run in Aubern, Nebraska in 1977. These had expanded nationally under the auspices of the American College of Surgeons by 1980. Early reports on the implementation and evaluation of these pilot courses and the improvements in rural trauma care appeared in the literature soon afterwards. Improvements were also noted in the quality of trauma care apparent upon the arrival of patients at a major hospital5 and on mortality rates, using multiple logistic regression analysis.6,7 Additional studies suggest an improvement related to the introduction of ATLS8 but others have failed to show significant improvement in patient outcome and assessment.9

In the late 1980s, a retrospective analysis of deaths attributable to injury reported that significant numbers could have been prevented.10 A subsequent Working Party Report from the Royal College of Surgeons, England noted the improvement in standards of care of the injured patient in the United States after the development of ATLS.11 ATLS was brought to the United Kingdom with the first course taught at the Royal College of Surgeons in 1988. By 1995, it had been taught in over 25 countries and has been shown to be an effective teaching course in both developing and developed countries.12 Today ATLS is the internationally recognised standard for the initial assessment and management of serious injury.13