Since the first ATLS® course in , the concept has matured, has been disseminated around the world and has become the. In many countries, Advanced Trauma Life Support(R) (ATLS) is the the primary survey, the mnemonic ABCDE is used to remember the order. Filed Under: Emergency Medicine, Trauma Tagged With: ABCDE approach, atls, emergency, initial assessment and management, primary.
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Abcdee Styner crashed his General Aviation aircraft in the plains of Nebraska. The rest is history: Abxde we describe how ATLS was introduced in the Netherlands; how feed-back was and is collected and how criticism is being reacted to.
When ATLS was introduced in the 2-day format was chosen for logistical and financial reasons. The Netherlands being a small country area Because of the latter many students nowadays are very inexperienced when they come on the course. At present some doctors are trained annually. Some are for several reasons not in favour 78and alternative courses have been developed 9.
It is interesting to note that in reviews no prospective trials were found assessing outcome of trauma care 1011 ; better outcomes have also been reported 12 – als In the Netherlands, as elsewhere, each course is evaluated by both instructors and students, using the form from the Faculty Manual. During many years recurring criticisms regarding the course format were: Comments like these have not been confined to the Netherlands.
Several authors 17 – 20 report comparable opinions: None of these however, would provide a solution to the first two criticisms mentioned above. Therefore, Dutch ATLS decided in to devise a new format, at first only as an intellectual exercise.
Knowing that simulation is a very effective way for transferring knowledge and skills 2324 that is also much liked by students, Dutch ATLS increased in its new format the number of moulage assessments, retaining only a few lectures.
Advanced Trauma Life Support®. ABCDE from a radiological point of view
The skills were rearranged in four blocks A, B, C and Deach consisting of a plenary demonstration and plenary minilecture, followed by a scenario-based practical in small groups, dealing with all relevant psychomotor skills. Although the program had been devised as a reaction to complaints by provider students, Dutch ATLS decided to run it, starting inat first as a trial with refresher candidates; to see whether it was viable and also because many versions of the refresher program that had been tried over the years had not been really satisfactory.
The program was very well received and with some minor modifications it has been used for the Refresher course till Dutch ATLS is of course very much aware of the fact that even after effective skills teaching, the student needs further practice in order to become proficient 25 The candidates have been asked in their feed-back form whether they thought a comparable program could be used for the Provider course.
A majority was of the opinion that provider candidates would need additional coaching because of their inexperience.
The ACS had announced in that an e-learning program was under construction and Dutch ATLS opted to wait for its completion, hoping it could be used for giving that extra coaching. The first version of the ACS program that was presented a year later obviously needed improvement. As little information on that process became available, Dutch ATLS decided in to develop an e-learning program of its own. In addition, it provides steps 1 and 2 of the 4-step method for teaching psychomotor skills; it teaches how to look at X-rays systematically and it also has a large number of self-assessment questions.
Finally, the student must successfully complete a newly developed MCQ test, before the 2-day face-to-face course can be attended. Extensive feed-back on that MCQ test is immediately provided to the student. The e-learning program was finalized in June ; to follow it completely takes on average 10—12 hours.
In order to make e-learning and a new face-to-face program fully complementary, Dutch ATLS then took the earlier mentioned refresher program and adapted it as required.
Both were beta-tested 12 times from June to November and then introduced in its final version in January Figure 1 shows the present 2-day face-to-face program.
During the beta-testing alts Dutch ATLS found that results pass-rate and number of practical re-exams had improved, but only slightly unpublished data.
When using the refresher format in an adapted version for the new provider program Dutch ATLS had recognized from the start that the Refresher course would need a new program as well. Up to several schemes had been tried to train physicians and nurses together.
To mention a few: None of these experiments worked out well. Clearly, to train for working as a team should also be done with the people who ats part of such a team, in surroundings they are familiar with. It was run for the first time abcre That program was much indebted to a training scheme of the Netherlands Army Medical Services that had been in place since That scheme recognizes that once basic skills are in place, learning is best achieved by doing, or in other words, that a higher level of proficiency is only reached by repeated experiences Also, it takes into account that systematic feed-back by skilled observers enhances the learning experience, and finally it emphasizes that for efficient and effective team work excellent communication is a prerequisite 28 – In the Netherlands Army Medical Services this system has been and still is being used, in particular pre-deployment, for making people of varying backgrounds junior doctors and military abcre with limited experience and medical orderlies with almost non-existent experience work together in an effective and safe way.
A training session goes through the following phases: Then, in a simulated environment that is identical to where that team will be working later, all preparations are abxde When the casualty, well-moulaged and well-prepared as to required behaviour, is brought in, the team listens to the hand-over, and then sbcde the assessment. Following the c-ABCD approach the team, under ayls team-leader, does everything that is necessary, in real-time with real resources; either on the casualty or, for invasive procedures, on a manikin.
Laboratory tests, X-rays and sonography are simulated but, again, in real-time. At the end of the assessment, the team leader, when necessary in consultation with medical specialists, decides when the casualty is ready to leave the emergency room, and after a hand-over the assessment phase abcdf concluded.
Immediately afterwards the emergency room ER is cleaned and consumables are replaced. The next phase is the feed-back session, where the team itself atlw through all steps of preparation and assessment; guided, when necessary, by the instructors. They steer the discussion in such a way that the team itself finds where improvements in those respects should be made. Training sessions as described above are repeated many abccde every time with a different casualty between andwhen the Netherlands were involved in Iraq and Afghanistan, a team had seen on average different cases, before being deployed.
ABCDE Approach to Emergency Management
This format was changed for the civilian on-site training sessions because the session is a one-time affair and limited in duration. The instructors begin by visiting the Hospital in question to find out what the size and composition of its trauma team is; what its standard operating procedures SOP are, but also to find out what the Atlls expects from the training session.
They then develop a scenario that is adapted to the situation in that particular Hospital. For example, abcse a hospital has no neurosurgeon practicing would include how to stabilize and transport a neurotrauma patient.
On the training day itself a program usually involving 2 cases is run, with 1 team performing and another observing ideally via a video link.
The observing team will perform on the next run, and the performers become the observers Figure 2.
Advanced trauma life support – Wikipedia
The program consists of simulated attls team activations: Once the team has arrived in the ER and has completed its preparations, the casualty is wheeled into the Trauma Room and after the hand-over assessment is begun.
The team itself decides when to transfer the patient out of the Trauma Room, thereby ending the simulation; after which a de-briefing session is held.
Group interaction and if necessary medical performance are carefully scrutinized; with comments from not only the instructors but also from the observing team. This program, which abcee similarities to the ACS Rural Trauma Team Development course, has been well received and over the years many Hospitals have developed comparable programs of their own.
After much deliberation xbcde following format was agreed upon: A 4 th student serves as the scribe; the 5 th is the casualty.
One instructor is the case manager, the other the CRM assessor. Both serve as nurses, when required. Students rotate through the different positions. Alternatively a manikin is used as the casualty; in that case the 5 th student observes.
Having five students in each group has no specific educational consideration Much attention is paid to the de-briefing session which mainly deals with CRM aspects. Feed-back is provided by the scribe medical aspects and the instructors CRM aspects. The program was generally speaking well accepted, although several instructors needed some time to get used to it. This option has turned out to be highly successful and appreciated. Every Refresher course is assessed afterwards, both by the students and the faculty.
Figure 6 shows the student evaluation form; we use a 5-point Likert scale and an opportunity for open comments. The main results are shown in Figure 7. From the open comments the following deserve mention: Likewise, as CRM principles are not known to all participants more information on the subject before the course is requested.
At this moment ATLS NL is running a self-developed hybrid Provider course with e-learning and a face-to-face program with ample opportunity for practising the Initial Assessment. All on-site activities are highly appreciated; both team training for physicians and nurses, and Refresher courses for physicians only. The time slots can be moved to the morning or afternoon if so preferred by the Hospital.
A checklist evaluating Crew Resources Management aspects can be found in Figure 3. Figure 7 Results of student evaluation on Refresher course.
J Emerg Crit Care Med ;2: