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Pre-Hospital Trauma Life Support ... Update

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By the end of last year, 402,639 prehospital care providers all over the world had completed Pre-Hospital Trauma Life Support (PHTLS) courses. The program’s success was enhanced by the 5th edition of PHTLS, NAEMT’s required textbook published by Mosby. Debuting in 2002, the 5th edition is now available in more versions and languages than ever before.

The PHTLS program first became widely available in the U.S. in 1984. The following year, Mexico, England and Ireland had their first courses. Canada, and Trinidad and Tobago entered the program in 1988. The courses in Trinidad, conducted under the guidance of Jameel Ali, MD, M Med Ed, FACS, also initiated the first scientific study on the effectiveness of the program in improving patient outcomes. Ali reported that a mortality rate of 15.7% improved to 10.6% after the PHTLS course.

In 1995, publication of the 3rd edition of the Mosby title fueled continuing interest in the program, and the first courses in Argentina, Israel and Colombia were conducted. Chile and Brazil joined the family in 1996. Italy, Sweden and Holland came on board in 1997, and Greece and Australia held their first courses in 1998 as the 4th edition was published. The 4th edition’s instructor materials infused scenario-based, interactive presentations throughout the course.

In 1999, faculty in Hong Kong, China and Panama conducted their first programs, and in 2000, Saudi Arabia, Norway and Switzerland began theirs. In 2001, the first courses were held in Bolivia, New Zealand and Venezuela.

As the 5th edition came online in 2002, Denmark, Uruguay and Peru joined the program. Even bigger news hit in 2003 when France and Portugal started programs. Until this point, faculties were often frustrated by having to use English texts to teach the course in places where English was minimally understood, if at all. A Spanish version of the 2nd edition has been available; there were Greek, Italian and Dutch versions of the 4th edition. Still, many course participants often relied on using the English text with a text-only translation provided by faculty. With the 5th edition came new translations in Portuguese, Spanish, French, Dutch, Italian, Norwegian and Greek. Chinese and Arabic translations are being pursued.

Instructor materials also saw enhanced interactivity in this edition, with the first DVD/video skill demonstration support. Sales of new PHTLS texts and materials have already surpassed the life-of-title for the previous edition, with two years to go before the next is released.

The U.S. military has always been a large part of the PHTLS program. Thousands of military medics have taken the course, and their experiences in combat situations continue to benefit our understanding of patients’ needs. Our military programs were further enhanced by the release of PHTLS, Military Edition, designed specifically for them. The 6th-edition military text will be a significant expansion of the work started in that revised 5th edition.

Furthermore, we will see the first courses in Germany, Ecuador and the United Arab Emirates this year. We also hope to generate potential new faculty through demonstration courses in Bulgaria, India and Africa.

Work on the next edition has progressed to the point of reviewing draft chapters and early developments of its instructor materials. The 6th edition will include at least six new chapters, and there will be an emphasis on science and treatment guided by benefit to the patient. The text will be available in July 2006, with instructor materials rolling out in time for the NAEMT/EMS EXPO conference later that fall.

More than ever before, the next edition of PHTLS will be the result of collaborations with faculty in this country and over 30 others where PHTLS is taught, continuously learning from instructors and providers. PHTLS continues to promote research through grants and symposia, with panel discussions addressing the controversies of trauma care, past and future. (It’s also important to note that the authors of both the text and the instructor materials receive no royalty or payment for their work. The revenue generated by PHTLS goes toward supporting the program and NAEMT’s efforts to be an advocate for prehospital providers here in the U.S. and abroad.) Through the program, we certainly have had the opportunity to share what we’ve learned. More important, though, we have broadened our horizons to take in lessons learned from a wide range of committed, intelligent and passionate faculty and providers the world over.

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