Teaching trauma management.

Teaching trauma management SirIn reference to the article on teaching trauma management in the accident and emergency department (Williams et al., 1991), we are concerned that it may per- petuate the myth that junior staff can and indeed should continue to manage critically injured patients.Many studies have shown that preventable trauma deaths can be reduced from 20-30% to less than 5% with appropriate organizational and staffing changes (Cales et al., 1985; Kreis et al., 1986).The management of major trauma presents a complexity of diagnostic and therapeutic decisions, in addition to requiring skill in multiple invasive procedures that cannot reasonably be expected of junior staff.The ATLS Programme teaches a basic approach to initial trauma care but in no way confers expertise on the participants and is therefore no substitute for management by experienced senior staff.The suggestion that an abbreviated version of ATLS might represent any type of solution to the problem of trauma care by junior doctors is unrealistic.Major trauma is a disease which demands the immediate presence of trained and experienced senior medical staff.Trauma centres, so favoured in the U.S.A., may not be a practical or economic solution in the U.K. environment with its comparatively low rates of trauma.However, redressing the serious imbalance in the ratio of junior to senior medical staff (10:1) in U.K. accident and emergency departments illustrated by Williams would improve the care of all critical and injured patients, not just those with major trauma, and must therefore represent an essential strategy.