Has ATLS Fallen Behind?
ATLS, and the Australian equivalent EMST, remains the global go-to trauma course for budding clinicians. The course was developed 40 years ago to fill a hole in critical care education and the improve the initial management of severe trauma.
This editorial piece in Anaesthesia, "ATLS: Archaic Trauma Life Support" stirs the pot and highlights the knowledge translation lag that the "standard of care" set by ATLS has behind modern trauma management and the current evidence.
Not to mention evolving discussions around spinal boards, hard cervical collars, the utility of log rolls and current RSI techniques including apnoeic oxygenation, as well as issues with the educational style that have been raised before. This has, of course, generated much discussion on Twitter amongst FOAMites:
— Salim R. Rezaie (@srrezaie) July 12, 2015
So what is the current role of ATLS?
ATLS/EMST may still have value as an introductory course to those not versed in the ways of trauma. It provides a foundation and common vernacular for clinicians to share a mental model.
You'd think initial management of trauma by an inexperienced trauma clinician would be better with ATLS than without, but this isn't supported in the literature; see this Cochrane review and study). Adhering to rigid ATLS protocols and algorithms in the modern trauma centre may result in substandard care for our patients. The foundation of ATLS must be built upon with current practices and innovations based on new evidence.
How do we change?
One of the suggestions given in this editorial is to regard ATLS as an introductory, basic course for those not experienced in managing trauma. The best trauma management must move with new innovations and research that provide evidence for mortality and morbidity benefit for trauma patients. This may be achieved at local or instiutional levels, although most clinicians will want the medicolegal protection of some sort of protocol supporting practice not in keeping with the widely-accepted ATLS algorithms.
There are also other more advanced trauma education options that appear to be more up-to-date and quicker to respond to new evidence in trauma management, including the Australian Emergency Trauma Management (ETM) and the British Anaesthesia Trauma and Critical Care (ATACC) courses. As I've highlighted before, the frequently updated ATACC handbooks are available online for all to use.
Have a look around at these other opinions in the FOAM world:
- Archaic Trauma Life Support from ScanCrit