Intended for healthcare professionals


Training in advanced trauma life support is unnecessary for all senior house officers in accident and emergency

BMJ 1998; 317 doi: (Published 29 August 1998) Cite this as: BMJ 1998;317:603
  1. J William, Specialist registrar (WillTice{at},
  2. S Tice, Specialist registrar
  1. Department of Trauma and Orthopaedics, Mayday University Hospital, Surrey CR7 7YE

    EDITOR—Price and Hughes's proposition that all senior house officers should be trained in advanced trauma life support before working in accident and emergency1 fails to tackle the fundamental problems in trauma care in the United Kingdom. Of course senior house officers in accident and emergency must be familiar with advanced trauma life support and be capable of initiating the management of a multiply injured patient, but they cannot and should not be expected to be an expert in trauma care. The management of major trauma remains unsatisfactory because of delays in providing experienced staff and timely operations.2 It is naive to think that completing a training course will give a newly registered senior house officer such expertise.

    The British Orthopaedic Association analysed the evidence from Britain and elsewhere and concluded that expertise should be concentrated in 30 centres that would receive all severely injured patients.3 This is a plan for the future, but in our present district general hospital system the trauma team concept has become the accepted standard. Contrary to Price and Hughes's survey, which found that only 38% of hospitals had a trauma team, published data suggest that only 37% have no such rapid response system.4 The rarity of major trauma means that it is difficult to acquire experience, and every case must be regarded as a training opportunity. Surgical and orthopaedic trainees must not be denied this opportunity. Full training in advanced trauma life support for all accident and emergency doctors may lead to complacency and a reluctance to involve other specialties early.

    Even a busy department will treat only one seriously injured patient a week3 so a senior house officer is likely to be involved in the management of only three or four cases in six months in accident and emergency. Less than a third of these senior house officers intend to pursue a career in surgery or accident and emergency.5 The shortening of working hours and training of junior doctors makes it more important than ever that training is efficient; both clinical experience and formal teaching must be relevant. Priority of places on advanced trauma life support courses must be given to those whose chosen careers involve trauma care. For these trainees I agree that training should occur early and ideally before or during an accident and emergency attachment.