I would not be so quick to dismiss this as a failure of knowledge retention. It is a well known principle in medical education that didactic lecture-obtained knowlede has a rapid attrition, and is almost complete at six months, far shorter than the re-certification cycle for ATLS. Unless people are constantly practicing and re-newing the lessons they've learned, the information wuill be lost before it is ingrained. If a student were to take ATLS, and then return to their hospital where they rarely or infrequently see trauma, their performance will degrade to a substandard level over time. <BR><BR>More simply stated: use it or lose it.<BR> <BR>Jeffrey Hammond MD, MPH<BR>New Brunswick, NJ<BR><BR><BR>----- Original Message -----<BR>From: Karim Brohi <karimbrohi@gmail.com><BR>Date: Thursday, November 22, 2007 6:19 pm<BR>Subject: Re: Trauma Care in the UK<BR>To: "Trauma &amp, Critical Care mailing list" <trauma-list@trauma.org><BR><BR>> Just to put the record straight I mistated the figures.<BR>> <BR>> ISS>15: US: 16% vs UK 30%<BR>> ISS>24: US: 30% vs UK 46%<BR>> <BR>> Now apart from the stsem issues, the other thing that is clear form<BR>> the report is that many of the cases of poor clinical care were with<BR>> fundamental ATLS principles. Now the UK has one of the <BR>> highest ATLS<BR>> uptakes in the world, with it being pretty much mandatory to progress<BR>> in training in surgery, anaesthesia, emergency medicine etc <BR>> without it<BR>> from approximately PGY3 onwards.<BR>> <BR>> So this appears to be either a failure of knowledge retention, which<BR>> is unlikely, but more probable is that it's a failure of<BR>> implementation. That there is a disconnect between knowing <BR>> what to do<BR>> and actually doing it. And I have no doubt that that is <BR>> not a UK<BR>> problem but a global problem.<BR>> <BR>> So how do you transition ATLS principles from 'knowing' to <BR>> 'doing' -<BR>> and how do you do it on a national level? (This applies to <BR>> medicaleducation in general, but ATLS is a great starting point <BR>> as it has<BR>> been so extensively studied)<BR>> <BR>> Ideas?<BR>> <BR>> Karim<BR>> <BR>> On 22/11/2007, Tony Joseph <tjoseph@ihug.com.au> wrote:<BR>> > Karim et al<BR>> ><BR>> > A major issue is that although there are no doubt other health <BR>> priorities,> traumacare is a relatively easy one to get <BR>> right by investing in a few<BR>> > major Trauma centers servicing a defined hub of smaller hospitals.<BR>> > The UK definitely has the expertise but not the mandated <BR>> organisation.><BR>> > As a large number of Trauma victims are young, it is also cost <BR>> effective in<BR>> > treating them right the first time so they can get back to <BR>> work and be<BR>> > productive.<BR>> > Maybe that is an argument your Government can understand.<BR>> ><BR>> > 43% mortality is pretty convincing something needs to be done <BR>> urgently?><BR>> > Also you only have to convince one layer of Government which <BR>> is a definite<BR>> > advantage?<BR>> ><BR>> > Regards<BR>> > Tony Joseph<BR>> ><BR>> ><BR>> > On 22/11/07 9:48 AM, "Karim Brohi" <karimbrohi@gmail.com> wrote:<BR>> ><BR>> > > Sadly the state of trauma care in the UK is exactly as <BR>> portrayed in<BR>> > > the NCEPOD report, if not worse. It depicts clearly <BR>> the effect of a<BR>> > > lack of a system and lack of any legislated standards of <BR>> care on the<BR>> > > quality of care delivered to trauma patients, despite this <BR>> being a<BR>> > > developed country with huge resources.<BR>> > ><BR>> > > I'd recommend the report to anyone involved in trauma care, <BR>> not only<BR>> > > those in the UK, as the findings have implications for all <BR>> of us.<BR>> > > This is a unique study in that all hospitals in England and <BR>> Wales are<BR>> > > mandated to submit data to a NCEPOD enquiry, and this is <BR>> self-reported<BR>> > > data on nearly 800 severely injured patients presenting a <BR>> country-wide<BR>> > > detailed snapshot of the delivery of trauma care. <BR>> Deficiencies in<BR>> > > process of care and their subsequent impact on outcome are <BR>> relevant to<BR>> > > all of us.<BR>> > ><BR>> > > Anyone in the UK who doesn't recognise these deficiencies is <BR>> frankly> > blinkered to reality. 2000-2005 outcomes for <BR>> severe injury (ISS>15):<BR>> > > UK Mortality 43%; US mortality 16% (these are not figures in the<BR>> > > report, this compares UK TARN data to US NTDB data).<BR>> > ><BR>> > > The fault lies not with individual specialties, providers or<BR>> > > hospitals, but with the lack of a appropriately resourced national<BR>> > > trauma system, with legislated standards of care and on-going<BR>> > > monitoring of the health of that system.<BR>> > ><BR>> > > This is the latest in a long litany of reports since the <BR>> Ormond-Clarke<BR>> > > report first recommended a UK trauma system in 1961. <BR>> In 2011 it will<BR>> > > be 50 years. It's about time.<BR>> > ><BR>> > > PDF available: http://213.198.120.192/2007b.htm<BR>> > ><BR>> > > Karim<BR>