Volume 10 - January 1995

The concept of ATLS started in 1976, after a tragic accident which ultimately resulted in conceptualizing the Advanced Trauma Life Support Course. A Nebraskan (USA) Surgeon piloting his small plane crushed into the woods. The Surgeon was seriously injured, his wife died instantly and four children were also injured. Reportedly the initial care received by the surgeon and his children was far below the minimum standard of trauma care. Recognizing this, the Surgeon wrote" Whenlcan provide better care in the field with limited resources than what my children and I received at the primary care facility-there is something wrong in the system and the system has to be changed."

This has ultimately resulted in an ATLS course by the American College of Surgeons and they have adopted it in 1979.

Trauma without respect for age swift in onset and slow in recovery, presents many pitfalls for the responsible physician carrying for the trauma patients. Trauma is merceless in its lethal and mangling pathways through our young and potentially productive members of the society. Prevention is the best cure but when prevention fails, the surgeon and physician must be sufficiently knowledgeable to meet the injured patient needs and reduce the morbidity and mortality of trauma. For every person dies due to injury there are 2-3 disabled persons in the society.

Injured patient must thoroughly and repeatedly examined and management should be started according to priority basis immediately. If patients condition exceeds the treating hospital treatment capabilities then the process of transferring the patient is initiated as soon as possible. Physician will be oriented to initial assessment and management of trauma victim with emphasis on first hour initial assessment, primary management starting from the time and site of accident followed by stabilization of the patient.

In this issue we have published an extensive review article on ATLS which I think will be emensly beneficial for all who treats trauma patients.

Treatment of the injured patients takes lot of time and energy all over the world and more so in our country with limited resources and manpower, If we want to maximize our services to the poor patient we have to have a new look to the whole situation of the hospital management around the country.

The cost of Road accident has been analyzed by Transport Reseasrch by Laboratory (TRL) Fouracre & Jacobs-76 showed that the accident costs were equivalent in any country be it developed or developing to approximately 1% of Annual Gross National Product (GNP) in current prices this suggests that it is costing Indonesia 600 million pound sterlingper annum, Pakistan 260 million, Egypt 200 million, Korea 60 million and probably in Bangladesh about 200 million pound sterling.

The cost of the injury management is very high. About 5 Billion US dollar are spent in UK for the injury management in USA 75-100 Billion are spent for injury management directly or indirectly. But very little is spent on injury research. In our country we do not have any exact statistics but we know that the cost of this management is very high.

If substantial pain, grief and suffering caused by road accident is not sufficient enough motivation for reduction of accidents, then there is very strong economic case to be made in the significant loss of resources each year due to accidents.

The first article of this issue is on investigation on length of hospital stay of trauma patients which shows about 47% of patients stay in hospitals for more than 3 weeks. The economic aspects of this long stay should also be considered by all.