Elsevier

Journal of Surgical Education

Volume 76, Issue 2, March–April 2019, Pages 487-496
Journal of Surgical Education

Original Reports
Global Collaboration to Modernize Advanced Trauma Life Support Training

https://doi.org/10.1016/j.jsurg.2018.08.011Get rights and content

Background

Each year, thousands of surgeons and other trauma health care providers participate in the American College of Surgeon's Advanced Trauma Life Support (ATLS) program, which historically has allowed trainees to practice cricothyroidotomy, chest tube insertion, pericardiocentesis, venous cutdown, and diagnostic peritoneal lavage on live dogs, pigs, sheep, and goats. However, more than 99% of ATLS programs in the United States and Canada have now ended animal use, driven primarily by simulation technology advancements.

Objective

This review details an international survey of animal versus simulation use in ATLS programs and summarizes the surgical training impact of a novel collaboration between the industry manufacturer of the TraumaMan human simulator, Simulab Corporation (Seattle, Washington), and an animal protection nongovernmental organization (NGO) based in Norfolk, Virginia, to replace animal use in ATLS programs with human simulators.

Methods

From 2012 through 2017, the NGO e-mailed formal surveys concerning program statistics and animal use practices to ATLS officials in various countries (N = 64). The survey response rate was 87.5% and included pre- and post-comparison surveys relative to the industry-NGO simulation collaboration.

Results

Eighteen ATLS programs (32.1%) initially replied that they use nonanimal training methods, whereas 38 ATLS programs (67.8%) replied that they use animals for surgical skills training and cited financial constraints as the primary barrier to adopting human simulation methods. Through the industry-NGO collaboration, the NGO donated 119 TraumaMan models valued at nearly $3 million (USD) to ATLS programs in 22 countries, such that 75% of those ATLS programs surveyed by the NGO now use exclusively nonanimal simulation models.

Conclusions

The industry-NGO collaboration successfully transformed the surgical skills laboratories of 22 international ATLS programs to replace animal use with nonanimal simulation models that are more anatomically realistic, cost less, and allow trainees to repeat surgical skills until proficiency.

Section snippets

BACKGROUND

The American College of Surgeons’ (ACS) Advanced Trauma Life Support (ATLS) program was introduced in 1978 and has become the standard of care for the initial assessment and treatment of trauma patients. The course, which involves didactic sessions and skills training, has been taught to more than 1 million physicians and advanced practice health care professionals and is now offered in 86 countries.1 Historically, the surgical skills station of the ATLS program – which covers invasive

METHODS

From 2012 through 2017, the NGO sent formal surveys via e-mail to officials representing the following international ATLS programs (N = 64) regarding their use of animals or simulators as part of the course's surgical skills laboratory: Argentina, Australia, Bangladesh, Bolivia, Brazil, Chile, China, Colombia, Costa Rica, Curacao, Cyprus, Czech Republic, Denmark, Ecuador, Egypt, Estonia, France, Germany, Ghana, Greece, Hong Kong, Hungary, India, Indonesia, Iran, Iraq, Ireland, Israel, Italy,

RESULTS

Numerous international ATLS officials from countries that use animals for this course expressed a desire to switch to nonanimal simulation models, yet cited financial constraints as the primary transition barrier.

CONCLUSION

Through participation in the industry-NGO collaboration to modernize medical training, 22 ATLS programs around the world have successfully been able to replace their use of animals in the surgical skills laboratory portion of the ATLS course with more realistic TraumaMan simulation models that – unlike animals – provide superior human anatomy, significantly lower costs for ATLS programs, and improve training by allowing ATLS participants to repeat procedures until proficient. This novel

DISCUSSION

Training surgeons in trauma management requires teaching models that convey realistic human anatomy, allow for repetitive use to develop skill proficiency, and facilitate team training – all of which, unlike using animals, can be achieved using TraumaMan and other ACS-approved nonanimal training methods.

In addition to the problematic ethical issues associated with using animals in surgical training, the choice to use live animals or nonanimal methods during an ATLS course should be based on

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