Advanced Trauma Life Support (ATLS) at the Accident Scene

The correct care of patients injured by trauma is very different from that of patients with medical (non-traumatic) diseases.

The Advanced Trauma Life Support course is the outstanding program designed and sponsored by the American College of Surgeons to insure that every trauma patient receives the very best care possible.*

The ATLS decision making process begins when the EMTs or paramedics arrive at an accident scene.

Seriously injured trauma patients need to go directly to a Trauma Center because immediate or urgent surgery may be necessary to safe the patient’s life.

The EMTs at the scene learn to proceed in the following way:

They first measure the injured patient’s vital signs and level of consciousness.

If the patient’s Glasgow Coma scale is less than 13, or the systolic blood pressure is less than 90, or the respiratory rate is less than 10 or greater than 29 (in infants less than one year of age a respiratory rate of less than 20 or greater than 29) or if the patient needs ventilatory support (assisted ventilation with bag and mask), then the EMTs are to immediately transport the patient the highest level trauma center in their area (there will be standing protocols on this).

If none of the above apply, then the next step is to examine the patient for anatomic injuries. Any injured patient with following wounds should be immediately transported to the trauma center:

Any penetrating injury to the head, neck, torso, or extremities proximal to elbows or knees.

Two or more fractures that involve the upper arms or the thighs.

Any mangled or pulseless extremity ir crushed or degloved extremity.

Amy amputation that is proximal to the ankle or wrist.

Any pelvic fracture (if recognized at the scene).

Any open or depressed skull fracture.

Any paralysis.

If none of the above apply, then the next step is to determine the mechanism of the injury. If any of the following mechanisms of injury occur, then the patient should be transported to the trauma center:

Any adult who falls greater than 20 feet

Any child (age less than 15 years of age ) who falls greater than 10 feet or greater than 2 to 3 times the child’s height

Any patient involved in a high risk auto crash (intrusion [collapse of the passenger compartment on the occupant’s side of greater than 12 inches or greater than 18 inches of any part of the interior of the car], ejection (partial or complete) from the car, death of another passenger in the car, vehicle telemetry indicating high risk of injury .

Any pedestrian or bicycle rider who is thrown, run over or hit (at greater than 20 miles per hour) by an autombile.

Any motorcycle rider involved in a crash at greater than 20 miles per hour.

If none of the above apply, the next step in the evaluation is consider medical history and if any of the following apply, then transport to a trauma center or other appropriate hospital and in making the decision consider consulting with medical control:

Older adults greater than 55 years of age (risk of death and injury increases above that age)

Older adults greater than 65 years of age with a systolic blood pressure of less than 110 (as this may indicate shock in these patients) .

Older adults greater than 55 years of age with ground level falls or other low impact mechanisms.

Children should be transported to pediatric trauma center if available.

Patients who are taking anticoagulants or who have bleeding disorders (because these patients if they have head injury [which might not be evident early on] are at high risk of sudden for sudden deterioration.


Pregnancy of greater than 20 weeks.

Patients who the EMT believes on clinical judgment that transport to trauma center or other appropriate hospital is indicated.

“When in doubt, transport to a trauma center”

*Advanced Trauma Life Support Student Course Manual,9th ed, 2013, American College of Surgeons, p. 5.

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