Advanced Trauma Care (ATC) Program

Course Introduction:

The Advanced Trauma Care (ATC) Program was designed to integrate the most current science, current evidence-based practice, and leading education concepts into a unique course that prepares the participant for real world events were time is short, stress is high, and errors cannot be abided in the pursuit of provision of patient care which results in the highest level of neurologically intact and functional outcomes possible.

Identifying a standardized body of trauma knowledge has long been postulated as a method to present core-level knowledge and psychomotor skills associated with implementing the trauma patient care processes and improving patient outcomes. But this has frequently been done at individual healthcare provider levels, rather than through a systems approach to the continuum of care for the trauma patient; but clearly, educating nurses, paramedics, technicians, and physicians to provide competent trauma care, results in the morbidity and mortality of trauma patients being reduced significantly19. It is the intent of the ATC that participants in the course be given the opportunity to enhance their knowledge, refine skills, and build a firm foundation in trauma care. The World Health Organization states trauma is a major cause of death and disability in our world. It accounts for 16% of the global burden of disease and 9% of global mortality, killing more than five million people.

For decades the continuum of care in trauma patients has suffered from meaningless debate, based on bad science; this debate is fueled with dogma, such as the “golden hour" which justifies much of our current trauma system; however, when detailed literature and historical record searches are done on this concept, no actual evidence is identified. The continuum of care frequently starts in the prehospital environment, where another senseless debate on the merits of “Scoop & Run” or “Stay and Play” has existed for decades, when in reality, actual evidence points to both being equally pointless, the right balance depends on the case involved, and one approach is not applicable to all cases in the prehospital care environment, but rather an integrated bundled care approach within a greater systems approach to care within the continuum of trauma care from the prehospital through to the discharge of the patient.

While these senseless debates have continued and our continuum of care has been fraught with dogma based on poor science from 50 years ago, the science has moved on in significant ways; culminating in the 2015/2017/2020/2023 International Liaison Commission of Resuscitation and European Resuscitation Council Guidelines including an aggressive approach to Traumatic Cardiac Arrest that has never existed in prior science recommendations. Yet in late 2023, this guideline has yet to be implemented in many of our most progressive EMS and Trauma systems in the United States. The reality is that minutes to care matter! In current studies on prehospital blood product administration, earlier administration in the field resulted in higher survival rates for patients.

As illustrative of the dogma from our recent past, let’s explore further the issue of “Scoop and Run”; while it has been promoted for decades, it has been perpetrated by several erroneous dogmatic statements within a research environment that has shown both ends of the spectrum:

• “Trauma is a surgical disease”, therefore lifesaving treatment must involve a surgeon. In fact, Steele and colleagues found that emergency operative intervention occurred in only 3.0% of adults and 0.35% of children.
• “ALS intervention slows scene times”, in fact, as far back as 1991 in a study by Spaite and colleagues8 discovered that “extremely short scene times can be attained without foregoing potentially life-saving advanced life support interventions in an urban EMS system with strong medical control”; indeed, a 2000 study by Henderson and colleagues showed that patients with longer scene times and more procedures accomplished decreased time to laparotomy.
• “Advanced medical care at the scene causes harm”, in the multitude of studies on this topic, it has become clear that it is a self-fulfilling prophecy. If personnel are not well trained and have poor quality assurance it will go quite badly in a difficult and high stress environment. When the procedures are performed by well trained, physician supervised, and quality assured personnel the patient outcomes improve.

To falsely dichotomize trauma care into two absolute choices is a fool’s errand; within the trauma patient spectrum, there are a segment who require emergent surgical rescue to prevent uncontrollable hemorrhage from resulting in patient demise. But, most patients in the spectrum do not require this time sensitive intervention, and those that do, clearly benefited from prehospital interventions, such as tourniquets, airway management, and blood products.

The truth of the pointless debate on “stay or play” completely misses the actual recommendation that scene time should be minimized, on scene care limited to what is needed for resuscitation, and rapid transport with further interventions and diagnostics done enroute to an appropriate facility will a proper report that allows the continuum of care to accurately react to the actual patient condition. This is what has not been adequately researched, and no system currently do this will ever have approvals to not treat patients in a manner they have found improves outcomes for the sake of proving advanced care integrated with rapid transport works to improve outcome.

The goal of the Advanced Trauma Care (ATC) Program is to improve outcomes in complex trauma emergencies by applying the international science guidelines for trauma, encouraging critical thinking, and improving decision-making strategies. Through instruction and active participation in case-based scenarios, learners enhance their skills in the differential diagnosis and treatment of critical trauma patients; with learning targeted to the level of the learner involved, within the trauma patient continuum of care.

The ATC Program reflects the current science from the following:

• 2015/2017/2020/2023 ILCOR Guidelines
• Congress of Neurological Surgeons Science Guidelines
• American College of Surgeons – Committee on Trauma
• Guidelines for essential trauma care; World Health Organization, International Society of Surgery, Societe Internationale de Chirurgie, and International Association for the Surgery of Trauma and Surgical Intensive Care.
• Current Guidelines for Advanced Trauma Life Support in the Emergency Department; 2011, Vol 3, Number 7

This course is for advanced providers who are proficient in performing BLS and ALS skills, reading and interpreting diagnostics, and understanding pharmacology.

The program uses case-based scenarios to move beyond the algorithms and show learners how to apply critical thinking to quickly reach a differential diagnosis and effectively manage treatment. Includes more of the cases and information learners wish, including pharmacology, airway, respiratory, permissive hypotension, high risk interventions, and mixed pathology cases.

The ATC exam and pre-course materials are completed online before the start of class allowing learners more time in class to complete an assessment exam and simulation cases; this results in a structured eight-hour program focused on simulation and case studies within an instructor led environment, with the opportunity for student interaction, questions, and clarification as needed throughout the day.

The Advanced Trauma Care (ATC) Program is not focused on what is being done in a specific location right now as the standard of care, but what the science indicates could be done to improve patient outcomes!

Accreditation:

The course is CAPCE and GEMR accredited for CME and/or endorsement

Exam:

The ATC Exam is completed pre-course through online testing, the participant must obtain a score of 84% or greater on the exam. The participant should review all pre-course materials and the course workbook prior to taking the exam.

Instructional Format:

Integrative review materials, practical skills lab, and immersive simulation case study. The program runs a full eight-hour class session.

Participation Expectations:

In order to receive continuing medical education (CME), a registered participant must be present for all scheduled hours and be engaged in the interactive discussions, case reviews and knowledge evaluation.

Participants will successfully:

• Complete the pre-course ATC exam after materials review.
• Complete skills stations on airway management, needle decompression, simple thoracostomy.
• Complete five trauma cases managements as a team member and/or leader.

Course completion:

Having met the Participation Expectations listed above, a participant will receive a Course Completion indicating the respective course or module hours completed. It is recommended that the participant also retain this Syllabus and the attached module descriptions as further documentation to professional certification/licensure agencies or employers of content, objectives, outcomes, and assessments.

Objectives:

Educational content covered in this module includes a review of current science and best practices on:

• Describe the physiology, patho-physiology, mechanisms, and kinetics of trauma.
• Demonstrate the need for a rapid assessment of the trauma patient, integrating assessment, interventions, and goal directed care.
• Describe specific examination and diagnostic skills which benefit patient outcome.
• Describe management methods for the pre-hospital and emergency department hospital care of the multi-system trauma patient.
• Describe pathophysiologic changes as a basis for signs and symptoms experienced with trauma.
• Describe the continuum of assessment for patients with trauma.
• Demonstrate the participant's level of competence, to their scope of practice, in regard to specific trauma intervention skills (airway management, ventilation, vascular access, chest decompression, chest tube placement, pericardiocentesis, spinal immobilization, splinting, assessment).
• Describe mechanisms for evaluating the effectiveness of interventions for patients with trauma.

Outcomes:

Participants who successful complete this module will be able to:

• Trauma Assessment Skills
• Airway Management/Ventilation Skills
• Chest Decompression Skills
• Open vs Tube Thoracostomy Skills
• Tourniquet use skills
• Vascular Access (IV or IO) skills
• Systems approach to care simulation
• All students participate in five trauma case learning simulations during the course, these include:
  • Case Simulation #1 – Chest trauma w/ hypotension and hypoxia (interventions include: oxygenation, airway management, decompression, chest tube placement, and vascular access/fluid resuscitation)
  • Case Simulation #2 – Extremity trauma w/ Hypotension (interventions include: tourniquet placement, oxygenation, vascular access, fluid resuscitation, splinting)
  • Case Simulation #3 – Head trauma (interventions include: oxygenation, airway management, vascular access, fluid resuscitation, mannitol use)
  • Case Simulation #4 – Poly Trauma w/ Hypotension (interventions include: oxygenation, airway management, spinal immobilization, vascular access, fluid resuscitation, TXA, blood administration)
  • Case Simulation #5 – Trauma Arrest (interventions include: oxygenation, compressions, airway management, chest tube, pericardiocentesis, vascular access, fluid resuscitation, Blood administration, TXA)

Assessments:

Knowledge Evaluation Tool completion and skills testing completion.

Sample Course Outline: