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Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS®) algorithms

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Pre-hospital trauma life support (PHTLS®) includes a standardized algorithm for pre-hospital care. Implementation of PHTLS® led to improved outcome in less developed medical trauma systems. We aimed to determine the impact of PHTLS® on quality of pre-hospital care in a European metropolitan area. We hypothesized that the introduction of PHTLS® was associated with improved efficiency of pre-hospital care for severely injured patients and less emergency physician deployment.


We included adult polytrauma (ISS > 15) patients that were admitted to our level one trauma center during a 7-year time period. Patients were grouped based on the presence or absence of a PHTLS®-trained paramedic in the pre-hospital trauma team. Group I (no-PHTLS group) included all casualties treated by no-PHTLS®-trained personnel. Group II (PHTLS group) was composed of casualties managed by a PHTLS® qualified team. We compared outcome between groups.


During the study period, 187,839 rescue operations were executed and 280 patients were included. No differences were seen in patient characteristics, trauma severity or geographical distances between groups. Transfer times were significantly reduced in PHTLS® teams than non-qualified teams (9.3 vs. 10.5 min, P = 0.006). Furthermore, the in-field operation times were significantly reduced in PHTLS® qualified teams (36.2 vs. 42.6 min, P = 0.003). Emergency physician involvement did not differ between groups.


This is the first study to show that the implementation of PHTLS® algorithms in a European metropolitan area is associated with improved efficiency of pre-hospital care for the severely injured. We therefore recommend considering the introduction of PHTLS® in metropolitan areas in the first world.

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  1. Häske D, Stuke L, Bernhard M, et al. Comparison of the prehospital trauma life support recommendations and the German national guideline on treatment of patients with severe multiple injuries. J Trauma. 2006;81(2):388–93.

    Article  Google Scholar 

  2. Wölf CG, Wentzensen A, Gliwitzky B. Standardisierte Primärtherapie des polytraumatisierten Patienten Prehospital Trauma Life Support® und Advanced Trauma Life Support®. Der Unfallchirurg. 2009;10:848–53.

    Google Scholar 

  3. NAEMT In: PHTLS: Prehospital Trauma Life Support. 8th ed. Burlington, MA: Jones & Bartlett Learning; 2016.

  4. Ali J, Adam RU, Gana TJ, et al. Effect of the prehospital trauma life support program (PHTLS) on prehospital trauma care. J Trauma. 1997;42:786–90.

    Article  CAS  Google Scholar 

  5. Häske D, Beckers SK, Hofmann M, et al. Subjective safety and self-confidence in pre-hospital trauma care and learning progress after trauma-courses: part oft he prospective longitudinal mixed-methods EPPTC-trail. Scand J Trauma Resc Emerg Med. 2017;25:79.

    Article  Google Scholar 

  6. Blomberg H, Svennblad B, Michaelsson K, et al. Prehospital trauma life support training of ambulance caregivers and the outcomes of traffic-injury victims in Sweden. J Am Coll Surg. 2013;217:1010–9.

    Article  Google Scholar 

  7. Johansson J, Blomberg H, Svennblad B, et al. Prehospital Trauma Life Support (PHTLS) training of ambulance caregivers and impact on survival of trauma victims. Resuscitation. 2012;83:1259–64.

    Article  Google Scholar 

  8. Wrobel F, Lenz M. Präklinisches traumamanagement. Notfall Rettungsmed. 2012;15:247–54.

    Article  Google Scholar 

  9. Polytrauma Guidelines Update Group. Level 3 guideline on treatment of patients with severe and multiple injuries. Eur J Trauma. 2018;44(S1):3–271.

    Article  Google Scholar 

  10. Copes WS, Champion HR, Sacco WJ, et al. The injury severity score revised. J Trauma. 1988;28(1):69–77.

    Article  CAS  Google Scholar 

  11. Raatiniemi L, Mikkelsen K, Fredriksen K, et al. Do pre-hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study. Acta Anaesthesiol Scand. 2013;57(10):1253–9.

    Article  CAS  Google Scholar 

  12. Weiss M, Bernoulli L, Zollinger A. The NACA scale. Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients. Anaesthesist. 2001;50(3):150–4.

    Article  CAS  Google Scholar 

  13. Ali J, Adam RU, Gana TJ, George B, et al. Impact of the prehospital trauma life support programme in Trinidad and Tobago. West Indian Med J. 1998;47(3):102–4.

    CAS  PubMed  Google Scholar 

  14. Salomone JP, Pons PT, McSwain NE. PHTLS Prehospital trauma life support. Military. 7th ed. St. Louis: Mosby JEMS Elsevier; 2011.

    Google Scholar 

  15. Gries A, Zink W, Bernhard M, Messelken M, Schlechtriemen T. Einsatzrealität im Notarztdienst. Notfall + Rettungsmedizin. 2005;8:391–8.

    Google Scholar 

  16. Moorthy K, Munz Y, Dosis A, et al. The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc. 2003;17(9):1481–4.

    Article  CAS  Google Scholar 

  17. Müller MP, Hänsel M, Fichtner A. Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study. Resuscitation. 2009;80(8):919–24.

    Article  Google Scholar 

  18. Günkel S, König M, Albrecht R. Deployment and efficacy of ground versus helicopter emergency service for severely injured patients. Analysis of a nationwide Swiss trauma center. Unfallchirurg. 2015;118(3):233–9.

    Article  Google Scholar 

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Correspondence to Michel Teuben.

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Teuben, M., Löhr, N., Jensen, K.O. et al. Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS®) algorithms. Eur J Trauma Emerg Surg 46, 1321–1325 (2020).

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