ATLS Training Programs in Albania: Our Experiences and Challenges in Implementation

ABSTRACT Background: Albania faces a substantial trauma burden, with road traffic injuries, falls, and interpersonal violence constituting the leading causes of morbidity and mortality. Prior to 2015, trauma care lacked standardized protocols, structured training, and simulation-based education, resulting in wide variability in practice and a preventable death rate approaching 35%. To address these deficiencies, the Advanced Trauma Life Support (ATLS) program was introduced as a national strategy to standardize early trauma management. Methods: Following a national needs assessment, ATLS implementation was initiated through collaboration with the American College of Surgeons Committee on Trauma and European ATLS centers. The program was launched in 2022 with international faculty, followed by structured instructor development and progressive localization. Barriers—including financial constraints, limited faculty, infrastructural gaps, language barriers, and resistance to change—were addressed through negotiated licensing, governmental support, local instructor training, development of simulation capacity, bilingual materials, and stakeholder engagement. Results: Between 2022 and 2025, ten ATLS courses were conducted, training more than 110 healthcare providers and certifying ten Albanian instructors. The program achieved self-sufficiency with regular national delivery and regional outreach. Implementation was associated with a 40% reduction in preventable trauma deaths, a 60% decrease in time to definitive treatment, improved completion of primary surveys, and a marked reduction in missed injuries. System-level changes included standardized trauma team activation, structured handovers, and trauma bay reorganization. Conclusions: ATLS implementation in Albania demonstrates that structured, evidence-based trauma education is feasible and transformative in resource-constrained settings. Success depends on strong partnerships, local capacity building, cultural adaptation, and data-driven advocacy. Integrating ATLS into national training pathways can sustainably improve trauma outcomes and serve as a scalable model for similar health systems. Keywords: ATLS; trauma education; capacity building; low- and middle-income countries; trauma systems; simulation-based training; emergency surgery;