Trauma is a growing problem world-wide.
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”.
The standard general surgical training received in the management of trauma is often deficient, partly because traditional surgical training is more and more organ specific 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 International Society of Surgery / Société Internationale de Chirurgie (ISS/SIC). Under the patronage and supervision of IATSIC, the Definitive Surgical Trauma Care (DSTC™) Course has been developed for surgeons who may be faced with the definitive care of a patient with multiple injuries. By the end of 2022, more than 640 Courses will have been delivered in over 30 countries in five different languages. In addition to training surgeons, DSTC provides the environment in which Operating Room nurses and Anaesthesiologists can also learn the technical and teamwork skills necessary to provide effective trauma care.
The DSTC™ Course was originally 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. For many years Operating Room nurses have contributed to the DSTC course, sometimes informally but increasingly as an integrated part of DSTC with a specific program designed for OR nurses. Similarly, in some countries a component of care relevant to anaesthetists has been developed by anaesthetists and is now being integrated into DSTC. This allows a more realistic experience for the entire team and provides the opportunity for anaesthetists to learn technical and resuscitation skills as well. With the whole OR team involved in the same training course the potential to maximise the learning is optimised.
The Director's Manual is a guide to help Course Directors and Course Coordinators ensure organisational aspects of the course are complete, and provides a template to ensure that communication, organisation and the necessary Ethics Committee approvals and clearances to International standards, have been completed.
Tarek Razek, MD
DSTC Program Director
Sandro Scarpelini, MD
Chair DSTC Committee
On behalf of the DSTC™ Subcommittee
Planned DSTC Courses
International DSTC Faculty