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 patients with ISS ≥ 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The frequency of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access (IV), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies (%) were 83.5 vs. 65.3 for ET, 97.3 vs. 98.0 for IV, 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG 18.4 vs. 47.0 for CT. In the emergency 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 3.9 vs. 95.2 for CT. The differences in the application of these life saving procedures between the pre-ATLS and post-ATLS periods were statistically significant (p < 0.05) except IV access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patients with severe chest injuries (AIS ≥ 3) 87.7% had chest tubes post ATLS (94.4% in ER) compared with 48.1% pre ATLS (3.2 % in ER). These differences were associated with significant improvement in trauma patiet outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS. This, as well as environmental changes which improved accessibility to such items as chest tubes in the ER, may account for the improved post-ATLS trauma patient outcome.