ATLS® International Meeting Minutes

October 22-23, 2011⦁San Francisco, CA

Saturday, October 22, 2011

Welcome – Dr. John Kortbeek

Tribute to Dr. Brent Krantz – Dr. Brent Eastman (former COT Chair, 1990-1994)

Krantz led in a very articulate way and sometimes with brute force. He had a vision for ATLS; he saw that ATLS had international implications. It was Brent that had the vision, passion, and energy to take ATLS to where it is today. Brent was an innovator and leader of men and women and played an integral role in this program. If Brent were here today he would say, “Get out there! We have ATLS business to take care of!”

Revisions for 9th Edition – Dr. Karen Brasel

  1. 9th Edition revisions underway
  2. Content, format
  3. E-version and 9th Edition to be released in October 2012
  4. Shows the new 9th Edition Student Manual cover
  5. New Content
  6. Table: A brief summary of Wright, et al. Levels of Evidence JBJS(A)
  7. Initial Assessment
  8. Team training
  9. Huddle
  10. Checklist
  11. Debrief
  12. Airway (pediatric)
  13. Uncuffed tubes infants (<12 mo.)
  14. Cuffed tubes
  15. Children
  16. Toddlers
  17. Circulation
  18. Balanced resuscitation
  19. Hypotensive
  20. Early use of plasma, platelets
  21. Until bleeding controlled
  22. Angioembolization emphasized
  23. Tourniquet
  24. No aggressive resuscitation
  25. Initial Assessment scenarios
  26. At least 8 new scenarios
  27. Geriatric focus
  28. Pelvic trauma
  29. Rib fractures
  30. Standard template for current scenarios
  31. New Format
  32. Pelvic trauma
  33. Abdominal evaluation
  34. Combined shock & surgical skills
  35. Educators
  36. National Educator Group
  37. 2 reps from North America
  38. 2 reps from each international region
  39. Revise Instructor course
  40. Emphasis on assessment, feedback
  41. Input on e-course format
  42. ATLS E-Learning
  43. 1-Day format
  44. 2-Day format
  45. App, mobile website
  46. Will include chapter key points, pitfalls, summaries, videos, formulas, and algorithms

Educator Update – Dr. Wesam Abuznadah (on behalf of Dr. Bonvin)

  1. Major revisions have been made to the feedback/assessment content in the Instructor course.
  2. Continueto work on the 9th edition Instructor course and Refresher course.
  3. Provide guidance on the e-course and other educational activities.
  4. Senior Educator Advisory Board
  5. 2 representatives for each Region
  6. 1 chair – Dr. Bonvin

ATLS Middle East & KSA 20th – Dr. Wa’elTaha

  1. Country and trauma statistics are provided.
  2. Trauma is leading cause of deaths – 6,000 annually.
  3. There are many challenges to the system.
  4. No hospital or trauma system, lack of cooperation
  5. ATLS has helped increase the number of trained physicians
  6. 1991: 0ne center
  7. Currently: 20 centers
  8. ATLS is now a requirement for residents (surgical, emergency med, and family)
  9. Developed new collaborations with the Ministry of Health to train physicians and nurses.

Promulgation Challenges in MENA – Dr. SubashGautam

  1. An overview of the new Region 17 boundary and listing of countries is provided.
  2. Safety continues to be a concern.
  3. Country GNP data is provided.
  4. Many countries cannot afford ATLS. This is our challenge for the future. Cost of surgical practicum is extensive. We need a low-cost option.

Educator Perspective in the Middle East – Dr. Wesam Abuznadah

  1. Culture and education citations are extensive.
  2. Dedication in MENA is outstanding.

Australian Instructor Course – Dr. Philip Truskett

  1. There has been growth in course numbers, faculty, and Coordinators since 2006.
  2. Philosophy
  3. To promote excellence in teaching using:
  4. Best practice educational methodology
  5. Opportunities for practice
  6. Feedback
  7. Clear assessment criteria
  8. ATLS content
  9. Modeled educational practices by Faculty
  10. Centralized location for all Australasia
  11. Strong collaboration between Course Director and Educator
  12. Consistent Faculty – attend entire course (all faculty types)
  1. Overview
  2. 2 ½ day course Fri – Sun
  3. Pre-course requirement - ATLS content
  4. 16 participants
  5. One course Director, one Educator, one Coordinator and 5 Instructors
  6. Always one committee member
  7. Course Overview, Day 1
  8. EMST Icebreaker
  9. Lesson Planning/learning objectives
  10. Making ATLS interactive
  11. Questioning techniques
  12. How to give effective feedback
  13. Practice Session – teaching
  14. Course Overview, Day 2
  15. Managing the difficult participant
  16. Principles of teaching a skill
  17. Practice Session – teaching a skill
  18. Assessment methodology
  19. Assessment – Teaching a skill
  20. Practice Initial Assessment station
  21. Course Overview, Day 3
  22. Assessment - Microteaching – assessed by the educator
  23. Assessment - Initial Assessment station – assessed by instructors
  24. Microteaching
  25. Given an ATLS topic
  26. 8 minute presentation that must demonstrate:
  27. Set/Body/Closure
  28. Time Management
  29. Interaction of participants
  30. Innovation
  31. Instructor Candidates provided with individual feedback (written and verbal) and DVD of performance for subsequent reflection
  32. Initial Assessment Station
  33. Assessed as an Instructor running the Initial Assessment Station:
  34. Briefing Patient
  35. Briefing Nurse
  36. Briefing Candidate
  37. Facilitating the scenario
  38. Providing Candidate with feedback
  39. Assessing the Candidate
  40. Assessment
  41. Clear criteria
  42. Individual assessment components and overall course assessment
  43. Candidates nominated by experienced Faculty to do the course
  44. Not always the right people
  45. Candidates do occasionally fail

RTTDC Promulgation in India – Dr. Mahesh Misra

India is receiving the heaviest injury in rural areas.

  1. Course Design
  2. Duration- one day course with 2 distinct sessions
  3. Morning session- consists of clinically focused didactic lectures on airway, breathing, circulation, disability, exposure and environment, as well as special considerations such as pregnancy, pediatrics, burns and geriatrics.
  4. Afternoon session- covers Performance Improvement and Patient Safety (PIPS) initiatives, followed by interactive small group case-based team scenarios designed to stimulate critical thinking and application of knowledge.
  5. Communication module emphasizing the importance of effective communication between the trauma center and rural center
  6. Between Next Appropriate Level Hospital – Able to cater to the needs of the patient
  7. Trauma Team Leaders – Made aware of the need to recognize the need for transfer and where to transfer
  8. Good communication makes for a good team - works for the benefit of the patient.
  9. India at a glance
  10. In the last 5 years there has been an 8% increase in road deaths.
  11. In 2009 over 350,000 people lost their lives in accidental deaths, which is an increase of 31.3%
  12. India records the highest number of deaths in RTA in World.
  13. 14 deaths per hour; these are numbers from 2009.
  14. India – Most Suited for RTTDC
  15. 70% to 80% of people in India live in rural areas
  16. Trauma care is one of the most common reasons for families going into debt.
  17. India is well-suited for the RTTDC program because of the absence of prehospital care in rural areas. This program can improve the chances of patients’ survival.
  18. Other Courses
  19. Promulgated ATLS in 2009
  20. 4 sites
  21. Promulgated ATOM in 2010
  22. RTTDC in India
  23. The Instructor course was held on 4-19-2011
  24. Participants- verified ATLS & ATCN faculty
  25. 18 participants were verified as RTTDC Instructors
  26. Inaugural RTTDC course was on 4-20-2011
  27. 25 Participants
  28. Participant’s Feedback
  29. 92% of the participants will seek additional information on this subject following the course.
  30. The modules on Performance Improvement & Patient Safety (PIPS) and communications were rated as most relevant.
  31. 100% participants indicated their intentions to improve communication for the benefit of the patient and to evaluate outcomes for improving patient care.
  32. The cost ($50) of the manual is an issue in India.
  33. Potential solutions from the participants
  34. A substantial decrease in the cost of the manual for developing countries
  35. Print the manuals in India.
  36. Language of Manual is also an issue, as some of the health care providers in rural settings are not fluent in English; so we need to obtain permission to translate & print the text in native language (Hindi) and other recognized regional languages of India if we want this to be adapted across India and South Asia.
  37. Acknowledges Dr.Jameel Ali and Dr.SubashGautam.
  38. Future Directions
  39. To disseminate RTTDC course across India and South Asia Region
  40. To study the impact of RTTDC on improving trauma care
  41. Need to design a study comparing RTTDC trained rural hospitals versus non RTTDC trained rural Hospitals

2011 Promulgations

Lebanon – Dr. George AbiSaad

  1. Lebanon is a small country with about 4 million to 4.5 million
  2. Site Visit- November 2008: Dr. Chris Kaufmann & Dr. Claus FalckLarsen
  3. Went to Fujairah for the Student and Instructor course in 2009. We graduated in October of 2009.
  4. The Inaugural Course – November 8, 2010
  5. Both courses: Student Course and Instructor Course provided back to back
  6. International Faculty and Coordinators, mainly from Chicago and the Middle East Chapter – Saudi Arabia and UAE
  7. Later courses
  8. February 2011
  9. May 2011 – Iraqi Doctors
  10. October 2011 – sponsored by “Roads for Life” foundation
  11. May 17, 2011 – Saudi Arabia Regional Meeting
  12. Committees were formed
  13. Celebration of the 20th year anniversary of ATLS in SA
  14. Challenges
  15. Other courses: German course given by another University in town. Short different but it’s an alternative. Costs less.
  16. ATLS is not a prerequisite in University programs, Trauma centers, or different Emergency Departments.
  17. Relatively expensive
  18. Doctors are convinced that they’re “ok without it”
  19. Hospitals in the nation are not properly classified, Trauma or otherwise.
  20. There is a fight against ATLS and its “exclusivity”.
  21. Language problems.
  22. The course is not endorsed by the Lebanese Order of Physicians or Ministry of health.
  23. Sometimes we have an issue with the volume of trauma victims.
  24. We have a strategy and funds for other courses like ATCN and ATOM. We’d like to help bring ATCN and PHTLS to Lebanon.

Slovenia – Dr. Roman Kosir

  1. Slovenia is a very small country and maybe twice the size of Lebanon. We have about 5,000 physicians taking care of all the patients.
  2. Reads a copy of the 1997 Edition of the ATLS Student Manual–this is what caught his interest in the ATLS Program.
  3. InauguralATLS course was held in 2010.
  4. Held 4 Student courses and 1 Instructor course in 2011.

Dr. Kortbeek says he is always struck by the variety of countries who are involved in ATLS and how we all share common problems.

Egypt – Dr. Hakim El-Kholy

  1. The inaugural course was held in June of this year.
  2. The second ATLS course was held last September, and the third course was in October.
  3. Trauma is one of the biggest reasons for death in Egypt.

Sunday, October 23, 2011

Region Reports

Latin America

  1. Countries with ATLS
  2. 14 countries
  3. Countries without ATLS
  4. 27+ countries
  5. Population
  6. Region 14: 569 million
  7. Countries with ATLS: 485.6 million
  8. Countries without ATLS: 83.4 million
  9. Annual Region 14 Meetings
  10. The 1st annual Region 14 meeting was held in Buenos Aires, Argentina in 2009
  11. 2nd annual meeting was held in Santa Cruz de La Sierra, Bolivia in 2010
  12. 3rd annual meeting was in Bonito, Brazil in 2011
  13. 25th anniversary of ATLS in Mexico – May 19-21, 2011 in Acapulco, Mexico
  14. Honduras Promulgation 2011
  15. Student course & Instructor course for Honduras was held in Costa Rica
  16. Promulgation – Other Courses
  17. DMEP Promulgation in Latin America
  18. September 2011: 2nd and 3rd courses in Brazil
  19. ATCN Promulgation in Colombia
  20. June 2011: Student course and Instructor course in Brazil
  21. November 2011: Student course in Colombia
  22. ATCN Promulgation in Paraguay
  23. November 2011: Course in Paraguay during Panamerican Trauma Congress
  24. PHTLS Promulgation in Ecuador
  25. September 2011
  26. TOPIC Promulgation in Brazil
  27. December 2011
  28. ATOM Promulgation in Brazil
  29. November 2010
  30. 2nd course in July 2011
  31. A course was held during Panamerican Trauma Congress in Paraguay
  32. Thanks to Paraguay, Peru, Trinidad & Tobago, Uruguay, Venezuela Chairpersons and others, the Chicago office, etc.

Middle East

  1. About the Region
  2. Newly created region
  3. Established in May 2011
  4. Covering all the Middle East regions
  5. 1st meeting held May 17th during the ATLS 20th anniversary in Saudi Arabia
  6. 1st elect President (Region Chief): Saud Al Turki
  7. 1st elect Secretary: SubashGautam
  8. Middle East central office – Trauma Programs office, KAMC, Riyadh, Saudi Arabia
  9. Current Members
  10. Saudi Arabia – October 1991
  11. UAE
  12. Lebanon – November 2010
  13. Syria – January 2011
  14. Oman– April 2011
  15. Egypt – June 2011
  16. ATLS Promulgation in Nigeria (June 2010) was initiated with the support of international faculty
  17. Promulgation
  18. Inaugural courses
  19. AUB, Beirut – November 201
  20. Hama, Syria – January 2011
  21. Cairo, Egypt – June 2011
  22. Oman – April 2011
  23. Site Visits
  24. Iran – December 2010 (estimated promulgation December 2011)
  25. Other Requests
  26. Iraq
  27. Sudan
  28. Jordan
  29. Libya
  30. Next ATLS M.E. Region Meeting will be held to coincide with the AMESCON 2012 Conference – Dubai, UAE - March 14-17, 2012

Europe

  1. ATLS Europe
  2. Board
  3. IngerSchipper (NL)
  4. Raphael Bonvin (CH)
  5. Ruth Dyson (UK)
  6. Laura Bruna (IT)
  7. Committees
  8. Promulgation
  9. Bob Winter (UK)
  10. Roman Kosir (SL)
  11. Giorgio Olivero (IT)
  12. External Affairs
  13. Olaf Roise (NW)
  14. EndreVarga (HU)
  15. Jose Maria (ES)
  16. Region 15 Chief: Clause Falck Larsen
  17. Members
  18. 17 countries
  19. Promulgation
  20. New members since 2010
  21. Slovenia – 2010 inaugural courses
  22. France – July 2010 inaugural courses
  23. Czech Republic – 2012 inaugural courses
  24. Georgia – 2012 inaugural courses
  25. Promulgation statuses
  26. Bosnia – training courses pending
  27. Croatia – application approved
  28. Poland – application approved
  29. Island
  30. Finland
  31. Romania
  32. Ukraine – demonstration course
  33. Other activities
  34. Research on cost-effectiveness of different methods of promulgation in Europe
  35. Information on EU funding possibilities for the promulgation process
  36. External Affairs
  37. Recent events
  38. Cooperation with ESTES (member of the board, educational committee, guest symposia)
  39. Involvement with ETC
  40. ATLS Europe Meeting – May 20-21, 2011 in Madrid, Spain
  41. Day 1
  42. Updates on Europe, Region 15, ATLS International
  43. Annual general assembly
  44. Promulgation, ETC, role in terrorist attack, ATLS-ATCN
  45. Day 2
  46. Professional development for ATLS Instructors
  47. Surgical skills DVD
  48. Interregional grants for ATLS
  49. Presentation of 2012 venue
  50. ATLS Europe Meeting 2012: April 27-28 in Berlin, Germany
  51. ATLS Europe Data
  52. Number of 2010 courses held in each country
  53. Other course information broken down by “Self-Reported” or “Reported to ACS”
  54. Other Activities
  55. II Moscow International Congress of Trauma & Emergency Surgery on March 24-25, 2011

Asia and Australasia

  1. Myanmar
  2. Promulgation initiated in Bangladesh
  3. Region 16 meeting in Pattaya, Thailand, July 2011
  4. Concurrent Regional Trauma Meeting
  5. Residents Papers Competition
  6. Business Meeting
  7. Coordinators Meeting
  8. Preparation Triage & Initial Assessment Scenarios
  9. Policy Development
  10. Outcomes
  11. Initial local policy decisions
  12. Non-surgical Directors
  13. Medical Educators
  14. National reports with identification problems
  15. Resident Papers Competition
  16. Dr. Chih Yun Lin, Taiwan
  17. Predicting prognosis of burn patients by assessing heart rate variability
  18. Australian/New Zealand Director Workshop
  19. Common Problems
  20. Cost
  21. Instructor burnout
  22. Surgical Skill Station esp. Simulation
  23. Educators
  24. Regional COT Courses
  25. ATLS, DMEP, ATOM
  26. PHTLS
  27. ATLS Future Promulgation
  28. Not just collecting stamps
  29. Need to understand individual nations and their people
  30. Genuinely ask what is best for each situation

ATCN – Ms. CristianeDomingues

  1. The Start
  2. June-July, 2008 - Student and Instructor Courses in Lisbon, Portugal
  3. ATCN in Brazil
  4. May 2009 -Student and Instructor Courses in Brazil
  5. 40 Instructors trained
  6. 5 Course Directors; 3 Director Candidates
  7. 43 Student courses held
  8. 5 Instructor courses held
  9. 652 nurses trained
  10. ATCN Student Manual in Portuguese is available
  11. Challenges: high failure rates
  12. ATCN has also been held in Colombia and Paraguay

Disaster Planning in Bangkok – Dr. Rattaplee Pak-Art

  1. Protests in Thailand between old and new PMS
  2. Background
  3. April 2010 protests involving hospital
  4. Bombs
  5. Result—downsize hospital
  6. Discharge early to home or nearby hospitals
  7. Limit admission
  8. No elective operation
  9. Policies for Hospital
  10. Protect patients, teams, ourselves
  11. Don’t fight
  12. Take evidence
  13. Must think about when, where, & how to evacuate.
  14. There were rumors of gas tanks, explosives, etc. no evidence
  15. April 27, 2010 7am – gas tanks confirmed
  16. Shows map of area of protest
  17. April 28, 2010 Searched building for signs of danger and asked authorities for guidance—conclusion: they could only rely on themselves
  18. Hospital has no security for patients so they planned to evacuate the hospital April 29
  19. Transferred 600 patients in under 1 hour—first time in hospital’s history having no patients
  20. Made plans to give signals to teams for guidance on what to do and where to go each day
  21. Had to wear comfortable clothes, wear backpacks, and protect faces from tear gas
  22. Hospital was surrounded and not accessible
  23. Shows map of hospital and block surrounding it
  24. Found the hospital was “under siege”
  25. Stabilized on the floor
  26. Ran low on food
  27. Threat of truck explosion less than 1 km from hospital
  28. Used Google maps and FB to communicate with one another
  29. May 19, 2010: Government announced end of protest which spurred on more violence
  30. Bombs 100 meters from the ER
  31. 50+ docs to help the injured in the ER
  32. Crisis is a great opportunity to learn how to protect our patients and team, that there is so much more knowledge to be obtained, and how much the hospital is loved.

WHO Trauma Recognition in Qatar – Dr. Ahmad Zarour

  1. Background
  2. Trauma major cause of death and disability
  3. According to IRF Qatar has one of higher road traffic deaths in world at 19 deaths per 100,00 population
  4. Falls closely below second most common cause of death
  5. Is there a problem with trauma at HGH
  6. Prior to Nov 2007 manage of traumatize patients was inconsistent.
  7. Clinical assess & arrangement was in conflict without leader
  8. No contemporary trauma registry
  9. Trauma system concept was nonexistent
  10. The initiative
  11. Started 1/11/2007
  12. Four teams, 5-nhospital trauma surgeons
  13. Trauma Leadership
  14. Trauma team--Composition of the trauma team (including response and support members)
  15. Prehospital
  16. Established 5-7 years before trauma service
  17. Travel time of 20 minutes; 200 ambulances
  18. Patient Flow
  19. EMS & Private to Trauma Room
  20. Determine from there where to transport patients
  21. Number of cases 2008-2010
  22. Registry
  23. Statistics
  24. What do we do?
  25. Case examples of injuries
  26. Most cases are blunt trauma
  27. Trauma ICU
  28. Annual report 2011
  29. Injury prevention
  30. MVC
  31. Pedestrian
  32. ATV
  33. FOHO
  34. FFH
  35. Child safety
  36. Alcohol related injuries prevention program
  37. Trauma PIPS
  38. TPIC
  39. TSIC
  40. Rehabilitation
  41. Fellowship and Education
  42. International fellowships—not an easy journey
  43. Fellows of 2010 with the current leadership of trauma surgery section
  44. Resident & Fellows Graduation Day
  45. Research & publications—striving to be more active
  46. Receiving funding for support and stimulating members to write more and do more research
  47. Hamad International Training Center—where most of the training take place
  48. Numbers of docs in Qatar
  49. Total 2500
  50. ATLS Course under Saudi Chapter teaching
  51. ATOM
  52. 15 courses
  53. 50 Candidates trained so far
  54. First course in Nov 2007
  55. TOPIC course – May 2011
  56. Challenges
  57. Increasing population
  58. Implementation of prevention programs
  59. Verification by ACS
  60. WHO recognition 2010
  61. Stars of Excellence Award

Breakout Sessions Presentations