Salvijus Milašius Chief of Military Medical training Center

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



  • 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

Treatment price

Trauma situation in Lithuania

  • Nelaimingus atsitikimus, apsinuodijimus ir traumas pagrįstai galima vadinti Lietuvos nacionaline nelaime, nes mirtingumas nuo jų, palyginti su kitomis Europos šalimis, yra labai didelis ir toliau sparčiai didėjantis (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


  • 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)


  • 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)

Disease triangle

Sample Haddon’s matrix for motor vehicle accidents prevention program creation

Injury has become a major

  • Injury has become a major

  • cause of death and disability

  • worldwide. Organized

  • approaches to its prevention

  • and treatment are needed.

  • These guidelines seek to set

  • achievable standards for

  • trauma treatment services

  • which could realistically be

  • made available to almost

  • Every injured person in the

  • world. They then seek to

  • define the resources that

  • would be necessary to assure

  • such care.



ATLS® intent

  • Originally, standard for doctors who do not manage major trauma on their daily basis

  • … but accepted to be a standard for those, who provide care for trauma patients in first hours after injury

  • … and standard for primary health care institutions and for modern trauma care centers

ATLS® goals

  • To provide basic knowledge necessary to:

  • Rapid and accurate assesment of the patient condition

  • Resucitation and stabilisation IAW priority

  • Determination of the patient´s needs

  • Arrangement for the patient´s transfer (medical evacuation)

  • Assure that optimum care is provided

ATLS® history

  • Plane crash in Nebraska, 1976

  • 1 killed, 4 injured


  • Injured orthopedic surgeon:

  • ” When I can provide better care in the field with limited resources than my children and I received at the primary care facility - there is something wrong with the system and the system has to be changed”


  • First course in USA in 1978

  • American college of surgeons

  • > 40 countries

  • (Canada, Denmark, England, Israel, Portugal, Italy, Sweden, etc.)

  • Hungary – inaugural courses in February 2005

International dissemination

Trimodal Death Distribution

ATLS® philosophy

  • Treat the greatest threat to life first

  • Lack of definitive diagnosis should never impede the application of an indicated treatment

  • A detailed history is not the essential prerequisite to begin the evaluation of an acutely injured patient

ABCDE mnemonic

    • A irway with cervical spine control
    • B reathing
    • C irculation
    • D isability or neurological status
    • E xposure with temperature control

ATLS Teaches

ATLS® Course structure and organisation

ATLS® course

  • ATLS manual

  • Pretest

  • Lectures

  • Demonstrations

  • Group discussions

  • Practical life saving skills

  • Simulated patients scenarios

  • Final test



  • Pretest before the course


  • Lectures


  • Group discussions


  • Practical life saving skills


  • Simulated patients scenarios


  • Test


  • Certificate valid for 4 years

  • After expiry – resertification

  • 1 day refreshment course

ATCN Advanced Trauma Care for Nurses

PHTLS® Prehospital Basic and Advanced Trauma Life Support

ATLS® Advanced trauma life support International promulgation

International promulgation

  • ”The development of ACS ATLS® Program within the requesting country via a recognized surgical organization or an ACS Chapter in that country, and outside the ACS COT network”

Implementation of ATLS® in Lithuania

Implementation process – main steps

  • Request initiation – request from Traumatologist Orthopaedic society approved for implementation of ATLS into Lithuania in August 2002

  • Introductory site (Military medical training center) visit by representatives from American college of surgeons ATLS committee – 28 of FEB 2003

  • Development and equipping of site for conducting of ATLS courses in Lithuania

  • Initial training of instructors –training of 8 Lithuanian instructors in USA – 07-17 of DEC 2003

  • Inaugural courses in Lithuania 15-20 NOV 2004

  • Continued promulgation

Introductory site visit 28 of February 2003

Representatives of variuos institutions signed the letter of intent to implement ATLS® in Lithuania

Training of Lithuanian ATLS® instructors candidates in Fresno, US 7-17 DEC 2003

ATLS® inaugural courses 15-20 NOV 2004

International ATLS® Faculty

ATLS® course possible students in Lithuania

  • Ambulance service doctors

  • Fire and rescue service doctors

  • Emergency room (patients admitting room) physicians

  • Search and rescue doctors (SAR)

  • Military medical doctors

  • Physicians, functioning at primary health care institutions (GP)

  • Surgeons

  • Anesthesiologists

  • ....others

ATLS® courses in Lithuania

  • 3 courses – 48 doctors participated in these courses

  • About 4-6 courses per year in future


  • ATLS® courses provide standardized information and skills for trauma patients treatment.

  • After implementation of ATLS® methodic in Lithuania it will be build basement for creation and development of trauma care system

  • Doctors will be proper trained for international missions

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