Advanced Trauma Life Support System (ATLS) in a Peripheral Hospital.

Abstract

Dear Editor, It was Dr James Stynor, an American Orthopaedic Surgeon who introduced a structural trauma management training programme, following the death of his wife and serious injury to his 3 children in an air crash in 1970s. This approach is now regarded as gold standard in early trauma, initial assessment and resuscitation. The basic philosophy of the ATLS is to treat lethal injury first, then reassess and treat again. Component steps of ATLS are:- Elements of primary survey are: Airway with cervical spine control Breathing and ventilation Circulation with control of haemorrhage Dysfunction of the central nervous system Exposure in a controlled environment Secondary survey: Head to toe examination of the undressed stable patient The ATLS approach focuses on the second or early death group where death is preventable [1]. At least one in five and possibly as many as one in three, trauma deaths in hospital are preventable [2]. We have adopted ATLS with modification as required for our hospital setting (Table 1). Pre-hospital trauma life support (PHTLS) is essential component of ATLS in which Regimental Medical Officers (RMOs), Nursing Assistants (NAs) and Battlefield Nursing Assistants (BFNAs) are trained in Combat Survival Skills. We have done away with the system of receiving the casualties in Ml Room and shifting them to the ward. We receive our casualties directly in the acute ward, where Nursing officer/NA on duty does the primary survey and sends information quickly to Duty Medical Officer (DMO) and surgical team. In primary survey they carryout ABCD of the ATLS. Doctors do the re-primary survey and secondary survey. In documentation, investigations and required X-rays are carried out in the acute ward itself. Focused abdominal sonogram for trauma (FAST) is done in the ward with portable ultrasound by the surgeon [3]. Triage of mass casualties is carried out by the surgeon. In this small peripheral 49 bedded hospital with limited staff and equipment we have managed 372 battle casualties successfully with no mortality in 2 years. Table 1 Advanced Trauma life Support System (ATLS) Protocol 169 MH Our experience with ATLS is wonderful. It is recommended that all large hospitals should have a trauma wing to handle polytrauma cases and follow ATLS to prevent early deaths. It is also recommended that the concept of PHTLS be taught to all officers of other Arms and Services during their training to enable them to ensure better Combat Survival Skills of their troops.