I first heard of ATLS when I was a very junior consultant in anaesthesia and ICU. I had attended a meeting at which a (quite famous) intensivist had said that all major trauma patients should be anaesthetised, paralysed, intubated, have bilateral chest drains inserted, and undergo diagnostic peritoneal lavage. He claimed that this (in my view, dangerous) philosophy was taught at ATLS courses. These courses had only just been introduced to the UK, and were being supported by the Royal College of Surgeons of England.

I therefore sought out an ATLS course to attend as a confirmed sceptic. It is a tribute to the teaching and quality of that course (Guildford, since you ask) that I became convinced that ATLS, although “American” in flavour, had much to offer UK trauma care at that time. I also learnt that much of what is said in criticism of ATLS is said by people who know very little about it.

It is difficult to believe how disorganised much of the trauma care in the UK was at that time. Many small hospitals not far removed from the “community hospital” of the triage scenarios received seriously ill trauma victims with only a senior house officer in the casualty department, and no other post-registration doctor on site. Early resuscitation was haphazard and poorly coordinated.

ATLS courses, instructors, and providers began to be part …