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Advanced trauma life support: back to basics
  1. S Bishara
  1. Mr S Hishara, Department of Physiology, University College London, Rowland Hill Street, London NW3 2PF, UK; s.bishara{at}

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The Advanced Trauma Life Support (ATLS) course aims to provide a universal framework for the management of trauma that will lead to a reduction in patient mortality. While it has achieved great success in global uptake, there is conflicting evidence of its benefit to patients.1 2

ATLS has great scope as it is designed for doctors practising away from the trauma centre in the USA and, as such, many candidates are presented with an unfamiliar expanded role—paramedic, emergency doctor, anaesthetist, crash site/crime scene investigator. Fortunately, for most, these roles would be divided and, as a result, most doctors will never be proficient at all of the techniques taught on the course.

The current course manual, which is the seventh version, was revised in 2004 and lacks a current evidence base. Of the 299 articles cited, only 49 have been published in the last 10 years. An example of outdated thinking is seen in the emphasis that is placed on learning the changes in physiological parameters that arise out of different classes of shock, based on estimated degrees of blood loss. Such data can only be accurately and ethically generated from anaesthetised animal models,3 and their applicability to clinical practice is questionable. As the baseline physiology and responses of patients are variable and continuous monitoring is readily available, fluid resuscitation guidelines based on measurable parameters rather than immeasurable blood loss would be easier to test.

ATLS is for doctors only; frontline medical professionals such as paramedics are excluded from certification. However, if the course is to remain universal, focus on generic skills seems sensible given the trend in modern medicine for greater subspecialisation. The controversies that arise from tackling issues relating to specialist care—where there may be little compelling evidence—can be avoided and left to local expertise until the evidence becomes available.



  • Competing interests: None.