Uncontrolled hemorrhaging is the leading cause worldwide of preventable death after injury. Trauma is the epitome of a time-sensitive problem because time to hemorrhage control and stabilization of injuries, along with resuscitation, is vital to patient survival. To improve the efficacy of initial resuscitation, especially among those who are less familiar with managing trauma, systematic protocols for initial assessment and resuscitation have been developed. The most widely used and best known is the system developed by the American College of Surgeons’ (ACS’s) Committee on Trauma: the Advanced Trauma Life Support Program (ATLS).1 This protocol uses an airway, breathing, circulation (ABC) sequence for initial evaluation that has been well established for many years. The evidence supporting the systematic ABC approach to injured patients is based on expert consensus, with little literature to support clinical application of the sequence of interventions.1 In many high-resource environments, such as urban trauma centers in the US, this approach is performed simultaneously rather than sequentially. But many other facilities have fewer resources and cannot afford to do the ABCs at the same time. In these low- and middle-income environments, often the resource that is most needed is the human resource. The paradox is that, in these places with fewer resources, penetrating trauma resulting in injuries that bleed rapidly occurs significantly more often.
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Corresponding Author: Paula Ferrada, MD, Division of Acute Care Surgery, Inova Health System, 3300 Gallows Rd, Fairfax, VA 22031 (email@example.com).
Published Online: May 17, 2023. doi:10.1001/jamasurg.2022.8436
Conflict of Interest Disclosures: Dr Dissanaike reported receiving personal fees from Heron Therapeutics outside the submitted work. No other disclosures were reported.
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