Further recommendations for trauma training of Indian medical officers and medical students.

In a recent article, [1] we have demonstrated a significant difference in the theoretical knowledge of both junior and senior emergency department (ED) medical offi cers (MOs) from Salem, Tamil Nadu, India, and the Royal Adelaide Hospital (RAH) Adelaide, South Australia, in the management of severely injured trauma patients, when comparing MOs who had completed an ATLS-type program with those who had not undertaken such a program. We recommended that a program based upon the principles of Advanced Trauma Life Support (ATLS) be integrated into the training of Indian ED MOs, and that such training be viewed as an integral part of medical training. Studies [2-4] have found that the initial resuscitation and management of severely injured trauma patients is often performed by relatively inexperienced junior MOs, often without adequate consultant (or senior MO) supervision, [5] and Wong [6] has shown that even in a major Australian trauma center, junior MOs, including basic surgery trainees, have minimal exposure to major trauma, restricted access to trauma education, and a limited self-perceived confi dence and experience in basic trauma resuscitative procedures. Medical students too have been shown to benefit f rom ATLS training. Canadian s tudies [7,8] have demonstrated that senior medical students perform better in trauma simulation scenarios after completion of the ATLS training. Even attendance at only the lecture series component of ATLS results in an increase in trauma management knowledge among junior medical students. [9] Subsequent research [10] has suggested that this form of training is more effectively directed at senior medical students. Coates [11] has suggested a similar scheme for the teaching of emergency medicine to Californian medical students in their senior-year rotation. In addition to the initial training of MOs and/or students in the management of the seriously injured trauma patient, there is a requirement to maintain ATLS-acquired skills. Trauma patient volume has been determined to be the most critical determinant of attrition rate of ATLS-acquired skills. [12] India's high burden of trauma [13] would appear to allow for the ready maintenance of ATLS-acquired skills among the trained staff, however, maintenance of these skills may be difficult, even in centers that receive a large volume of trauma victims, as there are difficulties with the provision of basic trauma equipment and supplies for the management of seriously injured trauma patients. There is also a dearth of the administrative functions required to assure quality trauma care, including trauma registries, trauma-related QI programs, and regular inservice training. [14] Discussion of these issues as well as the desirability of improved training for the pre-hospital staff is outside the scope of this article. Unfortunately, potential pitfalls exist for the broader introduction of ATLS-type programs into India. Introduction of ATLS-type courses into the United Kingdom resulted in consultants and senior registrars being preferentially offered course places. [15] As stated previously, the initial resuscitation and management of seriously injured trauma patients is often the responsibility of relatively inexperienced junior MOs, those who would appear to gain most from attending an ATLS-type program. Generally, there are far more applicants for ATLS programs than available places, resulting in long waiting lists. [16,17] Cost of the attendance