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.
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’.
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.
The PDF copy is available here
or in iBook format via iTunes here
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.
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…
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.
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)