Advanced Trauma Life Support

Advanced Trauma Life Support
Name	Advanced Trauma Life Support
Specialty	Emergency medicine; Trauma surgery
Developer	American College of Surgeons
Initial release	1970s
Latest revision	ongoing
Website	none

Advanced Trauma Life Support

Advanced Trauma Life Support is a standardized trauma care protocol developed to improve initial evaluation and management of injured patients in emergency settings, integrating rapid clinical decision-making, procedural skills, and systems-based approaches. The program emerged from collaborations among surgical leaders, academic centers, and professional organizations to reduce mortality from major trauma and to harmonize training across trauma systems, trauma centers, and prehospital services.

History and Development

The program originated in the 1970s through leaders at the American College of Surgeons, influenced by clinicians at Harvard Medical School, Johns Hopkins Hospital, University of Pennsylvania Health System, and international centers such as St Thomas' Hospital and St George's Hospital, with contributions from figures linked to the National Highway Traffic Safety Administration, World Health Organization, Royal College of Surgeons, and trauma registries like the National Trauma Data Bank. Early adopters included teams from Cook County Hospital, University of California, San Francisco, Massachusetts General Hospital, and Presbyterian Hospital (New York City). The curriculum evolved through iterations involving educators affiliated with Mayo Clinic, Cleveland Clinic, Vanderbilt University Medical Center, Mount Sinai Health System, University of Toronto, McMaster University, Karolinska Institutet, and the Royal Australasian College of Surgeons, reflecting influences from wartime casualty care studies such as lessons from the Vietnam War, the Falklands War, and civilian disaster responses like the Hillsborough disaster and 9/11 attacks.

Principles and Objectives

The core objectives prioritize rapid life-saving interventions rooted in priorities established by leaders from American Board of Surgery, Association of Academic Surgeons, Society of Critical Care Medicine, European Society for Trauma and Emergency Surgery, and policy bodies like the Institute of Medicine and Centers for Disease Control and Prevention. Emphasized principles were informed by research at Johns Hopkins Bloomberg School of Public Health, Columbia University Irving Medical Center, Yale-New Haven Hospital, Brown University, and operational doctrines from United States Army Medical Research and Development Command and Royal Army Medical Corps. Objectives include reduction of preventable death, team-based communication influenced by protocols from Federal Aviation Administration, implementation fidelity tracked by registries like Trauma Quality Improvement Program, and integration with prehospital frameworks such as those from National Association of Emergency Medical Technicians and International Committee of the Red Cross.

ATLS Patient Assessment and Management Algorithm

The assessment algorithm draws on models refined at Baylor College of Medicine, Duke University Hospital, Toronto General Hospital, Guy's and St Thomas' NHS Foundation Trust, and Karolinska University Hospital, aligning with triage systems used in London Ambulance Service, New York City Fire Department, Los Angeles County Fire Department, and disaster triage doctrine from Médecins Sans Frontières. The stepwise approach—rapid primary survey, resuscitation, secondary survey, and definitive care—was influenced by surgical protocols from Royal College of Surgeons of England, trauma outcome studies at Johns Hopkins, University of Washington Medical Center, and systems analyses published in journals affiliated with American College of Emergency Physicians and British Journal of Surgery.

Airway and Cervical Spine Control

Airway management protocols were guided by anesthesiology and trauma experts from Massachusetts General Hospital, University of Michigan Health, Stanford Health Care, University College London Hospitals, and device manufacturers engaged with regulatory bodies like the Food and Drug Administration. Cervical spine control practices incorporate evidence from studies at University of Oxford, McGill University Health Centre, Karolinska Institutet, Seoul National University Hospital, and consensus statements from bodies including World Society of Emergency Surgery and American Academy of Pediatrics for pediatric adaptations. Techniques reference training exercises developed at institutions such as Walter Reed National Military Medical Center and Royal Infirmary of Edinburgh.

Breathing, Circulation, Disability, Exposure (BCDE) Interventions

Interventions for respiration and hemodynamics reflect work from Royal London Hospital, Hospitals of the University of Pennsylvania, Toronto Western Hospital, Hôpital Européen Georges-Pompidou, and research centers like Scripps Research and Imperial College London. Circulatory management builds on transfusion protocols influenced by American Association of Blood Banks, damage-control surgery concepts from R Adams Cowley Shock Trauma Center, and hemorrhage control techniques derived from military medicine research at Walter Reed, Uniformed Services University, and studies related to tourniquet use from Operation Iraqi Freedom lessons. Neurologic assessment and disability screening use scales adopted across institutions including Massachusetts General Hospital and University Hospital of Zurich.

Adjuncts, Imaging, and Definitive Care

Adjuncts and imaging strategies utilize modalities and protocols standardized at Mayo Clinic, Cleveland Clinic, Royal Brompton Hospital, Karolinska University Hospital, and radiology departments at Johns Hopkins and Mount Sinai. Point-of-care ultrasound practice is informed by programs at University of California, Los Angeles, University of Edinburgh, University of Melbourne, and societies such as the American Institute of Ultrasound in Medicine. Definitive surgical treatments coordinate with specialty services at Memorial Sloan Kettering Cancer Center for oncologic reconstructions, Hospital for Special Surgery for orthopedics, and vascular surgery units like St Bartholomew's Hospital.

Training, Certification, and Global Implementation

Training and certification pathways were formalized by the American College of Surgeons with course management involving centers in India, Brazil, South Africa, Kenya, Japan, Germany, and Australia. International implementation involved partnerships with World Health Organization, International Committee of the Red Cross, Pan American Health Organization, and national surgical colleges such as the Royal Australasian College of Surgeons, Royal College of Surgeons of Edinburgh, College of Surgeons of East, Central and Southern Africa, and Indian Medical Association. Evaluation and quality improvement draw on datasets from the National Trauma Data Bank, regional trauma registries like Trauma Audit and Research Network, and academic collaborations with University of Cape Town, Universidade de São Paulo, Peking University Third Hospital, and Seoul National University.

Category:Trauma care