Advanced Trauma Life Support

Advanced Trauma Life Support ( ATLS ) is a training concept that defines standardized diagnostic and therapeutic courses of action in the early in-hospital first aid for serious injuries ( polytrauma ) patients in the emergency room. It was developed in the 1970s by the American College of Surgeons (ACS ) and is now trained and applied in a variety of countries. Advanced Trauma Life Support / ATLS are registered service marks.

Development

The impetus for the development of the ATLS concept has been an accident of the U.S. trauma surgeons James Styner, which crashed in 1976 with his family in a private plane. The emergency primary medical care was so poor that Styner serious deficiencies in the training of doctors to supply stated seriously injured. On his initiative, various regional working groups set up, lined up the concepts for initial treatment of casualties. In the late 1970s ATLS was developed by the American College of Surgeons on the basis of this work. They used this didactic concepts that the American Heart Association had recently introduced with the Advanced Cardiac Life Support. ATLS has since become the standard in the United States in the care of trauma patients. It is now formed in over 50 countries, the UK, Switzerland, Netherlands and other countries, it is a compulsory part of medical training. From ATLS now various approaches to preclinical trauma care were derived by the emergency service (International Trauma Life Support, Pre Hospital Trauma Life Support).

Concept

The basic idea of ​​ATLS is to capture the most threatening injuries and disorders of the vital functions of the patient quickly and treat ( " treat first what kills first" ). This is done by the first examination and supply ( "primary survey" ) which follows the so-called ABCDE scheme: The airway (A - airway ) is secured, a ventilator (B - Breathing ), if necessary, carried out, the circuit ( C - Circulation) stabilized by stopping massive bleeding and infusion therapy or by cardiac massage and an orientating neurological examination performed ( D - Disability ). As a final point, the patient is undressed, orienting examined surgically and then reheated (E - Exposure). Following this initial treatment are in a second, more detailed phase ( "secondary survey" ) diagnosed all relevant injuries and illness, while also imaging techniques (X-ray, CT) are used.

Training

The training of ATLS takes place in a two-day course; in Germany, the German Society of Trauma Surgery is certified to carry. To this end, there will be a theoretical preparation with the help of a course manual, the course itself included both theoretical units mainly practical exercises. After a written and oral examination, the certificate is ATLS provider, which is valid for five years, forgiven.

Reviews

Benefits, structural quality and the adoption of the ATLS concept to Europe are controversial. Since the need for a priority -oriented, standardized treatment is generally accepted, see proponents of the concept in ATLS an appropriate means to treat patients effectively. The simple and clear structure, it is internationally used without any problems and improve the care of severely traumatized patients. Critics counter that a benefit to the patient and an improvement of the prognosis but so far could not be detected.

Weaknesses also be seen in the methodology of the concept. So ATLS leg hold according to the criteria of the German Instrument for Methodological Guideline Appraisal ( DELBI ) defects in different fields: An interdisciplinary cooperation ( surgery, anesthesia, radiology, etc.), as usual in the emergency room is not provided in the surgically oriented ATLS; as ATLS licensee may only national trauma surgery professional societies occur. The updating of course content also is proceeding slowly, an adaptation to regional conditions will not permitted by the ACS. The ATLS manual is still not available in the free trade, the contents thus not openly accessible. Criticism is also practiced at the commercial aspects, as the ACS annually large sums of royalties occupies, so that editorial independence is not given.

Further, various technical aspects of the concept are criticized, do not match the current state of knowledge and must be regarded as outdated, such as an inadequate airway management, the assessment of the circulatory status on the basis of obsolete parameters (see shock index) as well as an uncritical onset of immobilization of the can result in various side effects.

The takeover of the American ATLS is assessed differently in Europe. While it is part of medical education and training in different countries are different to the concept rather hostile. After claims of British doctors had not been complied with by local adaptations of ACLS, developing its own concept was discussed in the United Kingdom. Due to the discussed weaknesses of the European ATLS trauma work group composed of representatives from various professional societies, a European interdisciplinary alternative concept, the European Trauma Course (European Trauma Course ) has developed on the initiative of the European Resuscitation Council.