ANÁLISE DO PROTOCOLO DO ATLS NA ABORDAGEM INICIAL AO PACIENTE

• DOI: https://doi.org/10.22533/at.ed.8208162501106

• Palavras-chave: Traumatologia, Suporte avançado de vida ao trauma, Mortalidade, Protocolos clínicos, Politrauma

• Keywords: Traumatology, Advanced Trauma Life Support, Mortality, Clinical protocols, Polytrauma

• Abstract: rauma is one of the leading causes of morbidity and mortality in individuals under 45 years of age, and appropriate initial management is essential to reduce preventable deaths. In this context, ATLS (Advanced Trauma Life Support), developed by the American College of Surgeons Committee on Trauma (ACS-COT) in the late 1970s, has become a standardized protocol for managing the polytraumatized patient. Based on the philosophy of “treat first what threatens life,” ATLS organizes care by priorities using the primary ABCDE assessment, secondary assessment, and continuous reassessments, promoting better team coordination, faster critical diagnostics, and a reduction in potentially preventable deaths. The protocol originated after the plane crash experienced by surgeon James Styner in 1976 and was officially adopted in 1980, evolving through successive editions and incorporating structured teaching methods, including high-fidelity simulation, which enhances skills such as decision-making, leadership, and communication in critical situations. The integration of tools like eFAST allows for rapid diagnosis of hemoperitoneum, hemothorax, pneumothorax, and pericardial effusion, with high sensitivity and specificity, reducing the time to definitive interventions. Recent studies associate ATLS training with a significant reduction in preventable deaths, emphasizing the importance of its systematic application. Hemorrhage management, the main cause of preventable death, aligns with massive transfusion protocols (MTP) and early use of tranexamic acid (TXA), integrating into the “C” assessment of ABCDE. However, skill retention is limited, requiring periodic recertification and deliberate practice with simulation, including Mastery Learning approaches that improve psychomotor and cognitive performance. Moreover, disparities in access to training, especially in low- and middle-income countries, increase the risk of mortality in regions with limited course availability and certified instructors. Alternative strategies, such as local modules, hybrid courses, and tele-education, have shown promising results, as long as the core ABCDE principles are maintained. ATLS is consolidated as an essential tool to standardize initial trauma care, improving processes, coordination, and communication, and reducing complications when implemented in structured trauma systems, integrating emerging technologies, adjacent protocols, and active teaching methodologies. Nevertheless, its effectiveness depends on contextual factors, institutional resources, continuous updates, and equitable access to training. Thus, ATLS should be regarded as a dynamic platform, adaptable to local realities and in constant scientific evolution, ensuring clinical, educational, and operational relevance in polytrauma management.