Advanced trauma life support training for hospital staff

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Abstract
Injury is responsible for an increasing global burden of death and disability. As a result, new models of trauma care have been developed. Many of these, though initially developed in high-income countries, are now being adopted in low and middle-income countries (LMICs). One such trauma care model is advanced trauma life support (ATLS) training in hospitals, which is being promoted in LMICs as a strategy for improving outcomes for victims of trauma. However, the evidence of effectiveness for this health service intervention, in either HIC or LMIC settings, has not been rigorously tested using methodology such as a systematic review. To quantify the effectiveness of hospitals with an ATLS-trained trauma response system versus hospitals without such a response system in reducing mortality and morbidity following trauma. We searched the Cochrane Injuries Group Specialised Register (CIGSR), the Cochrane Controlled Trials Register (CCTR), MEDLINE & PubMed, EMBASE, CINAHL, Science Citation Index, National Research Register, and web-based trials databases such as Current Controlled Trials. We checked references of background papers and contacted authors to identify additional published or unpublished data. Randomised controlled trials, controlled trials, controlled before- and- after studies comparing effectiveness of hospitals with an ATLS-trained trauma response system versus hospitals without such a response system in reducing mortality and morbidity following trauma. Two reviewers independently applied eligibility criteria to trial reports for inclusion and to extract data. There is a limited literature relating to this topic but none of the studies identified met the inclusion criteria for this review. There is no clear evidence that ATLS training (or similar) impacts on the outcome for victims of trauma, although there is some evidence that educational initiatives improve knowledge of what to do in emergency situations. Further, there is no evidence that trauma management systems incorporating ATLS training impact positively on outcome. Future research should concentrate on the evaluation of trauma systems incorporating ATLS, both within hospitals and at the health system level, by using rigorous research designs.