Looking forward – March 2018

David B. Hoyt

David B. Hoyt, MD, FACS

This month’s Bulletin focuses largely on the 40th anniversary of the Advanced Trauma Life Support® (ATLS®) program. Over the last four decades, this program has experienced tremendous growth, revolutionizing the care of trauma patients around the world.

The birth of ATLS

The driving force for establishing the course was orthopaedic surgeon James K. Styner, MD, FACS, who had been involved in a plane crash in a Nebraska cornfield in 1976. His wife died on impact. He and three of his children were severely injured, and the fourth child suffered more minor injuries. Dr. Styner was very dissatisfied with the quality and timeliness of care he and his family received in the hours subsequent to the crash. To address these inadequacies, Dr. Styner joined forces with Ronald Craig, MD, a family medicine physician in Lincoln, NE, to develop a program that would provide physicians and surgeons who infrequently see advanced trauma patients with the skills, knowledge, and resources they need to provide lifesaving care to severely injured patients.

The first course took place in Auburn, NE, February 11−12, 1978. The course lectures were limited to 30–45 minutes, and the target audience was the small-town physician. The second course was offered in Scottsbluff, NE.

At the invitation of C. T. Thompson, MD, FACS, then-Chair of the American College of Surgeons (ACS) Committee on Trauma (COT), Paul “Skip” Collicott, MD, FACS, at the time a general surgeon in Lincoln, NE, introduced the concept of the ATLS course to the COT at its 1979 meeting in Houston, TX. The COT enthusiastically embraced the program and called upon its Region Chiefs to meet in Lincoln for an introduction to the course. That initial training session took place in January 1980.

At the urging of R. W. Gillespie, MD, FACS, the Immediate Past-Chair of the COT, and Harris Graves, MD, FACEP, then-president of the American College of Emergency Physicians, the ACS COT agreed to assume responsibility for promulgating ATLS throughout the nation on a regional basis. (See the related article in this issue for a more detailed account of the program’s inception.)

ATLS training: A transformative experience

In 1980, the ATLS course was presented in a number of U.S. cities, including San Diego, CA. It was at this course that I, as a surgery resident at University of California San Diego School of Medicine, was first exposed to ATLS and the ACS. Dr. Collicott, Past-Director, ACS Division of Member Services and a recipient of the ACS Distinguished Service Award, was the instructor. Fellow students included a young surgeon in San Diego, ACS Past-President A. Brent Eastman, MD, FACS, and Donald D. Trunkey, MD, FACS, from San Francisco. An icon of trauma surgery, Dr. Trunkey in 1976 had led the COT’s efforts to publish Optimal Hospital Resources for Care of the Seriously Injured—the first document aimed at defining and developing trauma centers and trauma systems.

Other early participants in the ATLS course include Frank R. Lewis, Jr., MD, FACS, past executive director of the American Board of Surgery; C. James Carrico, MD, FACS, Past-Chair, ACS Board of Regents; and Ronald V. Maier, MD, FACS, ACS President-Elect.

During the course, we and the other physicians in attendance were exposed to a concise, standardized approach to caring for severely injured patients within the “golden hour” of a traumatic incident. We learned everything from assessing a patient’s condition, to resuscitating and stabilizing the patient, to determining if our institution had the resources necessary to meet the patient’s needs. It also covered how to arrange for a patient’s interhospital transfer and ensure that optimum care was provided throughout the process. In short, the ATLS course provided an easy-to-remember method to use when evaluating and treating a trauma victim.

My experience was enlightening, inspiring, and deeply personal. In a weekend, I was educated in how to care for trauma patients and my confidence was established. I had become adept and skilled in delivering a type of care that had previously been a source of anxiety and confusion. For the first time, I had been introduced to an “organized course” with standards for quality, validated education and skills training, and verification of these skills. It was a life-transforming experience, and I chose a career in trauma surgery in part as a result.

ATLS today

ATLS 40 Year AnniversarySince my introduction to ATLS, the program has been diligently refined and improved year after year, decade after decade. It has become the foundation of care for injured patients, providing physicians around the world with a common language and common approach to trauma care. In fact, it has become a global movement. More than 1 million students have been trained in at least 86 countries, and more than 60 percent of ATLS courses are now taught outside of North America. As a result of this program and its global reach, countless lives have been saved.

This spring we will introduce the 10th Edition of ATLS. This latest version continues the tradition of innovation started by the founders of the program 40 years ago. The 10th Edition will be available in both the traditional format and electronically as part of an effort to expand the accessibility and effectiveness of the course.

Under the leadership of Sharon Henry, MD, FACS, the ATLS Subcommittee Chair, and Monique Drago, MA, EdD, ACS Trauma Education Program Manager, the College has been able to evolve the program even further, building on the foundation laid in the Ninth Edition by Karen Brasel, MD, MPH, FACS, Past-ATLS Subcommittee Chair. The 10th Edition of the ATLS program takes this revolutionary program to the next level.

ATLS is as iconic as any program that the College has produced, and given the number of lives it has saved, it should probably be awarded a Nobel Prize. All this progress began with a handful of physicians who 40 years ago identified a void in patient care, and with passion and commitment, the College’s leadership filled that gap. It is one of my fondest hopes that other surgeons will be inspired to apply this model in their quest to improve patient care in all of the surgical disciplines.

If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at lookingforward@facs.org.

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