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 (ATLSŪ) 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.