Provision of Trauma Services
Within the UK, few trauma centres have enough volume to justify dedicated trauma surgeons. Trauma commonly affects more than one part of the body and so trauma surgery necessarily spans a number of specialties. Pre-hospital medicine is involved in the extraction and safe retrieval of patients to hospital. Once in hospital, the receiving trauma team is often composed of anaesthetics, emergency medicine and the surgical specialties. Subsequently, critical care and rehabilitative medicine also play important roles. It is impossible for one specialty to acquire and maintain all the necessary skills and expertise. For this reason, team work and collaboration are important components in the effective management of trauma.
Trauma centres are classified according to what they can provide. The UK definitions are different from the US - see Levels of trauma care.
The ATLS Approach
The principles of ATLS represent a sort of "copernican revolution" in the provision of care to major trauma patients. The Hippocratical approach (based on history taking, system enquiry, orderly clinical examination of cardiovascular, respiratory, digestive, genitourinary and neurological systems, diagnosis, prognosis and therapy), although very effective for patients with non acute illnesses, is inadequate to manage trauma patients.
The term ATLS is the acronym for Advanced Trauma Life Support and consists of a set of guidelines for the initial assessment and management of victims of major trauma. Developed initially as a set of guidelines by a group of trauma care providers in Nebraska led by Dr Styner, they were further elaborated by the American College of Surgeons and published for the first time in 1980.
The main assumption on which the ATLS protocol is based is that the most potentially life-threatening injuries must be recognized and treated first and in an orderly fashion, starting from the airways, and moving "down" to breathing, circulation and disability, before assessing the patient from head to toe. Although apparently simple and intuitive as a concept, this innovative approach created a framework for the management of patients with multiple potentially life-threatening injuries.
Originally, the ATLS approach was conceived for those who are less exposed to major traumas or less familiar with its management, such as practitioners who work in small Emergency Units in rural locations with a very low volume of severe trauma. However, its principles - now universally accepted and widely implemented worldwide - allow all the care providers (doctors, nurses, radiographers, etc) involved in the management of major trauma patients to have a uniform behaviour and to communicate efficiently with each other, optimizing the management of complex clinical cases and minimizing the risk of missing or mismanaging important injuries.
The latest edition of the ATLS guidelines has been published in 2005.