Outcomes of advanced trauma life support training: questioning the role of observer

Trauma is the leading cause of mortality in young adults in the United Kingdom. Many such deaths are preventable if patients are treated effectively. Delay in providing care by experienced, trained staff is seen as a major factor in unsatisfactory trauma management. In order to reduce the number of deaths, the Advanced Trauma Life Support (ATLS) system has been recommended for use in the management of patients with major injuries. However, there is little evidence to support the participation of nurses in the ATLS system. The aim of this study was to investigate the influence of ATLS training on the performance of nurses in Accident and Emergency, taking account of experience and intuition. Results suggest that the Trauma Nursing Core Course and the Advanced Trauma Nursing Course have a positive influence on nurses' performance. Experienced staff who had received full, participative ATLS training demonstrated an improved understanding of the trauma situation resulting in rapid and accurate decision-making. However, attending the ATLS course as an observer appears to have minimal effect on a nurse's performance and such non-participant training should no longer be considered as equivalent to participant training.     

Clinical impact of advanced trauma life support

The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons Committee On Trauma (ACSCOT) presents a standardized method of initial trauma care. This study attempted to measure any changes in morbidity and mortality in trauma patients after the introduction of ATLS training. Over a 3-year period (May 1996 to September 1997-pre-ATLS period; December 1997 to April 1999-post-ATLS period), 63 trauma patients with an Injury Severity Scale (ISS) > or =16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community teaching hospitals. There was no significant difference in mortality rate between groups (48% [15 of 31] pre-ATLS vs. 30% [10 of 32] post-ATLS; P = .203, Fisher exact test). Mortality rates within the ISS range of 16 to 25 were 64% (nine of 14 pre-ATLS) versus 29% (five of 17 post-ATLS), and for the ISS 26 to 35 subgroup, 40% (four of 10 pre-ATLS) versus 25% (two of eight post-ATLS), and within the ISS 36 to 75 subgroup, 29% (two of seven pre-ATLS) versus 43% (three of seven post-ATLS). There was a significant difference in mortality during the first 60 minutes after admission: 0.0% post-ATLS versus 24.2% pre-ATLS (P = .002, Fisher exact test (95% confidence interval ranged from 12-45% in the pre-ATLS group and 0-11% in the post-ATLS group). According to the TRISS methodology (a worldwide-accepted mathematical method to calculate chances of survival through logistical regression),ATLS improved outcome from sub-"Major Trauma Outcome Study" (MTOS) standard results (z = -2.9 to a MTOS standard result z = -0.49). Our data demonstrate that introduction of the ATLS program significantly improved trauma patient outcome in the first hour after admission, as well as improvement from sub-MTOS standard to MTOS standard levels.     

On-scene time in advanced trauma life support by anaesthesiologists.

OBJECTIVES: Severe injury is the leading cause of death among the young. Trauma systems have improved management of the severely injured and increased survival rates, but there is no level-1 evidence of advanced prehospital trauma care. Advanced prehospital trauma care prolongs on-scene time, which may imply a risk of significant delay in definitive trauma care. The aim of this study was to evaluate on-scene time and influence of (1) the presence of an anaesthesiologist on-scene, (2) prehospital intubation, (3) entrapment, and (4) injury severity. METHODS: A cohort of registry-based patients brought to Aarhus Trauma Centre. Data were consecutively reported. On-scene time was defined as the time from vehicle arrival to departure. Severe injury is defined by an injury severity score >15. The study was conducted over the period 1998-2000; only patients brought primarily to the trauma centre were included. Statistical tests used include chi, Kruskal-Wallis, Wilcoxon's rank sum and Spearman's rho. RESULTS: Seven hundred and forty-one patients triaged to Aarhus Trauma Centre from which we obtained all information in 596 cases constituted the study group. In 472 cases, an anaesthesiologist was present. On-scene times, median and 95% confidence interval, were as follows: entire study group (n=596) 15.5 min (15-17); ambulance only: 14.0 min (12-15); anaesthesiologist present, no intubation, no entrapment: 15.0 min (14-16); intubation, no entrapment: 21.5 min (16-27); entrapment, no intubation: 21.5 min (17-25); both intubation and entrapment: 22.0 min (16-36). CONCLUSION: The presence of an anaesthesiologist prolonged the median on-scene time by 1 min and in cases of prehospital intubation by 7.5 min. This result was no different from the prolongation caused by entrapment.     

Advanced trauma life support

The care of the trauma patient is a complex undertaking involving multiple health care professionals and represents one of the greatest challenges to any physician. There is perhaps no greater opportunity to have a positive impact on patient care than in the care of these patients. By adhering to a systematized and prioritized approach, the chances of the patient's survival with decreased morbidity are dramatically improved. It is the physician's responsibility both to provide the best care he or she is capable of delivering and to oversee the care delivered by other professionals. With proper motivation and experience, the physician's care of trauma patients will continually improve. This will lead to a rewarding experience for the patient and the physician alike.     

Review of effective advanced cardiac life support training using experiential learning

Aims and objectives. This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training. Background. The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains – how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner‐centred education techniques are required. Method. A review of available literature regarding ACLS training has been conducted for this discussion. Data sources and selection: MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English‐language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed. Results. There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result. Conclusions. The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim. Relevance to clinical practice. It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes.     

Pediatric advanced life support

Important changes or points of emphasis in the recommendations for pediatric advanced life support are as follows. In infants and children with no signs of life, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds. New evidence documents the important role of ventilations in CPR for infants and children. Rescuers should provide conventional CPR for in-hospital and out-of-hospital pediatric cardiac arrests. The initial defibrillation energy dose of 2 to 4J/kg of either monophasic or biphasic waveform. Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position.     

Developing leaders for advanced life support: evaluation of a training programme

AIM: To evaluate the effectiveness of a leadership development seminar introduced into the Resuscitation Council (UK) Advanced Life Support (ALS) Provider course. METHODS: Observational assessments of leadership performance during cardiac arrest scenarios before and after a leadership seminar. RESULTS: The leadership training programme significantly improved candidates leadership performance in the training situation. CONCLUSION: A formal leadership development programme should be introduced into advanced life support courses.