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Aeroplane crash experience in Nebraska leads pilot to develop worldwide improvements in trauma treatment
What is the number one killer of people under the age of 40 in the United States of America? AIDS, cancer or even drug and alcohol–related deaths might come to mind, but serous injury, from accidents or acts of violence represent the leading cause of premature death according to the American Trauma Society, writes Nick Adams.
The Society, and modern trauma care, has its origins in the United States in 1976, when a doctor piloting a light aircraft crashed his plane into a field in Nebraska. His wife was killed instantly and three of his four children received critical injuries. But the medical treatment provided to his children was 'haphazard' and he was appalled.
The event spurred him to change the way in which the State trauma care was delivered and these developments have since spread throughout the world.
Various medical, emergency medical [ambulance] services and nursing groups in the Nebraska region began to collate a set of protocols for the management of trauma patients. These were then taken–up and modified by the American College of Surgeons in 1980 and published as the Advanced Trauma Life Support manual – the modern day bible for trauma care.
In general, the Society says, every physician and surgeon involved in the management of the injured patient should have been through an Advanced Trauma Life Support [ATLS] course. It sets–out a safe, systematic approach to the seriously injured patient that can be followed by any doctor.
Ideally, there will be a team of doctors and nurses under a senior emergency physician who will take a co–ordinated and multi–disciplinary approach to provide immediate care to stabilise the patient.
The skills of emergency medical and ambulance services have developed hugely and the importance of 'aggressive' treatment in the first hour after an incident, called the 'golden hour', is enshrined into ALTS.
But what happens thereafter is also vitally important and depends on the capability of a hospital and its medical professionals to handle complex, major trauma cases. Studies show that the best outcomes happen in hospitals with major trauma centres with a staff of highly trained doctors, from all surgical specialties, with a commitment to this aspect of their work.
Not surprisingly, the some of the finest trauma care is found in some of the world's most dangerous and violent places. For example, Johannesburg in South Africa has a world–renowned trauma centre at its metropolitan hospital, while Tel Aviv in Israel also boasts great expertise in this field.
But terrible injuries sustained in a car crash in rural England can be as life threatening as a gunshot wound sustained in Soweto, and the challenge for professional bodies is to provide expertise in trauma care, whenever and wherever it is needed, so that more lives can be saved.
This challenge has been taken–up by the biggest trauma organisation outside of the US, the International Association for the Surgery of Trauma and Surgical Intensive Care. Part of the International Society of Surgery, based–in Basel, Switzerland, it serves as a forum for trauma surgeons worldwide.
In association with the World Health Organization, it has developed the Essential Trauma Care Project, which aims to improve trauma care across the globe in a low–cost fashion by better organisation, planning and training.
The project has already been used in pilot fashion in several countries, such as Ghana, Mexico, Vietnam and India, and the Trauma Society of South Africa has called for its urgent implementation.
The Association also supports the Definitive Surgical Trauma Care course, developed by the Royal College of Surgeons of England with the Royal Defence Medical College and the Uniformed Services University of the Health Sciences in the United States.
Recently, the Royal College of Surgeons of England launched a course to teach civilian and military surgeons how to deal more effectively with complex injuries caused by gun, knife and motor vehicle trauma. Some of the world's leading trauma surgeons were on–hand to teach emergency, life–saving techniques in advanced resuscitation, chest and heart surgery and vascular surgery to their British colleagues, who do not normally receive such training in trauma surgery. [See feature at: www.communicatormentalhealth.org/180607features1.htm].
Courses such as this combine the surgery of war with civilian surgical practice. Indeed, it has often been said that the only thing which advances in war is surgery – and there is evidence to support this.
For example, some of the 20th century’s major conflicts, the first and second world wars, Korea and North Vietnam, have given general surgeons more opportunities to perform emergency intestinal surgery, blood transfusions, the surgery of repairing blood vessels along with plastic and reconstructive surgery have been pioneered or perfected.
There are also the psychological consequences of trauma, the best known of which are probably shell–shock experienced by soldiers in the First World War and more recently Post Traumatic Stress Disorder, which has received considerable attention from healthcare professionals in recent years. The stigma and shame associated with mental health problems such as these has declined as they have gained recognition and attitudes have changed.
As a growing consensus of opinion calls for trauma care to receive more support and recognition, President Bush recently signed into law the Trauma Care Systems Planning and Development Act of 2007, to expand effective trauma care to all areas of the United States, which suggests trauma care is on the political agenda in the country where advanced trauma life support was developed.
Infolink: For further information visit the following websites at The American Trauma Society: www.amtrauma.org. The American College of Surgeons: www.facs.org. The Royal College of Surgeons of England: www.rcseng.ac.uk. The International Association for the Surgery of Trauma and Surgical Intensive Care: www.trauma.org.
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