Objective For the early recognition and management of hypovolaemic shock, ATLS suggests four shock classes based upon an estimated blood loss in percent. The aim of this study was to assess the confidence and acceptance of the ATLS classification of hypovolaemic shock among ATLS course directors and instructors in daily trauma care.

Methods During a 2-month period, ATLS course directors and instructors from the ATLS region XV (Europe) were invited to participate in an online survey comprising 15 questions.

Results A total of 383 responses were received. Ninety-eight percent declared that they would follow the ‘A, B, C, D, E’ approach by ATLS in daily trauma care. However, only 48% assessed ‘C-Circulation’ according to the ATLS classification of hypovolaemic shock. One out of four respondents estimated that in daily clinical routine, less than 50% of all trauma patients can be classified according to the current ATLS classification of hypovolaemic shock. Additionally, only 10.9% considered the ATLS classification of hypovolaemic shock as a ‘good guide’ for fluid resuscitation and blood product transfusion, whereas 45.1% stated that this classification only ‘may help’ or has ‘no impact’ to guide resuscitation strategies.

Conclusions Although the ‘A, B, C, D, E’ approach according to ATLS is widely implemented in daily trauma care, the use of the ATLS classification of hypovolaemic shock in daily practice is limited. Together with previous analyses, this study supports the need for a critical reassessment of the current ATLS classification of hypovolaemic shock.