PreHospital Trauma Life Support

     As the 1970s ended and the 1980s began, the Advanced Trauma Life Support course began to establish itself as the standard in physician trauma training. As a developer of the first ATLS text and courses, Norman McSwain, MD, was certain that the information in this course would be of even more value to EMS providers.

     McSwain set about finding a partner to develop and disseminate a prehospital version of ATLS. The National Association of EMTs accepted his proposal, and the American College of Surgeons agreed to provide medical oversight to the partnership. A committee was formed within NAEMT to coordinate development of the course and work out faculty training across the United States. NAEMT's PHTLS Committee later became a division of the association to accommodate the needs of the PHTLS Executive Council in coordinating PHTLS activities all over the world.

     With a team of NAEMT members working with McSwain, pilot courses were conducted regionally in the United States. Based on the experiences of those first courses, the program was formalized and regional workshops were conducted to train faculty. With publication of the PHTLS textbook in 1984, the program began to grow rapidly. By publication of the third edition, its architects had placed PHTLS on a four-year revision schedule to ensure it was consistent with changes in the ATLS content and that standards were updated.

Research Funding
     PHTLS, together with NAEMT, continues to fund trauma-related research studies. Currently, three projects are ongoing, looking at improving pain management in patients with fractures and burns, supplemental support with blanket roles during rapid extrication, and evaluating the reliability and sensitivity of prehospital clinical examinations to detect pelvic fractures in blunt trauma patients.

PHTLS Sixth Edition Text
     As PHTLS releases its sixth edition text and instructor resources, a half-million providers have been trained in 38 countries. The PHTLS Executive Council has created the most comprehensive text yet, with new materials that reflect the latest in educational standards and create interactive learning environments that allow participants to apply course concepts throughout the course.

     As with previous editions, the PHTLS text begins with ATLS. In this case, the ATLS seventh edition was used as a basis to develop the text, which creates consistency with the physicians trained in ATLS and the nurses taking Advanced Trauma Care for Nurses courses.

     The text is evidence-based. Position papers are included where appropriate and the text is fully referenced. Another enhancement throughout this text is the inclusion of expanded information on prolonged or extended transport. The sixth edition is divided into five divisions:

Energy and Injury
     The first division includes the introduction and chapters on injury prevention and kinematics. The introduction includes a new section on reading medical literature to give providers guidance on deciphering published prehospital research. Injury prevention includes updated statistics and a new section on preventing injury in EMS providers, including information on ambulance crashes. The kinematics chapter has been significantly revised, including a section on shotgun injuries.

Assessment and Management
     The second division includes chapters on the scene, the patient, airway and ventilation, and shock. The scene is an all-new chapter that looks at street survival, hazardous materials/decontamination, bloodborne diseases and crime scenes. The patient content includes a look at hemorrhage control and triage. Airway and ventilation content reflects recent research on intubation and ventilation rates and quality, and includes discussion on capnography. Shock content features expanded physiology and the latest evidence regarding hemorrhage control.