Advanced Trauma Life Support (ATLS): necessary for emergency physicians?

A survey was conducted to determine differences in perspective towards Advanced Trauma Life Support (ATLS) between emergency medicine (EM) physicians and other specialties (OS), assess its value in the management of acute trauma, and identify areas in the course which could be revised or updated. The survey was devised and completed by physicians after ATLS. Of 26 course participants, there were 11 EM physicians (42%), four family practitioners (15%), four surgeons (15%), four internists (15%), two paediatricians (8%), and one anaesthesiologist (4%). Both groups found ATLS useful and relevant, and reported little deviation from their prior management of acute trauma. Unclear topics identified were airway, spine trauma, and burns/cold injury for EM, and head, abdominal, and paediatric trauma for OS. Significant differences were noted for the following: 91% EM vs. 13% OS felt ATLS could be shortened into a one-day course (p = 0.002), 64% EM vs. 7% OS thought the laboratory could be omitted (p = 0.003), and all (100%) EM vs. 60% OS believed the course could be taught by EM physicians as effectively as surgeons (p = 0.02). EM disagreed with OS over the proposed requirement that all EM physicians be required to take ATLS (2.0 +/- 0.2 vs. 3.5 +/- 0.4, p = 0.03). The EM group reported doing > 20 per year of airway, vascular, and thoracostomy procedures in their own practice, whereas OS did significantly fewer. ATLS may not be useful for EM practitioners actively involved in trauma care. Proposed changes from the EM perspective include shortening ATLS to one day, increased use of EM instructors, clarifying certain portions of the manual, and omitting the laboratory section or making it optional.