"To promote and enable the training of medical professionals to manage and treat severely injured patients in low & middle income countries. The desired outcome is that lives are saved and disabilities are avoided" Our original PTC Manual stated "most countries of the world are experiencing an epidemic of trauma". The Primary Trauma Care course was developed to provide the principles of the priorities of trauma management and skills needed to accurately assess and manage trauma patients' needs. Since the start in 1996, PTC courses have been introduced in more than 75 countries.
The Trauma Burden[edit | edit source]
Disease burden is defined by the WHO as "the impact of a health problem on an area measured by financial cost, mortality, morbidity or other indicators". Low and Middle Income Countries have particular difficulties with management of trauma: patients often need to be transferred for great distances, and arrive late after injury. There may be no high-tech equipment (and sometimes not even electricity, oxygen & running water) and small numbers of health professionals with training. It is difficult to make reliable accurate estimates of the incidence and burden of trauma in low and middle income countries. Population-based injury surveillance systems are obviously the best source but unlikely to be established in these regions for several decades. In many regions a reasonable estimate of this burden comes from the existing medical sources, including hospital records, police reports, health surveys and death registers. Many hospitals need trauma registries. Accurate trauma data is needed to inform policy-makers and health officials about the true magnitude and ranking of trauma as a major burden of disease in individual countries.
In 2000 – 2015 the WHO Global Burden of Disease (GBD) project aided informed decision-making and increased attention on this significant public health problem. The WHO GBD programme currently indicates that nearly 3,500 people die on the world's roads every day. Tens of millions of people are injured or disabled every year with a huge burden of disability. Children, pedestrians, motor-cyclists and the elderly are among the most vulnerable of road users. We now have a better understanding of the leading causes of death/burden of disease in relation to geographical region, income levels, by age and sex. This can allow rational cost effective decisions to be made to improve patient outcome from trauma intervention programmes. PTC provides a great opportunity to introduce a trauma management system into patient management and improve patient outcome. Trauma training needs to be done in a cost effective, clinically effective and outcome effective way so as to make the most of resources. We regularly update the Primary Trauma Care Manual. The manual's robustness since 1996 has been due to its simplicity, its clarity and its ability to be used in all regional areas without the need for high technological support. The Primary Trauma Care Manual is not a substitute for advanced trauma management programmes such as ATLS™ and other similar courses. It is a method that has proved successful in training health care professionals in one method of trauma management in low and middle income countries (LMICs). The objectives of the Primary Trauma Care course remain the same: For the candidate to understand the clinical priorities in trauma management and be competent to undertake a rapid systematic assessment and to resuscitate and stabilise trauma patients in environments of limited resource.
Primary Survey: The ABCDE of Trauma[edit | edit source]
It is important to recognise priorities in the management of severe multiple injuries. The goal in initial assessment is to determine those injuries that threaten the patient's life. This first survey, the 'primary' survey, if done correctly should identify life-threatening injuries such as:
- Airway obstruction
- Breathing difficulties with chest injuries
- Circulation problems due to severe external or internal haemorrhage
- Disabilities: head and spinal injuries.
If there is more than one injured patient then treat patients in order of priority (Triage). This depends on experience and resources; we will cover this in the practical sessions. Apply oxygen and monitoring equipment as soon as available. Ideally monitoring should include ECG, blood pressure, pulse oximetry, and some method of assessing CO2.
The Primary survey is Airway, Breathing, Circulation, Disability and Exposure. It must be performed in no more than 5 minutes and it involves assessment and immediate treatment of any life threatening injuries. Simultaneous treatment can occur when more than one life-threatening injury exists in a trauma victim.
Airway
Assess the airway and protect the Cervical Spine.
Can the patient talk and breathe freely? Give Oxygen.
If obstructed, further steps need to be considered.
Breathing
Is the patient breathing normally? Give oxygen.
Is the chest moving equally on both sides?
If abnormal, further steps need to be considered.
Circulation
Assess circulation: colour, perfusion, pulse, blood pressure.
If abnormal, further steps need to be considered.
Disability
Assess the patient for neurological disability from brain or spine injury. Is the patient:
Awake? A
Opening eyes to Voice? V
Opening eyes to Pain? P
Unresponsive? U
If abnormal, further steps need to be considered
Exposure
Undress the patient and look for hidden injury. Keep their temperature stable.
(See Appendix 1 – Primary Survey flow Chart)
Authors[edit | edit source]
Original[edit | edit source]
Revision Team 2013-14[edit | edit source]
e-PTC[edit | edit source]
Affiliations[edit | edit source]
Syllabus[edit | edit source]
- Overview
- NREMT course (prerequisite)
- Airway
- Airway Management
- Breathing
- Chest Trauma
- Circulation
- Limb Trauma
- Abdominal & Pelvic Trauma
- Primary Survey
- Circulation and shock
- Limb Trauma
- Head Trauma
- Paediatric Trauma
- Trauma Triage
- Trauma in Pregnancy
- Focussed Assessment with Sonography for Trauma (FAST) Scan
- Secondary Survey
- Spinal Trauma
- Burns
- Transport of Critically Ill Patients
Appendix[edit | edit source]
Appendix 1: Primary Survey Flow Chart[edit | edit source]
Appendix 2: Airway Management Techniques[edit | edit source]
Appendix 3: Breathing Management and Chest Injuries[edit | edit source]
Appendix 4: Equipment requirements/ airway & breathing management[edit | edit source]
Appendix 5: Vital Signs and Blood Loss[edit | edit source]
Appendix 6: Massive Transfusion[edit | edit source]
Appendix 7: Pain Management in Trauma[edit | edit source]
Appendix 8: FAST[edit | edit source]
Appendix 9: Dermatomes[edit | edit source]
Appendix 10: Paediatric Physiological Values[edit | edit source]
Appendix 11: Trauma Triage[edit | edit source]
Appendix 12: Preparing for Mass Casualties[edit | edit source]
Course Authors[edit | edit source]
Create sections and subsections to get into details.
Original Authors[edit | edit source]
Dr Douglas Wilkinson - BSc, MBChB, MRCGP, FRCA, FFICM
Dr Marcus Skinner - MSc, BMedSc, DipDHM, MBBS, FANZCA
With assistance from PTC colleagues
Revision Team[edit | edit source]
Dr Marcus Skinner - MSc, BMedSc, DipDHM, MBBS, FANZCA
Dr Saeed Minhas - MBBS, FCPS
Dr Haydn Perndt - AM FFARCS, FANZCA, MPH, TM
Dr Jayakrishnan Radhakrishnan - MBBS, HDip Surg (SA), FCS (SA)
Dr Juan Carlos Duarte Giraldo - MD, MTSVA, CLASA Trauma Committee
Dr Georgina Phillips - MBBS, FACEM
Dr James de Courcy - MB BS, DCH, FHEA, FRCA, FFPMRCA
Mr Charles Clayton - BSc, MA, FIOD, FRSA
With additional advice from:
Dr Michael Dobson - MB ChB MRCP FRCA