1. Lesson 1 Introduction and Overview of Trauma Care and PHTLS
Instructor Notes
Lesson 1 will provide an introduction and overview of trauma care and the PHTLS program.

2. Trauma Overview (1 of 3)
Worldwide, more than 5.8 million people die from trauma annually
Motor vehicle-related injuries are the leading cause of trauma deaths
Ninety percent of the trauma deaths occur in low- and middle-income countries
Instructor Notes
Expand on the following points:
Worldwide, more than 5.8 million people die from trauma annually.
Motor vehicle-related injuries are the leading cause of trauma deaths.
Ninety percent of the trauma deaths occur in low- and middle-income countries.

3. Trauma Overview (2 of 3) In the United States, annually:
60 million injuries
40 million emergency department visits
2.5 million hospitalized
9 million disabled
8.7 million — temporarily
300,000 — permanently
Instructor Notes
Expand on the following points:
Annually, In the United States, there are:
60 million injuries
40 million emergency department visits
2.5 million hospitalized
9 million disabled
8.7 million — temporarily
300,000 — permanently

4. Trauma Overview (3 of 3)
In the United States, more than 179,000 people die from trauma annually
It is the leading cause of death in persons between 1 and 44 years of age
80% of teenage deaths
60% of childhood deaths
Instructor Notes
Expand on the following points:
In the United States, more than 179,000 people die from trauma annually.
It is the leading cause of death in persons between 1 and 44 years of age.
Trauma accounts for 80% of teenage deaths.
Trauma accounts for 60% of childhood deaths.

5. Cost of Trauma Annually in the United States
Total economic impact of $684 billion Lost productivity from disabilities
5.1 million years
$65 billion
Trauma deaths
5.3 million years of life lost
Average loss — 34 years per death
$50 billion
Instructor Notes
Point out the staggering cost of trauma in dollars and lost years of productivity and life.
The total economic impact of trauma is $684 billion annually in the United States alone.
The lost productivity from disabilities equals 5.1 million years and $65 billion.
Because of trauma deaths, 5.3 million years of life are lost, with an average loss of 34 years per death. $50 billion are lost due to trauma deaths.
Remind participants that these numbers are further compounded by worldwide injury.
Most major trauma patients are either underinsured or uninsured.

6. PHTLS Goals Reduce mortality and morbidity from trauma
Provide knowledge and skills for all prehospital trauma team members
Deliver appropriate care to the trauma patient in the field in a timely fashion
No less
No more
Instructor Notes
Expand on the following points:
The goals of PHTLS are to:
Reduce mortality and morbidity from trauma
Provide knowledge and skills for all prehospital trauma team members
Deliver appropriate care to the trauma patient in the field in a timely fashion
No less
No more

7. PHTLS Philosophy (1 of 2) Trauma care should be based on research
Interventions are based on the assessment of each trauma patient
Deliver the trauma patient:
With the appropriate interventions
To the right facility
Utilizing the right mode of transport
In the right amount of time
As safely as possible
Instructor Notes
Expand on the following points:
The PHTLS textbook and program are based on current available research. That research is cited throughout the textbook.
Prehospital care providers should be comfortable reading research on prehospital care. Some suggested journals for prehospital research include:
Prehospital Emergency Care
Journal of Trauma
Annals of Emergency Medicine
Journal of the American College of Surgeons
Journal of Emergency Medicine
Academic Emergency Medicine
The appropriate interventions are based on the assessment of each trauma patient.
Knowing when to do something is important and knowing when not to do something may be even more important.
Prehospital care providers must deliver the trauma patient:
With the appropriate interventions
To the right facility
Utilizing the right mode of transport
In the right amount of time
As safely as possible

8. PHTLS Philosophy (2 of 2)
Research provides us with the foundation for the best practices for trauma care
Research may:
Validate our current practices
Refute our current practices
Determine future practices
Instructor Notes
Encourage the participants to read Chapter 3, The Science, Art, and Ethics of Prehospital Care: Principles, Preferences, and Critical Thinking, which describes how to read and evaluate research.
Expand on the following points:
Research provides the foundation for determining the best practices for trauma care.
Research may validate current practices, refute current practices, and determine future practices.
In the past, prehospital research was limited and often poorly done, but is now getting better.
All research must be critically evaluated to see if the findings truly apply to individual EMS systems and patient populations before a practice is changed.

9. Team Approach (1 of 2)
A diverse team must work together in order to provide trauma patients with the best chance for a favorable outcome
Instructor Notes
Expand on the following points:
Trauma care is a team sport, and prehospital care is the first component of the team structure.
It involves a diverse team that must work together in order to provide trauma patients with the best chance for a favorable outcome.
© Dan Myers

10. Team Approach (2 of 2) This team includes: Citizens, dispatch
System activation
Emergency medical responders
EMS
Transport services
Emergency department
Surgery
Other specialty services
Rehabilitation
Instructor Notes
Expand on the following points:
This team includes:
Citizens, dispatch
System activation
Emergency medical responders
EMS
Transport services
Emergency department
Surgery
Other specialty services
Rehabilitation

11. Communication and Documentation (1 of 3)
Communication among all trauma team members is critical in ensuring that proper care is provided to the patient
Timely
Verbal
Written
Instructor Notes
Expand on the following points:
Communication among all trauma team members is critical in ensuring that proper care is provided to the patient.
Discuss what constitutes ideal:
Timely communication
Verbal communication
Written communication
© Jones and Bartlett Publishers. Courtesy of MIEMSS.

12. Communication and Documentation (2 of 3)
Clear, concise, accurate, and complete communication between the prehospital care provider and the receiving hospital facilitates optimal care
Instructor Notes
Expand on the following points:
Clear, concise, accurate, and complete communication between the prehospital care provider and the receiving hospital facilitates optimal care.
It allows the receiving hospital to prepare for the patient and have the trauma team fully assembled upon the patient’s arrival.
Courtesy of Anthony Caliguire, NREMT-P.

13. Communication and Documentation (3 of 3)
Good documentation is required:
To maintain continuity of care
Copy of prehospital care report left at receiving hospital
For medical and legal reasons
For trauma research
To support trauma system funding
Instructor Notes
Expand on the following points:
Good documentation is required to maintain the continuity of care.
To ensure this, a copy of the prehospital care report is left at the receiving hospital.
Documentation is also essential:
For medical and legal reasons
For trauma research
To support trauma system funding

14. PHTLS Around the World Instructor Notes
Expand on the following points:
The PHTLS program is presented throughout the world and is changing the way trauma patients are treated globally.
The countries with PHTLS programs are in red.

15. PHTLS
Based on the Advanced Trauma Life Support (ATLS) course by the American College of Surgeons Committee on Trauma (ACS-COT)
A joint effort between the ACS-COT and the National Association of EMTs (NAEMT)
First offered in 1983, has been offered in 57 countries, and has trained more than 700,000 providers
Instructor Notes
Expand on the following points:
PHTLS is based on the Advanced Trauma Life Support (ATLS) course created by the American College of Surgeons Committee on Trauma (ACS-COT).
PHTLS is a joint effort between the ACS-COT and the National Association of Emergency Medical Technicians (NAEMT).
PHTLS was first offered in 1983, has been offered in 57 countries, and has trained more than 700,000 prehospital care providers.

16. PHTLS Course (1 of 3)
Builds upon each participant’s current knowledge base and skills to enhance critical thinking and problem-solving abilities
Stresses teamwork between providers with diverse levels of knowledge, skills, and resources
Provides a structured environment to practice trauma assessment and treatment skills
Instructor Notes
Expand on the following points:
PHTLS builds upon each participant’s current knowledge base and skills to enhance critical thinking and problem-solving abilities.
PHTLS stresses teamwork between prehospital care providers with diverse levels of knowledge, skills, and resources.
PHTLS provides a structured environment to practice trauma assessment and treatment skills.

17. Medical practices change!
PHTLS Course (2 of 3)
We must critically examine everything we do (i.e., how and why)
Science is always evolving and helps us verify or disprove our approach to trauma care
Health care providers must be lifelong learners
Medical practices change!
Instructor Notes
Expand on the following points:
Medical practices change, and they change quickly.
Trauma team members must stay abreast of current knowledge and changes in practice.
Trauma team members must critically examine everything we do (i.e., how and why).
Science is always evolving and helps to verify or disprove our approach to trauma care.
Health care providers must be lifelong learners.

18. PHTLS Course (3 of 3) Based on available research
Updated every 4 years as supported by new research
Teaches the principles of care rather than focusing on preferences
Instructor Notes
Expand on the following points:
Optimal trauma care relies on up-to-date knowledge and technical expertise.
Skills rapidly deteriorate when unused and require ongoing practice.
PHTLS is based on available research and updated every 4 years as supported by new research.
PHTLS teaches the principles of care rather than focusing on preferences.

19. Trauma Care (1 of 3)
Principle is what needs to be done for a patient based upon the assessment
Preference is how the principle is accomplished
This will change depending on the:
Situation at the scene
Severity of the patient
Knowledge and skills of the prehospital care provider
Resources available
Instructor Notes
Expand on the following points:
The principle is what needs to be done for a patient based upon the assessment.
The preference is how the principle is accomplished.
The principle remains the same regardless of the level of prehospital care provider.
The preference of how the principle is accomplished is affected by:
The situation at the scene
The severity of the patient
The knowledge and skills of the prehospital care provider
The resources available

20. Trauma Care (2 of 3) Based on assessment
Begins long before you reach the patient
Information provided from the call for help
Scene and situation
Safe
Available resources
Number of patients
Instructor Notes
Expand on the following points:
Certain situations will alter the trauma care provided (e.g., wilderness, combat, tactical)
Trauma care is based on assessment.
It begins long before reaching the patient with the information provided from dispatch.
The scene and situation impact trauma care.
Is the scene safe?
What are the available resources?
How many patients are present?

21. Trauma Care (3 of 3) Mechanism of injury (kinematics) Patient
Primary assessment
Secondary assessment
Reassessment
Instructor Notes
Expand on the following points:
The mechanism of injury (kinematics) directly impacts trauma care.
The results of the entire patient assessment will direct trauma care:
Primary assessment
Secondary assessment
Reassessment

22. Patient Assessment (1 of 2)
Primary assessment
A-B-C-D-E approach
Taught sequentially, performed “simultaneously”
Assess for and correct immediate threats to life
Secondary assessment
“Head-to-toe” assessment
Assess for all other injuries — usually non-life-threatening
Includes measurement of vital signs
Instructor Notes
Expand on the following points:
Primary assessment
Emphasize that although the A-B-C-D-E approach is taught in a sequential fashion as individual assessment points, in reality, the points should be accomplished virtually simultaneously.
The prehospital care provider assesses for and corrects immediate threats to life during this phase.
Secondary assessment
This phase is the head-to-toe assessment.
The prehospital care provider assesses for all other injuries — usually non-life-threatening.
This phase includes the measurement of the patient’s vital signs.

23. Patient Assessment (2 of 2)
Reassessment
Important to look for changes in the patient’s condition
Response to treatment
Ongoing to determine any apparent change in patient status
Instructor Notes
Expand on the following points:
During the reassessment phase, it is important to look for changes in the patient’s condition and response to treatment.
The reassessment phase is ongoing to determine any apparent change in patient status.

24. Critical Trauma Patient (1 of 2)
Primary assessment
Treat at the scene versus treat while en route
Knowing when to do something is important; knowing when not to do something is even more important
Reassessment
Secondary assessment
Only when time and situation allow
Instructor Notes
Expand on the following points:
In the critical trauma patient, the following modifications to the patient assessment process are made.
Primary assessment
Determine whether to treat at the scene versus treating while en route.
Knowing when to do something is important; knowing when not to do something is even more important.
Perform reassessment to determine any apparent change in patient status.
Secondary assessment
Perform only when time and situation allow.

25. Critical Trauma Patient (2 of 2)
Transport
Ground versus air
Mode of transport
Emergent versus non-emergent
Appropriate destination
Instructor Notes
Expand on the following points:
The factors to weigh when determining transport for the critical trauma patient include:
Ground versus air
The best mode of transport
Emergent versus non-emergent patient
The location of the appropriate destination for the patient

26. Potential Pitfalls of Assessment and Management (1 of 3)
Not establishing a safe scene
Overlooking life threats by not adequately assessing or exposing the patient
Focusing on distracting, non-life-threatening injuries
Performing a secondary assessment prior to stabilizing all life threats
Instructor Notes
Expand on the following points:
The potential pitfalls of assessment and management include:
Not establishing a safe scene
Overlooking life threats by not adequately assessing or exposing the patient
Focusing on distracting, non-life-threatening injuries
Performing a secondary assessment prior to stabilizing all life threats

27. Potential Pitfalls of Assessment and Management (2 of 3)
Performing “advanced” interventions before “basic” procedures
Not performing a secondary assessment when appropriate
Prolonged scene times
Instructor Notes
Expand on the following points:
The potential pitfalls of assessment and management include (continued):
Performing “advanced” interventions before “basic” procedures
Not performing a secondary assessment when appropriate
Prolonged scene times

28. Potential Pitfalls of Assessment and Management (3 of 3)
Overlooking signs of deterioration in a patient who initially appeared noncritical
Failure to reassess
Transport or destination decision error
Instructor Notes
Expand on the following points:
The potential pitfalls of assessment and management include (continued):
Overlooking signs of deterioration in a patient who initially appeared noncritical
Failure to reassess the patient
Transport or destination decision error
Consider starting a discussion using the questions below:
What are some things we can do, as prehospital care providers, to make sure we are detecting changes in the patient’s condition?
How can we continue to improve in providing prehospital trauma care?
How do we best determine the appropriate resources for the patient based on the patient’s assessment?

29. Prevention Trauma is preventable
Prevention training is available for everyone
PHTLS faculty and providers should be advocates for and active participants in trauma prevention programs
Prehospital care providers are the “eyes” of the prevention effort
Instructor Notes
Expand on the following points:
Prehospital care providers are the only health care providers to actually see the trauma scene and assess for preventable causes.
Trauma is preventable.
Prevention training is available for everyone.
PHTLS faculty and providers should be advocates for and active participants in trauma prevention programs.
Prehospital care providers are the “eyes” of the prevention effort.

30. Course Mechanics Housekeeping How the course will run
Course expectations
Evaluation process
Instructor Notes
At this point, the course coordinator should describe to the participants the logistics for the course (e.g., breaks, meals, stations).
Expand on the following items:
Housekeeping (e.g., breaks, meals, stations)
How the course will run (i.e., the course schedule)
Course expectations
The evaluation process

31. Questions? Instructor Notes
Allow time for a question and answer session to answer any questions about the topics presented in the lesson.