The Advanced Trauma Life Support (ATLS®) Course of the American College of Surgeons
has had a dramatic effect in improving outcome of patients by standardising their resuscitation and initial assessment, and providing one safe simple way for the initial care of such patients. However, ATLS® makes very little provision for care beyond the “Golden Hour”, and often the surgical care that the patient receives after resuscitation is performed by those inexperienced in the surgical management of the trauma patient.
“Standard” general surgical training received in the management of trauma is often deficient, partly because traditional surgical training is more and more organ specific, concentrating on “superspecialties” such as vascular, hepatobiliary or endocrine surgery, and partly because in most developed training programs, there is limited exposure to the range of injured patients.
It is not enough to be a good operator. The effective practitioner is part of a multidisciplinary team that plans for, and is trained to provide, the essential medical and surgical response required in the management of the injured patient.
Planning the response requires an understanding of:
• The causation of injuries produced in the local population. An urban population with motorways will have a different spectrum of injury to an armed inner-city population.
• The emergency, pre-hospital and emergency room care of the patient. The condition in which the patient is delivered to the hospital and subsequently to the operating room will be determined by the emergency response, and in many respects will determine outcome.
• The resources, both physical and intellectual within the hospital, and the ability to anticipate the specific problems associated with the patient with multiple injuries.
The International Association for Trauma Surgery and Intensive Care (IATSIC) is a founding component of the Société International de Chirurgie (International Society of Surgery) – ISS/SIC. Under the patronage and supervision of IATSIC, the Definitive Surgical Trauma Care (DSTCTM) Course has been developed for
surgeons who may be faced with the definitive care of a patient with multiple injuries.
The DSTCTM Course is designed for surgeons and surgical trainees, by surgeons. Many situations require specialist trauma surgical expertise, yet because of local conditions this is simply not available. Its intention is not to duplicate ATLS®, nor to provide an in depth course in surgery, but rather to teach those techniques particularly applicable to the patient who requires surgery and intensive care for major trauma, in a setting where such care is not commonly practised or even necessarily available. At the same time, Trauma Care is changing all the time, and this course also serves as an update of knowledge and information in the field of Trauma Care.