ADVANCED TRAUMA LIFE-SUPPORT PROGRAM INCREASES EMERGENCY ROOM APPLICATION OF TRAUMA RESUSCITATIVE PROCEDURES IN A DEVELOPING-COUNTRY

Over a 9-year period (July 1981-December 1985-pre-ATLS period; January 1986-June 1990-post-ATLS period), the hospital charts of 813 trauma p atients with ISS greater than or equal to 16 were reviewed (n = 413, p re-ATLS and n = 400, post-ATLS) in order to assess the impact of the A TLS program. The frequency of endotracheal intubation (ET), nasogastri c tube insertion (NG), intravenous access (IV), Foley catheterization of the bladder (Foley) and chest tube insertion(CT) were compared by P earson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencie s (%) were 83.5 vs. 65.3 for ET, 97.3 vs. 98.0 for IV, 74.6 vs. 96.3 f or Foley, 68.3 vs. 91.3 for NG, and 18.4 vs. 47.0 for CT. In the emerg ency room these frequencies (%) were 26.1 vs. 36.4 for ET, 98.8 vs. 98 .7 for IV, 11.0 vs. 97.1 for Foley, 3.2 vs. 95.9 for NG, and 3.9 vs. 9 5.2 for CT. The differences in the application of these life saving pr ocedures between the pre-ATLS and post-ATLS periods were statistically significant (p < 0.05) except IV access, which showed no difference b etween the pre-ATLS and post-ATLS groups. Of the patients with severe chest injuries (AIS greater than or equal to 3) 87.7% had chest tubes post ATLS (94.4% in ER) compared with 48.1% pre ATLS (3.2% in ER). The se differences were associated with significant improvement in trauma patient outcome post ATLS. We conclude that the frequency of lifesavin g interventions, particularly in the ER, was increased post ATLS. This , as well as environmental changes which improved accessibility to suc h items as chest tubes in the ER, may account for the improved post-AT LS trauma patient outcome.