When the Advanced Trauma Life Support (ATLS) was introduced into the United Kingdom in 1988 it revolutionised trauma training for doctors who were expected to treat seriously injured patients. The American College of Surgeons’ Committee on Trauma (ACS COT) had compiled a course manual that, in the main, represented state of the art practice in the treatment of major trauma. The style of teaching was refreshing; indeed, much of medical education in the UK has evolved into the same scenario based interactive format. I had the opportunity to take the course in Baltimore, Maryland in 1989. In the following year, as an attending anaesthesiologist at the Shock Trauma Center in Baltimore, I was then able to see the teaching applied while resuscitating seriously injured patients covering the range of blunt and penetrating trauma. I gained my ATLS instructor status while in Baltimore and taught on two provider courses there before returning to the UK. When I started teaching on ATLS courses in the UK in 1991, I was immediately impressed by the highly interactive format and strict adherence to core content; both of these features were different from my experience on courses in United States.

Although ATLS is considered an international course, and is run in at least 23 countries (http://www.facs.org/meetings_events/atls/region15.html), the course content is controlled entirely by the ACS. Like many of the early ATLS instructors in the UK, I was led to believe that our constructive comments would be fed back to the ACS COT and that this feedback would be taken into consideration when revising the course core …