Basic trauma life support: What is it?

Abstract

After the National Academy of Science identified trauma as “the neglected disease of modern society” in 1966,’ there has been a massive effort to upgrade emergency medical care in the ‘United States. Early training of paramedics concentrated on field stabilization because of the intense medical scrutiny of lay personnel performing skills previously the prerogative of physicians. The initial success of stabilizing cardiac patients at home by taking an “emergency room on wheels” and in some cases even a physician to the scene, set the trend for emergency medical services (EMSs) of the 1970~.~ We have since realized that serious trauma cannot be stabilized in the field, but needs expeditious supportive care during transport to a facility prepared to immediately treat this surgical emergency. Basic trauma life support (BTLS) has evolved to train prehospital care personnel to properly handle seriously injured patients. In September 1986 at the American College of Emergency Physicians (ACEP) Scientific Assembly in Atlanta, GA, the Board of Directors of the ACEP recommended that BTLS be “endorsed and promulgated” as a course for teaching paramedics advanced trauma care in the pre-hospital setting.3 A similar program, Pre-Hospital Trauma Life Support (PHTLS) has been developed by the American College of Surgeons.4 Emergency physicians, trauma surgeons, and emergency medical service system directors will increasingly be interfacing with prehospital care providers trained by these programs. BTLS incorporates the current fund of knowledge regarding trauma care into a philosophy of prehospital management stressing rapid examination, rapid identification of life threatening problems, and rapid transport to a facility capable of dealing with the multiply injured. It encompasses an educational system for training paramedics, relying heavily on adult education techniques and the development of advanced psychomotor skills, requiring approximately 24 hours of instruction. Heavy emphasis on role playing in moulaged scenarios is used to teach initial assessment. A main component of the course is to teach the student how to perform a rapid physical examination to identify