Article Text

Download PDFPDF
Protocol compliance and time management in blunt trauma resuscitation
  1. W R Spanjersberg1,
  2. E A Bergs1,
  3. N Mushkudiani2,
  4. M Klimek3,
  5. I B Schipper1
  1. 1
    Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3
    Department of Anaesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Dr I B Schipper, Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, PO Box 2040, 3000 CA Rotterdam, The Netherlands; i.schipper{at}


Objectives: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients.

Patients and methods: All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a “minor trauma” team and patients with an RTS of less than 12 were resuscitated by a “severe trauma” team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment.

Results: From 1 May to 1 September 2003, 193 resuscitations were included. The “minor trauma” team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1–45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7–55.9). The “severe team” assessed 74 patients, with a mean ISS of 22 (range 1–59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6–44.1).

Conclusion: Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.

  • Ethics approval: Ethics approval was obtained.

Linked Articles

  • Primary survey
    Darren Walter