[Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support].
BACKGROUND
Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases. From an analysis of the trauma register of the German Society for Trauma Surgery (DGU), we know that a seriously injured patient remains on the road for 70 min on average before transferral to hospital. This requires improvement. With the 2003 introduction of the ATLS programme in Germany, the initial clinical phase could be improved upon simply by means of standardised training. PHTLS und ATLS complement one another.


RESULTS
PHTLS und ATLS represent training concepts which teach standardised, priority-based prehospital and hospital trauma management. The aim is to make an initial rapid and accurate assessment of the patient's condition, thereby identifying the"critical" patient. The concepts also make priority-based treatment possible and facilitate decision-making as to whether patients can receive further on-the-spot treatment or whether immediate transport is necessary. The procedure is identical in the shock room. The primary consideration is to prevent secondary damage, not to lose track of time and to ensure consistent quality of care. The courses teach systematic knowledge, techniques, skills and conduct in diagnosis and therapy. The courses are oriented to all medical specialities associated with trauma care. With the support of the German Society for Trauma Surgery (DGU) and the German Society for Anesthesiology and Intensive Medicine (DGAI), the German Professional Organisation of Rescue Services (DBRD) has adopted the PHTLS course system on licence from the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and has been offering it in Germany since late 2007. ATLS was established by the DGU in 2003 and represents successful and similarly structured shock-room management.


CONCLUSIONS
PHTLS und ATLS are established and standardised concepts, which are constantly reviewed and updated according to the latest medical knowledge. They provide the opportunity to standardise prehospital and primary clinical trauma management for all specialties and hospitals, while incorporating own knowledge.
Wölfl
C G
CG
Klinik für Unfallchirurgie und Orthopädie, Luftrettungszentrum Ch. 5, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen. woelfl@bgu-ludwigshafen.de
Gliwitzky
B
B
Wentzensen
A
A
D004632:Emergency Medical Services / Q000592:standards*; D005858:Germany; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D009104:Multiple Trauma / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D014193:Trauma Centers / Q000592:standards*