Skip to main content
SpringerLink
Log in

Advanced Trauma Life Support® – ein Versorgungsstandard für Deutschland?

Keine wesentliche Verbesserung der Versorgung zu erwarten

Advanced Trauma Life Support® – A standard of care for Germany?

No substantial improvement of care can be expected

  • Notfallmedizin
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

In den letzten 30 Jahren hat sich der Advanced-Trauma-Life-Support®- (ATLS®-)Kurs zum erfolgreichsten Trainingsprogramm weltweit in der Frühversorgung von Schwerverletzten entwickelt. Es hat in vielen Ländern Traumaversorgungssysteme geprägt und ist nun im Begriff in Deutschland von der Deutschen Gesellschaft für Unfallchirurgie (DGU) eingeführt zu werden. Nach dem Erscheinen der letzten Auflage im Jahr 2004 wurde ATLS jedoch zunehmend wegen mangelhafter Interdisziplinarität, überholter Inhalte und fehlender Anpassbarkeit an regionale Bedürfnisse kritisiert. Dieser Artikel hinterfragt den Nutzen von ATLS® für das deutsche Traumaversorgungssystem und kommt zu dem Schluss, dass ATLS® wahrscheinlich keinen Beitrag zur Verbesserung der Traumaversorgung in Deutschland leisten kann.

Abstract

Over the last 30 years the Advanced Trauma Life Support (ATLS®) course has become the most successful training program in the world for the early care of severely injured patients. It has shaped trauma care systems in many countries and is now on the verge of being introduced into Germany by the German Society of Trauma Surgery (DGU). However, after publication of the latest edition in 2004 there are rising concerns regarding the lack of multi-disciplinarity, out-dated contents and lack of adaptability to regional needs. This article questions the beneficial effect of ATLS® on the advanced German trauma care system and concludes that ATLS is not likely to improve trauma care in Germany.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Adam R, Stedman M, Winn J et al. (1994) Improving trauma care in Trinidad and Tobago. West Indian Med J 43: 36–38

    PubMed  CAS  Google Scholar 

  2. Albert J, Phillips H (2003) Trauma care systems in the United Kingdom. Injury 34: 728–734

    Article  PubMed  Google Scholar 

  3. Ali J, Adam R, Butler AK et al. (1993) Trauma outcome improves following the advanced trauma life support program in a developing country. J Trauma 34: 890–898

    PubMed  CAS  Google Scholar 

  4. Bouillon B, Kanz KG, Lackner CK et al. (2004) Die Bedeutung des Advanced Trauma Life Support® (ATLS® im Schockraum). Unfallchirurg 107: 844–850

    Article  PubMed  CAS  Google Scholar 

  5. Campbell B, Heal J, Evans S et al. (2000) What do trainees think about advanced trauma life support (ATLS)? Ann R Coll Surg Engl 82: 263–267

    PubMed  CAS  Google Scholar 

  6. Collicott PE (1979) Advanced Trauma Life Support Course, an improvement in rural trauma care. Nebr Med J 64: 279–280

    PubMed  CAS  Google Scholar 

  7. Collicott PE, Hughes I (1980) Training in advanced trauma life support. JAMA 243: 1156–1159

    Article  PubMed  CAS  Google Scholar 

  8. Davies G, Deakin C, Wilson A (1996) The effect of a rigid collar on intracranial pressure. Injury 27: 647–649

    Article  PubMed  CAS  Google Scholar 

  9. Davis M (2005) Should there be a UK based advanced trauma course? Emerg Med J 22: 5–6

    Article  PubMed  CAS  Google Scholar 

  10. Demetriades D, Chan LS, Bhasin P et al. (1998) Relative bradycardia in patients with traumatic hypotension. J Trauma 45: 534–539

    PubMed  CAS  Google Scholar 

  11. Driscoll P, Wardrope J (2005) ATLS: past, present, and future. Emerg Med J 22: 2–3

    Article  PubMed  CAS  Google Scholar 

  12. Empfehlungen zur Erstversorgung des Patienten mit Schädel-Hirn-Trauma bei Mehrfachverletzung. http://www.dgai.de/06pdf/05_299-Notfallmed.pdf

  13. Graham CA, Sinclair MT (1996) A survey of advanced trauma life support training for trainees in acute surgical specialities. Injury 27: 631–634

    Article  PubMed  CAS  Google Scholar 

  14. Gwinnutt CL, Driscoll PA (1995) Advanced Trauma Life Support. Eur J Anaesth 3: 95–101

    Google Scholar 

  15. Hamilton-Davies C, Mythen MG, Salmon JB et al. (1997) Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry. Intensive Care Med 23: 276–81

    Article  PubMed  CAS  Google Scholar 

  16. Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgemeinschaften. Programm für nationale Versorgungsleitlinien. http://www.delbi.de/

  17. Trauma Audit & Research Network. https://www.tarn.ac.uk/Login.aspx

  18. Hilbert P, Hoeller J, Wawro W et al. (2005) Emergency room management of multiple injured patients. A multislice computed tomography orientated treatment algorithm. Anasthesiol Intensivmed Notfallmed Schmerzther 40: 720–725

    Article  PubMed  CAS  Google Scholar 

  19. Jemmett ME, Kendal KM, Fourre MW, Burton JH (2003) Unrecognized misplacement of endo-tracheal tubes in a mixed urban to rural emergency medical services setting. Acad Emerg Med 10: 961–965

    Article  PubMed  Google Scholar 

  20. Jones JH, Murphy MP, Dickson RL et al. (2004) Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Acad Emerg Med 11: 707–709

    Article  PubMed  Google Scholar 

  21. Katz SH, Falk JL (2001) Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med 37: 32–37

    Article  PubMed  CAS  Google Scholar 

  22. Kwan I, Bunn F, Roberts I, on behalf of the WHO Pre-Hospital Trauma Care Steering Committee (2003) Timing and volume of fluid administration for patients with bleeding (Cochrane Review). The Cochrane Library, Issue 3, Oxford, Update Software

  23. Kwan I, Bunn F, Roberts I, on behalf of the WHO Pre-Hospital Trauma Care Steering Committee (2004) Spinal immobilisation for trauma patients (Cochrane Review). The Cochrane Library, Issue 3, Wiley & Sons, Chichester, UK

  24. Landelijk Protocol Ambulancezorg (2005) Stichting LAMP. Zwolle

  25. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgemeinschaften (2002) Leitlinie Polytrauma http://www.uni-duesseldorf.de/awmf/ll-na/012-019.htm

  26. Mackway-Jones K, Foex BA, Kirkman E, Little RA (1999) Modification of the cardiovascular response to haemorrhage by somatic afferent nerve stimulation with special reference to gut and skeletal muscle flow. J Trauma 47: 481–485

    PubMed  CAS  Google Scholar 

  27. McKeown D (2005) Should the UK develop and run its own advanced trauma course? Emerg Med J 22: 6–7

    Article  PubMed  CAS  Google Scholar 

  28. Nolan JP (2005) Advanced trauma life support in the United Kingdom: time to move on. Emerg Med J 22: 3–4

    Article  PubMed  CAS  Google Scholar 

  29. Nolan J (2001) Fluid resuscitation for the trauma patient. Resuscitation 48: 57–69

    Article  PubMed  CAS  Google Scholar 

  30. Nolan J (2007) Training in trauma care moves on – The European Trauma Course. Resuscitation 74: 11–12

    Article  PubMed  Google Scholar 

  31. (2002) Politieauto wordt cabriolet. De Telegraaf 18.12.2002

  32. Sander-Jensen K, Secher NH, Bie P et al. (1986) Vagal slowing of the heart during haemorrhage: observations from 20 consecutive hypotensive patients. BMJ 292: 364–366

    Article  PubMed  CAS  Google Scholar 

  33. Riddez L, Hahn RG, Brismar B et al. (1997) Central and regional haemodynamics during acute hypovolaemia and volume substitution in volunteers. Crit Care Med 25: 635–640

    Article  PubMed  CAS  Google Scholar 

  34. Sauerland S, Waydhas C, Raum MR, Neugebauer E (2002) Systematische Literatursuchen in der Erstellung klinischer Leitlinien am Beispiel der prä- und frühklinischen Versorgung polytraumatisierter Patienten. Unfallchirurg 105: 1022–1026

    Article  PubMed  CAS  Google Scholar 

  35. Sims JK (1979) Advanced Trauma Life Support Laboratory: pilot implementation and evaluation. JACEP 8: 150–153

    PubMed  CAS  Google Scholar 

  36. Shakiba H, Dinesh S, Anne MK (2004) Advanced trauma life support training for hospital staff. Cochrane Database Syst Rev 3: CD004173

    PubMed  Google Scholar 

  37. Styner JK (2006) The birth of Advanced Trauma Life Support (ATLS). Surgeon 4: 163–165

    Article  PubMed  CAS  Google Scholar 

  38. Duis HJ ten, Werken C van der (2003) Trauma care systems in the Netherlands. Injury 34: 722–727

    Article  PubMed  Google Scholar 

  39. Thies KC (2004) ATLS – Mit Blaulicht in die Sackgasse? Dtsch Arztebl 101: A-1874

    Google Scholar 

  40. Thies K, Gwinnutt C, Driscoll P et al. (2007) The European Trauma Course – From concept to course. Resuscitation 74: 135–141

    Article  PubMed  Google Scholar 

  41. Olden GD van, Meeuwis JD, Bolhuis HW et al. (2004) Clinical impact of advanced trauma life support. Am J Emerg Med 22: 522–525

    Article  PubMed  Google Scholar 

  42. Gödecke A von, Keller C, Völckel WG et al. (2006) Mask ventilation as an exit strategy of endotracheal intubation. Anaesthesist 55: 70–79

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: K.C. Thies ist Vorsitzender der European Trauma Working Group, die den „Europäischen Traumakurs“ entwickelt.

Author information

Authors and Affiliations

  1. Anaesthetics Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, U. K.

    K.-C. Thies

  2. Dept. of Anesthesiology, Washington University School of Medicine, St. Louis, U.S.A

    P. Nagele

  3. Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Wien, Österreich

    P. Nagele

Authors
  1. K.-C. Thies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Nagele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K.-C. Thies.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thies, KC., Nagele, P. Advanced Trauma Life Support® – ein Versorgungsstandard für Deutschland?. Anaesthesist 56, 1147–1154 (2007). https://doi.org/10.1007/s00101-007-1254-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-007-1254-1

Schlüsselwörter

Keywords

Search

Navigation