What is advanced trauma life support?

Advanced trauma life support, also known as ATLS, is a method used by medical professionals to immediately assess and treat injured patients.

The ATLS programme was adopted by the American College of Surgeons (ACS) in 1980 and delivered to healthcare professionals by the American College of Surgeons Committee on Trauma. Today, advanced trauma life support has been taught to more than 1 million doctors, and is used in more than 80 countries. 

According to the American College of Surgeons, ATLS offers an organised approach for evaluating and managing seriously injured patients, and works on the assumption that the doctor who first attends to an injured patient has the greatest opportunity to impact the patient’s health outcome.

By learning and adhering to the advanced trauma life support method and course manual, a doctor or health professional working with an injured patient will be equipped to:

1. Assess the patient’s condition quickly and accurately.
2. Resuscitate and stabilise the patient according to priority.
3. Determine if the patient’s needs exceed a facility’s capacity.
4. Arrange appropriately for the patient’s inter-hospital transfer.
5. Ensure optimum care is provided, and the level of care does not deteriorate at any point during the evaluation, resuscitation, or transfer process.

“For doctors and other qualified healthcare professionals who infrequently treat trauma, the ATLS course provides an easy-to-remember method for evaluating and treating the victim of a traumatic event,” the ACS states. “For doctors and other qualified healthcare providers who treat traumatic disease on a frequent basis, the ATLS course provides a scaffold for evaluation, treatment, education, and quality assurance. In short, ATLS is a measurable, reproducible, and comprehensive system of trauma care.”

The ATLS programme was introduced in the United Kingdom in 1988 and is delivered by the Royal College of Surgeons of England. It now trains thousands of UK clinicians each year.

What are the three phases of advanced trauma life support?

There are three general phases used in advanced trauma life support. These are typically called surveys – the primary survey, secondary survey, and tertiary survey.

Primary survey

The primary survey identifies life-threatening injuries while simultaneously starting resuscitation if necessary. Initial management is focused on major trauma interventions and stabilising patients’ vital signs.

Primary surveys are typically conducted at the scene of a patient’s injury, prehospital, to provide critical care and stabilise patients for transfer to an A&E or emergency department, trauma centre, or other healthcare facility.

It is during the primary survey that advanced trauma life support protocol is followed. 

What is advanced trauma life support protocol?

Advanced trauma life support protocol dictates the steps taken during the primary survey. These steps are typically remembered using the mnemonic ABCDE:

• Airway management and cervical spine control
• Breathing and ventilation
• Circulation and haemorrhage control
• Disability and neurologic function
• Exposure and environmental control

Secondary survey

The secondary survey begins after:

• the primary survey is completed
• resuscitation efforts are established
• the patient’s vital signs are normalising or maintained.

The secondary survey includes a head-to-toe physical and historical evaluation of the trauma patient, and is used to determine and prioritise treatment plans. During the secondary survey’s patient assessment, each area of the patient’s body is examined for injury, and the medical professional may order additional labs and tests, such as:

• blood type tests
• pregnancy tests
• drug screenings
• urinalysis
• x-rays

Tertiary survey

The tertiary survey follows the primary and secondary surveys to provide a close, careful examination and assessment of trauma patients to detect any undiagnosed injuries or issues that were missed during the first two phases of advanced trauma life support.

Why is ATLS important?

To understand the importance of advanced trauma life support in emergency medicine and medical education, it’s helpful to understand its history.

The ATLS method was initially developed by James K. Styner, an orthopaedic surgeon and now a Fellow of the American College of Surgeons (FACS), following a plane crash that killed his wife, and injured his four children as well as himself. Despite his injuries, Styner carried out an initial assessment and triage of his children at the site of the crash, and then walked miles to find transport to the nearest hospital – which was closed. Even once under emergency care, Styner found the treatment of his family was insufficient and he resolved to develop a reliable method for trauma management to help healthcare providers who handle traumatic injury situations.

Styner’s initial advanced trauma life support course was introduced in 1978, and just two years later the student course was adopted by the American College of Surgeons before spreading to dozens of other countries.

Now, the ATLS method forms the standard practice for treating injured patients. Understood and adopted by healthcare professionals around the world – from medical students to trauma teams and general surgeons – it provides a universal standard of care in emergency situations. There are different levels of ATLS training available, as well, with healthcare provider courses as well as instructor courses available for those who want to train other medical professionals in ATLS.

What is the difference between ATLS and ACLS?

The advanced trauma life support method was developed using a similar model to the advanced cardiac life support (ACLS) method. 

While ATLS is focused on treating life-threatening injuries, ACLS outlines definitive care guidelines to be followed in the event of treating urgent, life-threatening cardiovascular conditions – particularly conditions that impact heart functionality and have caused, or are likely to cause, cardiac arrest.

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