Global Collaboration to Modernize Advanced Trauma Life Support Training

Abstract

Each year, thousands of surgeons and other trauma health care providers participate in the American College of Surgeon's Advanced Trauma Life Support (ATLS) program, which historically has allowed trainees to practice cricothyroidotomy, chest tube insertion, pericardiocentesis, venous cutdown, and diagnostic peritoneal lavage on live dogs, pigs, sheep, and goats. However, more than 99% of ATLS programs in the United States and Canada have now ended animal use, driven primarily by simulation technology advancements. This review details an international survey of animal versus simulation use in ATLS programs and summarizes the surgical training impact of a novel collaboration between the industry manufacturer of the TraumaMan human simulator, Simulab Corporation (Seattle, Washington), and an animal protection nongovernmental organization (NGO) based in Norfolk, Virginia, to replace animal use in ATLS programs with human simulators. From 2012 through 2017, the NGO e-mailed formal surveys concerning program statistics and animal use practices to ATLS officials in various countries (N = 64). The survey response rate was 87.5% and included pre- and post-comparison surveys relative to the industry-NGO simulation collaboration. Eighteen ATLS programs (32.1%) initially replied that they use nonanimal training methods, whereas 38 ATLS programs (67.8%) replied that they use animals for surgical skills training and cited financial constraints as the primary barrier to adopting human simulation methods. Through the industry-NGO collaboration, the NGO donated 119 TraumaMan models valued at nearly $3 million (USD) to ATLS programs in 22 countries, such that 75% of those ATLS programs surveyed by the NGO now use exclusively nonanimal simulation models. The industry-NGO collaboration successfully transformed the surgical skills laboratories of 22 international ATLS programs to replace animal use with nonanimal simulation models that are more anatomically realistic, cost less, and allow trainees to repeat surgical skills until proficiency.