Dr. James K. Styner

Trauma surgery is one of the most time-sensitive fields in surgery, involving the immediate surgical treatment of patients who have sustained life-threatening injuries. Upon arrival at the hospital, the patient's vital signs (heart rate, blood pressure, breathing) are usually unstable and require stabilisation, which is done through administering oxygen, fluids, or blood transfusions. Once stable, trauma surgeons perform operations based on the nature and severity of the injuries. This can include repairing fractures, controlling bleeding, and repairing damaged tissue or organs. The margin for error is razor-thin, and outcomes depend not only on the intervention, but also on post-operative care.

In the 1970s, trauma care was uneven and dangerously inadequate in rural areas throughout the United States. For Dr. James Kenneth Styner, an orthopedic surgeon from Nebraska, that reality became devastatingly personal. Dr. Styner was flying a small private plane with his wife and four kids on February 18, 1976, when it crashed into a cornfield. His wife was killed instantly, and three of his children sustained severe injuries. Despite his injuries, Dr. Styner was able to get his family to safety. Upon reaching the nearest hospital, Dr. Styner was confronted with inadequate facilities, a lack of trained staff, and absence of clear treatment protocols for trauma patients. He later remarked, "When I can provide better care in the field with limited supplies than my children received in the hospital, something is wrong with the system, and that system needs to be changed.”

As a result of this tragedy, Advanced Trauma Life Support (ATLS) was developed. According to Dr. Styner, medical teams should treat severely injured patients using a single, safe method regardless of the setting. He collaborated with colleagues, such as Dr. Paul E. "Skip" Collicott from the University of Nebraska Medical Centre, to create a course that taught doctors how to rapidly assess and stabilize trauma patients. The first ATLS course was held in Nebraska, 1978. At the core of ATLS is a simple method which is typically referred to with the ABCDE mnemonic—Airway, Breathing, Circulation, Disability and Exposure. Regardless of the patient's age, gender, or type of injury, this approach guarantees that life-threatening issues are addressed first. Through a combination of lectures, hands-on skill practice, and emergency simulation, the training equips healthcare providers to react accurately and confidently even under pressure.

According to early studies, preventable trauma deaths in Nebraska have dramatically decreased, going from over 33% before ATLS to less than 10% after it was implemented. The largest hospital in Trinidad and Tobago was used to compare trauma outcome variables between July 1981 and December 1985 (pre-ATLS) and January 1986 and June 1990 (post-ATLS). After ATLS was implemented, both hospitals experienced an approximate drop of 30% in both Injury Severity Score (ISS) categories. Pre-ATLS mortality for ISS >= 24 was 47.9% compared to 16.7% post-ATLS; pre-ATLS mortality for ISS 25-40 was 91.0% compared to 71.0% post-ATLS.

The American College of Surgeons adopted ATLS in 1980 and started making it available across the country. Today, it is the gold standard for trauma management in over 80 countries. Be it a disaster area, a city hospital, or a rural clinic, ATLS offers a universal framework that saves lives in any setting. While ATLS does not replace advanced surgical care, it bridges the critical gap between injury and definitive treatment.

Written by Shanisse Tan at Incisionary

APA References

J.K. Styner, The birth of Advanced Trauma Life Support (ATLS),The Surgeon,Volume 4, Issue 3,2006,Pages 163-165,ISSN 1479-666X,

https://doi.org/10.1016/S1479-666X(06)80087-9

(https://www.sciencedirect.com/science/article/pii/S1479666X06800879)

Driscoll, P., & Wardrope, J. (2005). ATLS: past, present, and future. Emergency medicine journal : EMJ, 22(1), 2–3. https://doi.org/10.1136/emj.2004.021212

Williams, M. J., Lockey, A. S., & Culshaw, M. C. (1997). Improved trauma management with advanced trauma life support (ATLS) training. Journal of accident & emergency medicine, 14(2), 81–83. https://doi.org/10.1136/emj.14.2.81

Collicott, P. E., & Hughes, I. (1980). Training in advanced trauma life support. JAMA, 243(10), 1156–1159. https://pubmed.ncbi.nlm.nih.gov/7359667/

ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, & International ATLS working group (2013). Advanced trauma life support (ATLS®): the ninth edition. The journal of trauma and acute care surgery, 74(5), 1363–1366. https://doi.org/10.1097/TA.0b013e31828b82f5

Ali, J., Adam, R., Butler, A. K., Chang, H., Howard, M., Gonsalves, D., Pitt-Miller, P., Stedman, M., Winn, J., & Williams, J. I. (1993). Trauma outcome improves following the advanced trauma life support program in a developing country. The Journal of trauma, 34(6), 890–899. https://doi.org/10.1097/00005373-199306000-00022 

Carmont M. R. (2005). The Advanced Trauma Life Support course: a history of its development and review of related literature. Postgraduate medical journal, 81(952), 87–91. https://doi.org/10.1136/pgmj.2004.021543