ATACC Manual – Quality FOAMed

For those of you have been reading KIDocs over the past year or so will know that I am a harsh critic of the ATLS course (EMST in Australia). Not because I think it’s pants – it’s not. It does what it says on the tin, namely it teaches a basic approach to trauma management for the single responder in a community hospital. The A-B-C-D-E approach is easily taught and easy to recall under times of stress. I have no doubt that the ATLS course has done a world of good in bringing structure to trauma care worldwide.

I’ve been teaching on ATLS-EMST since 2006 and a course Director here in Australia for the past few years. In recent times I’ve seen how quickly FOAMed can narrow the ‘knowledge translation’ gap from concept to practice – and become increasingly frustrated that the ATLS-EMST manual doesn’t really address nuances of modern trauma care.

It should be borne in mind that the ATLS-EMST course is considered mandatory for credentialling in many hospitals. Like many other courses (APLS, ELS, ALSO, ALS) I think this is fine when setting a minimum standard. However it frustrates me that experienced clinicians are expected to repeat these ‘alphabet’ courses every few years.

Don’t get me wrong – I am not saying that experienced clinicians don’t need regular updates and ‘benchmarking’ – but it would be good if the content of the course built upon the basics, not just repeated the entry-level content. I have heard that post-Fellowship emergency physicians in the UK have been required to complete an ATLS course as part of revalidation – when the skills that they apply in their day-to-day job far outstrip those taught on ATLS.

And of course, successful trauma management isn;t just about knowledge and procedural skill. It requires an understanding of how a trauma team functions. We’ve all seen dysfunctional trauma teams, despite the individual excellence of the clinicians, dysfunction arises because of a complex interplay including human factors.

Last year the Australians kicked off the Emergency Trauma Management course (ETMcourse), which is aimed not to replace ATLS-EMST, but to offer content that includes cutting edge FOAMed good ness as well as apply principles of teamwork (clearly human factors are important in how a trauma team functions – or fails). You can read a review of the ETMcourse here.

Other courses such as the anaesthetists EMAC and the retrievalists STAR courses also explore some of these aspects, as well as more challenging scenarios – details on available courses here.

 

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Introducing the Anaesthesia, Trauma & Critical Care Course (ATACC)

But there is another course – the ATACC course. I’d heard about this via doctors.net.uk and been in touch with the course organisers with a view to trying to get a course ‘down under’….which might be difficult! ATACC has an excellent reputation in the trauma world, for teaching real life scenarios in multi-disciplinary team. I am busting to attend one of these courses if I can get back to the UK

The ATACC Faculty include not just clinicians, but also luminaries of extrication such as Ian Dunbar (of the Holmatro extrication techniques app and book fame). Similarly the course is open to all – doctors, nurses, paramedics, physicians assistants, operating department practitioners – anyone who is involved in trauma. A far cry from the College of Surgeon’s ‘Advanced Trauma Life Support Course – for doctors’.

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ATACC Faculty includes Ian Dunbar (@Dunbarian) author of the excellent extrication manual sponsored by Holmatro – also available as a truly interactive app/iBook – worth every penny for anyone interested in prehospital care

 

ATACC Manual Available as FOAMed – PDF or iBook versions

 

So mega-kudos to the ATACC mob for launching their course manual as FOAMed – I’ve just got my hands on a copy and I can attest that it is thoroughly excellent.

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The PDF copy is available here

http://www.atacc.co.uk/e-learning/

or in iBook format via iTunes here

https://itunes.apple.com/us/book/anaesthesia-trauma-critical/id917866158?ls=1&mt=13

I cannot begin to tell you how good this manual is – it covers modern trauma management, is interactive and authoritative. It covers the usual trauma stuff, but is packed with some extra nuggets – I am a big fan of the MARCH approach and was pleased to see this included, along with some other adjuncts to haemorrhage control including haemostatic agents, clamps and the like. Up to date controversies (#dogmalysis) on topics such as cervical spine immobilisation are also covered – and my understanding is that content will be regularly updated.

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The ITclamp for haemostasis
The MARCH approach to roadside trauma
The MARCH approach to roadside trauma

One of the strengths of the manual is that it covers trauma from the roadside, through retrieval, the ED and to ICU. It’s trauma run by traumatologists (did I just say that? Bah!) – not by surgeons. As such I recommend it to anyone involved in trauma care – prehospital clinicians & retrievalists, rural docs, EM types, anaesthetists, doctors, nurses, paramedics…

Awesome
Everything is Awesome When You Are Part of A (Trauma) Team

That the authors have made it freely available as FOAMed is truly humbling! I remember that it was only a couple of years ago that ATLS made their course manual available for non-attendees…and they still charge a packet for the hardcopy. There is an ATLS app – but the less said about that, the better.

The ATACC manual is true FOAMed – quality medical education, up-to-date and freely available because the ATACC mob believe in what they do.

Kudos to you. Seriously.

Loving the section on cervical collars - mentions the Brisbane protocol, decision-making rules, clearance in ICU etc
Loving the section on cervical collars – mentions the Brisbane protocol, decision-making rules, clearance in ICU etc

I’ll let you know if I ever get to an ATACC course in the UK and review it online. From what I’ve heard and seen of the manual, the three day intensive course must be orders of magnitude of awesomeness!

Meanwhile, I will leave you with this thought on the 9th edition of ATLS-EMST (attribution unknown, apologies)

...seriously - does EVERY trauma patient need a rectal exam? ATLS dogma still says YES (except on courses I direct)
…seriously – does EVERY trauma patient need a rectal exam? ATLS dogma still says YES (except on courses I direct)

8 Comments

  1. Truly kind words Tim, thank you! We are all clearly speaking the same language across the globe with true passion for our work.

    Huge thanks to all of the Faculty who have and still are contributing and updating the manual, but special thanks to Jason Van Der Velde and Pete Lax for making this happen.

    The free ATACC course place is here waiting for you buddy when you step off that plane!

    Best wishes
    Mark

    Reply
    • It will be in a couple of days – we’re just clearing some technical hurdles with the iBooks store and the final manual is in review with Apple, so it should be online worldwide by Wednesday hopefully….

      Reply
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  3. I’m not sure what to think of this type of access. What was the problem with the I/O’s, did they try bilateral humeral? Why couldn’t they get access in subclavian or femoral vv?

    I guess for me I’ve used the belmont through a well functioning humeral I/O (100 cc/min), so I’m not sure this cut down would be my first/second or third choice. Also this isn’t a super sterile procedure, so maybe throwing a clean probe on the groin (not wasting time with sterility) and getting access that way seems like it would be equally as fast as the cut down for an ED/ICU doc (maybe a trauma surgeon could get access the way described here more quickly?) I’m speculating since Ive never gotten access via saphenous cutdown.

    Reply
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