Advanced Trauma Life Support is revolutionising the delivery of care to critically injured patients. This article describes its background and highlights the primary assessment designed to appraise the seventy of injury

Two reports were published in 1988 which had a significant impact on those of us in A&E care (1, 2). The first looked at coroners’ reports of one thousand deaths due to injury. These were reviewed by four expert assessors who had to determine the following: ‘If this patient had been admitted to afully staffed and equipped trauma centre, might death have been prevented.’ All four considered that 20 per cent of the deaths should have been preventable. The principal causes of death were hypoxia, continuing haemorrhage and a lack of timely surgery.