Experience of implementation of standardized trauma treatment methodology Advanced Trauma Life Support courses (ATLS) in Lithuania

Salvijus Milaius Chief of Military Medical Training Center

Trauma

Trauma
Leading cause of death < 44 years of age Third cause of death in all age groups (in 2020 may be second cause of death) 3.2 million deaths and 312 million patients seek medical attention worldwide (1990) Lost life years, disability Major socio-economic problem

Lost life years

40

30

20 36

10

16 12

0 Trauma Cancer Cardio vascular

Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003

Treatment price
400

300

200 334 100 88 0 Trauma Cancer Cardio vascular

51

Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003

110102 +SDR, external cause injury and poison, all ages per 100000
Russian Federation2002
CIS-12 average 2002

Belarus2003 Kazakhstan2002 Ukraine2002 Latvia2002 Lithuania2002 Estonia2002

Republic of Moldova 2002

EUROPE2002
Kyrgyzstan 2002 CARK-5 average 2001 Hungary 2002 EU-10 (MSs after 1.5.2004) average 2002

Finland2002 Slovenia2002 Romania2002

Poland 2002 Turkmenistan 1998 Luxembourg 2002

Czech Republic2002 France2000

Slovakia 2002

Croatia2002 Belgium1997
Uzbekistan 2002

Denmark1999
Bulgaria 2002 Portugal 2002

Austria2002 Albania2001
Iceland 2001

EU-25 average2002
Serbia and Montenegro 2000 Ireland 2001 Switzerland 2001 Sweden 2001 Norway 2001 EU-15 (MSs prior 1.5.2004) average 2001 TFYR Macedonia 2000

Israel1999 Armenia2002 Greece2001

Italy 2001

Germany2001
Spain 2001

Tajikistan2001 Netherlands2000
Malta 2002

United Kingdom2002 Georgia2001 Azerbaijan2002

San Marino 2000 0 50 100 150 Last available 200 250

110102 +SDR, external cause injury and poison, all ages per 100000, Last available
30

25

20

15

Estonia Lithuania Latvia Ukraine Netherlands

10

Belarus

Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Israel Kazakhstan Latvia Lithuania Netherlands Romania Russian Federation Slovenia Tajikistan Turkey Ukraine United Kingdom EUROPE EU-25 average

Country number

0 0 35 70 105 140 175 210 245

Trauma situation in Lithuania

Trauma situation in Lithuania

Nelaimingus atsitikimus, apsinuodijimus ir traumas pagrstai galima vadinti Lietuvos nacionaline nelaime, nes mirtingumas nuo j, palyginti su kitomis Europos alimis, yra labai didelis ir toliau spariai didjantis (Lietuvos sveikatos programa, 1998)

The need for standardized training of medical personnel

Severely injured patients must be evacuated as quickly as possible They are passing different levels of medical care, the same passing different medical doctors (and other personnel) Managing of trauma patients often will be in stressful environment Trauma causes are different

Trauma
In many countries reduction in trauma mortality of 15-20 % have been achieved largely as a result of improved health care interventions and trauma care systems (Cales 1984, Lecky 2000) Initiatives such as the Advanced Trauma Life Support training program in North America succesfully reduced mortality (Kirsch 1998, Reines 1988) Population based studies from North Carolina showed, that ATLS training is associated with a low rate of deaths from trauma (Rutledge et al., 1994)

Trauma
One of three deaths occurred in hospital as a result of injury could be prevented Often avoidable factors include simple management errors in the early stages (golden hour), rather than a failure of complex definitive treatment (Royal College of surgeons of England, 1988)

20%

Bendras mirtingumas

15%

10%

5%

0% Prie PHTLS Po PHTLS

Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003

Disease triangle

Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003

Haddon matrix

Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003