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Fri Nov 23 17:42:29 GMT 2007

Karim,

> - snip - So how do you transition ATLS principles from 'knowing' to 'doing' -
> and how do you do it on a national level?  (This applies to medical
> education in general, but ATLS is a great starting point as it has
> been so extensively studied)
interesting discussion indeed! In my part of the world there are
fundamental changes to come in the attitude towards trauma care.
Traditionally the care for the injured was part of any hospitals duty
and there was a long fight to establish trauma surgery (Unfallchirurgie)
as a profession. Keep in mind that those trauma surgeons, once
established, recently decided to merge with orthopedic surgeons. In my
view, they will in short loose the close connection to anything besides
bone and joint surgery. A pity in a country where the bulk of trauma
still is blunt trauma.

Second, the DGU (German society of trauma surgery) licensed only a short
time ago the ATLS system. So there are still few of those staff members,
who deal with trauma, trained in ATLS.

Third, the DGU developed a national trauma registry, unfortunately not
mandatory.

And fourth, the plan is to establish local trauma networks with only few
dedicated trauma centres - about 15% of the hospitals now offering
trauma care shall do that in the future.

Now, will that  be good or bad? As a surgeon with interest in trauma,
living and working in a rural part of my country, my emotions are mixed:
in contrary to many "centres of excellence" my shop is a member of the
trauma registry since a couple of years and thus I now that at least
trauma care *can* be delivered in small hospitals at least as good as in
dedicated trauma centres. I encourage awareness to trauma, a *mandatory*
participation in a national registry and accepted training guidelines.
But I doubt, whether the separation of trauma care from general surgery
will do good at the long run and I have pretty much doubt if the
hospital companies are willing to pay for mandatory ATLS training (and
recertification, for that matter). My fear is, this will only speed up
the rapid change in my countries health care system and extinguish local
hospitals *without* thinking.

My 2 cents.

Mathias

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