Modern management of the injured
Before turning to retrieval, hospital reception and care of the injured it is necessary to outline the fundamental changes in the management of the injured that have taken place in recent decades. The 1988 Royal College of Surgeons of England report on the management of the multiply injured highlighted that at least one in five, and possibly as many as one in three, trauma deaths in hospital were avoidable. They further concluded that death in such cases was due to medical mismanagement at every level and throughout all specialties. Later that year the Advanced Trauma Life Support Course (ATLS®) was introduced, followed by the Advanced Trauma Nursing Course (ATNC). More recently the Pre-Hospital
Trauma Life Support Course (PHTLS) was introduced for those working in the prehospital setting. These training courses have radically altered the way in which the injured patient is perceived and managed throughout the chain of care from point of injury onwards. In this chapter concern is focused on management by surgeons in hospital. Nevertheless, readers must be aware that recovery following injury is dependent upon a collaborative approach involving health professionals throughout the chain of care. A break in the chain at any point is likely to affect outcome adversely. ATLS and its derived variants such as ATNC and PHTLS provide a framework and a common language throughout the chain.
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