Trauma is a leading cause of death worldwide and in the United States. Annually in the US, trauma results in over 179,000 deaths, 60 million injuries, 40 million emergency department visits, and $684 billion in economic costs. The goals of PHTLS are to reduce mortality and morbidity from trauma through providing appropriate prehospital care. It teaches a team-based approach and emphasizes clear communication and documentation. PHTLS is based on current trauma research and aims to teach assessment and treatment principles to enhance critical thinking and patient care.

1. Lesson 1
Introduction and Overview of
Trauma Care and PHTLS

2. Trauma Overview (1 of 3)
• Worldwide, more than 5.8 million people
die from trauma annually
– Motor vehicle-related
injuries are the leading
cause of trauma deaths
– Ninety percent of the
trauma deaths occur in
low- and middle-income
countries

3. Trauma Overview (2 of 3)
• In the United States, annually:
– 60 million injuries
– 40 million emergency department visits
– 2.5 million hospitalized
– 9 million disabled
• 8.7 million — temporarily
• 300,000 — permanently

4. Trauma Overview (3 of 3)
• In the United States, more than 179,000
people die from trauma annually
– It is the leading cause of death in persons
between 1 and 44 years of age
• 80% of teenage deaths
• 60% of childhood deaths

5. Cost of Trauma Annually
in the United States
• Total economic impact of $684 billion Lost
productivity from disabilities
– 5.1 million years
– $65 billion
• Trauma deaths
– 5.3 million years of life lost
• Average loss — 34 years per death
– $50 billion

6. PHTLS Goals
• Reduce mortality and morbidity from
trauma
• Provide knowledge and skills for all
prehospital trauma team members
• Deliver appropriate care to the trauma
patient in the field in a timely fashion
– No less
– No more

7. PHTLS Philosophy (1 of 2)
• Trauma care should be based on research
• Interventions are based on the
assessment of each trauma patient
• Deliver the trauma patient:
– With the appropriate interventions
– To the right facility
– Utilizing the right mode of transport
– In the right amount of time
– As safely as possible

8. PHTLS Philosophy (2 of 2)
• Research provides us with the foundation
for the best practices for trauma care
– Research may:
• Validate our current practices
• Refute our current practices
• Determine future practices

9. Team Approach (1 of 2)
• A diverse team
must work
together in order
to provide
trauma patients
with the best
chance for a
favorable
outcome © Dan Myers

10. Team Approach (2 of 2)
• This team includes:
– Citizens, dispatch
• System activation
– Emergency medical responders
– EMS
– Transport services
– Emergency department
– Surgery
– Other specialty services
– Rehabilitation

11. Communication and
Documentation (1 of 3)
• Communication among all trauma team
members is critical in ensuring that proper
care is provided to the patient
– Timely
– Verbal
– Written
© Jones and Bartlett Publishers. Courtesy of MIEMSS.

12. Communication and
Documentation (2 of 3)
• Clear, concise,
accurate, and
complete
communication
between the
prehospital care
provider and the
receiving hospital
facilitates optimal care
Courtesy of Anthony Caliguire, NREMT-P.

13. Communication and
Documentation (3 of 3)
• Good documentation is required:
– To maintain continuity of care
• Copy of prehospital care report left at receiving
hospital
– For medical and legal reasons
– For trauma research
– To support trauma system funding

14. PHTLS Around the World

15. PHTLS
• Based on the Advanced Trauma Life
Support (ATLS) course by the American
College of Surgeons Committee on
Trauma (ACS-COT)
• A joint effort between the ACS-COT and
the National Association of EMTs
(NAEMT)
• First offered in 1983, has been offered in
57 countries, and has trained more than
700,000 providers

16. PHTLS Course (1 of 3)
• Builds upon each participant’s current
knowledge base and skills to enhance
critical thinking and problem-solving
abilities
• Stresses teamwork between providers
with diverse levels of knowledge, skills,
and resources
• Provides a structured environment to
practice trauma assessment and treatment
skills

17. PHTLS Course (2 of 3)
• We must critically examine
everything we do (i.e., how
and why)
• Science is always evolving
and helps us verify or
disprove our approach to
trauma care
• Health care providers must be lifelong
learners
Medical practices change!

18. PHTLS Course (3 of 3)
• Based on available research
• Updated every 4 years as supported by
new research
• Teaches the principles of care rather than
focusing on preferences

19. Trauma Care (1 of 3)
• Principle is what needs to be done for a
patient based upon the assessment
• Preference is how the principle is
accomplished
– This will change depending on the:
• Situation at the scene
• Severity of the patient
• Knowledge and skills of the prehospital care
provider
• Resources available

20. Trauma Care (2 of 3)
Based on assessment
– Begins long before you reach the patient
• Information provided from the call for help
– Scene and situation
• Safe
• Available resources
• Number of patients

21. Trauma Care (3 of 3)
– Mechanism of injury (kinematics)
– Patient
• Primary assessment
• Secondary assessment
• Reassessment

22. Patient Assessment (1 of 2)
• Primary assessment
– A-B-C-D-E approach
– Taught sequentially, performed
“simultaneously”
– Assess for and correct immediate threats to
life
• Secondary assessment
– “Head-to-toe” assessment
– Assess for all other injuries — usually
non-life-threatening
– Includes measurement of vital signs

23. Patient Assessment (2 of 2)
• Reassessment
– Important to look for changes in the patient’s
condition
• Response to treatment
– Ongoing to determine any apparent change in
patient status

24. Critical Trauma Patient (1 of 2)
• Primary assessment
– Treat at the scene versus treat while en route
– Knowing when to do something is important;
knowing when not to do something is even
more important
– Reassessment
• Secondary assessment
– Only when time and situation allow

25. Critical Trauma Patient (2 of 2)
• Transport
– Ground versus air
– Mode of transport
• Emergent versus non-emergent
– Appropriate destination

26. Potential Pitfalls of Assessment
and Management (1 of 3)
• Not establishing a safe scene
• Overlooking life threats by not adequately
assessing or exposing the patient
• Focusing on distracting,
non-life-threatening injuries
• Performing a secondary assessment prior
to stabilizing all life threats

27. Potential Pitfalls of Assessment
and Management (2 of 3)
• Performing “advanced” interventions
before “basic” procedures
• Not performing a secondary assessment
when appropriate
• Prolonged scene times

28. Potential Pitfalls of Assessment
and Management (3 of 3)
• Overlooking signs of deterioration in a
patient who initially appeared noncritical
• Failure to reassess
• Transport or destination decision error

29. Prevention
• Trauma is preventable
• Prevention training is available for
everyone
• PHTLS faculty and providers should be
advocates for and active participants in
trauma prevention programs
• Prehospital care providers are the “eyes”
of the prevention effort

30. Course Mechanics
• Housekeeping
• How the course will run
• Course expectations
• Evaluation process

31. Questions?