In 1976, an orthopaedic surgeon, whilst piloting his plane, crashed in a rural area of the United States of America. His wife died in the accident and he and his children sustained serious injuries. They were treated in a rural hospital with limited resources. He felt that the whole family had received substandard care due to the absence of a proper system of management of severely injured patients. He therefore, formed a team consisting of surgeons, physicians and nurses with the help of the American College of Surgeons. Subsequently, systematic guidelines, popularly known as the ‘Advanced Trauma Life Support (ATLS)’, were introduced for appropriate identification and management of life threatening injuries.

All health professionals involved in the management of trauma patients should receive ATLS training according to the standards laid down by the American College of Surgeons. Polytrauma patients may have multiple injuries involving the head, chest, abdomen, pelvis and musculoskeletal system. Cervical spine fractures especially those affecting C3 and C4 nerve roots may be fatal due to the involvement of the phrenic nerve, which innervates the diaphragm. Spinal cord injuries are often associated with severe neurological impairment.

Trimodal death pattern

According to this concept there are three peak periods of death:

First peak: Death occurs within seconds to minutes of injury and is mainly due to major visceral damage, e.g. brain stem or spinal cord injury, rupture of great vessels, etc.