Trauma training in the UK: is ATLS past its ‘sell‐by date’?

ATLS has been the gold standard for management of major trauma on arrival to hospital for nearly 30 years. From its endorsement by the American College of Surgeons Committee on Trauma (ACSCOT) in 1979, approximately half a million clinicians worldwide have completed the course in more than 40 countries [1]. The success of this system has in part been attributed to the rigid framework of principles prescribed by ACSCOT. It has helped doctors of different disciplines and seniority to be able to ‘sing off the same hymn sheet’ when treating victims of major trauma, in the highly stressful environment of the resuscitation room. With differing models of practice of trauma medicine between the UK and the US, there have been calls for a UK-orientated trauma course [2, 3], and the significance, relevance and application of ATLS in its current format in the UK have been questioned [1–5]. In particular, there have been questions about whether the ATLS course is ‘fit for purpose’ in anaesthesia training, whether it represents good value for money and whether is should be necessary for career progression [5]. We carried out a postal survey of the 26 UK Regional Advisors to Schools of Anaesthesia. We asked questions regarding local ATLS training, as well as requesting subjective personal opinions. We received 19 (73%) replies. Five respondents stated that ATLS certification was not required to gain a national training number (NTN) in anaesthesia in their Deanery. Eleven respondents felt that ATLS was required during Specialist Registrar (SpR) training, but only one felt that an ATLS-qualified anaesthetist should be required to attend trauma calls, with 13 stating it was desirable. Thirteen respondents felt that ATLS courses were not good value for money. The responses suggest that opinions on ATLS training in anaesthesia are divided. With the introduction of the Acute Common Stem training programme, an ATLS course may be better delivered as part of the core knowledge required prior to specialisation. This may be consistent with the responses on the requirement for obtaining ATLS prior to gaining a NTN in anaesthesia. The results suggest that ATLS is not seen to be good value for money; the cost of the course is normally approximately £500, which is a large proportion of a trainee doctor's annual study allowance. Revalidation is necessary every 4 years, implying that SpRs may have to undertake the course at least once in their training and twice during a 7-year Specialist Training programme. The introduction of ATLS was aimed at improving trauma care in rural US hospitals, where advanced trauma and critical care help was often not available. This is not a reflection of current UK hospital practice. Schools of Anaesthesia must decide where these courses fit into training and, if required, how to incorporate them into structured training. With the imminent introduction of ‘run through’ training there may be an opportunity for change and the implementation of a tailor-made course for anaesthesia training. This may incorporate both the initial treatment of the trauma patient (as covered by ATLS) and anaesthesia and ongoing critical care.