-ABCs

Just like me, my dad had been paralyzed.  With Ron’s words, he got up and began to walk again.  He began to really talk.  His mind began to engage and soon the ideas were flowing from the two of them. 

They had determined early in the conversation that what was really needed was fairly simple:  There was a basic lack of consistency in trauma care and they needed a system to address this inconsistency.  In other words, they needed a method to educate rural physicians in a systematic way to treat trauma that was applicable to all facilities all over the state.  All of the doctors at these facilities were perfectly competent to treat their patients, but many were using out of date or obsolete methods because there was no consistent system, and if there was, there was no way to deliver it. 

The two of them soon managed to get together with a nurse who worked with the Lincoln Mobile Heart Team named Jodie Upright very early in the discussion.  The Mobile Heart Team itself was a recent innovation that dealt with, as the name implied, cardiac trauma and the standardization of cardiac care. 

The three of them hashed the issue out, comparing their own experiences, and quickly decided there was indeed a need for this new system.  They were all aware that if this was possible, it would call for the creation of a training course for the small hospitals – ones like the hospital in Hebron.  These kinds of facilities were literally all over the state, and dad, Ron and Jodie all had the same conclusion through their individual dealings that very little consistency in trauma care existed among any of them. 

And that’s what had caused the problems dad had encountered in Hebron, that lack of consistency.  It wasn’t the standard of care.  Most of these facilities, including Hebron, could handle the emergencies, and most patients didn’t suffer inadequate care.  They probably could have handled us just fine if dad hadn’t lost it.  But in trauma, there could be, and should be, a standard.  A system to deal with all kinds of cases in a similar and by-the-numbers fashion.

They were all aware of and familiar with the work of another Lincoln physician named Steve Carvith, who had created a course with a similar objective called Advanced Cardiac Life Support, which addressed similar issues in cardiac care.  Jodie had worked with Doctor Carvith on that project, so she was a good source of knowledge for how it came about and the format used.  ACLS was a great idea and provided the level of consistency in cardiac care that dad, Jodie, and Ron were looking for in trauma care. 

Influenced by the concepts, and realizing that if something works, you should go with it, they decided to use a similar format, and call the new course Advanced Trauma Life Support (ATLS).  Not too original, they knew, but it seemed to catch on with them, and had a solid sounding ring to it. 

The first thing they knew they had to do was to become experts on the conceptual framework that Steve had developed, so over the next several months they all took courses, and became certified ACLS instructors so that they could learn intimately how the course was organized.  It was hard work and a huge commitment to their professional and personal lives, but they had all become entranced by the project, and to them it was well worth it. 

As they went along, they began to see the enormity of what they had started.  They could see that a lot of help would be needed, if this was going to work.  Intensive training was the key to it, and to do that a syllabus had to be created and arranged into a framework that presented a logical and consistent approach to all manner of trauma. 

Somewhere along the way they had realized that the problem in many trauma cases was the wrong order of treatment.  If a patient was bleeding profusely, sure that looks horrible and could certainly kill them, but the crushed chest you are ignoring while you treat the ghastly looking gusher of blood will kill them quicker than the bleeding itself.  Simply put, a doctor had to understand the necessary order of treatment and treat people appropriately. 

They got the idea that it would be more effective if a doctor could quickly evaluate a patient as soon as they came into the ER, know the severity of the various injuries based on known facts, and fix the worst ones first, and before attacking the next problem.  This, rather than look at every system involved and every problem, figure out which one to treat, and then began treatment - which was pretty much the way it had been done, and was based on the individual doctor, who was, after all, human and limited by his or her level of training, knowledge, and experience.  This created inconsistency. 

They began to call their new concept of the correct order of treatment the ABC’s of trauma.

As they expected, this idea created a bit of controversy and rumbling from the establishment as word of the ABC concept spread.  As it is with many things, it is very difficult to get people, even highly educated and progressive people, to step out of their comfort zone, get away from what they knew, and try something new.  It is no different with doctors; at least it wasn’t at the time.  Doctors see themselves, and rightly so, as the captain of their respective ships.  The call may be right or wrong, but it was still their call.  Some complained that the standardization of the process took the ability away from them to make good decisions. 

Some just had big egos.  But even the staunchest of critics couldn’t argue away the simple logic of the concept, and it began to catch on. Soon that simplicity was implemented into the creation of the ATLS course as its central dogma.  Everything else would be based on the ABC’s.