INTRODUCTION

Trauma is a common disease worldwide. Injuries account for over five million deaths per year across the world. Trauma is the leading cause of death in patients aged 1–44 in the United States. All patients require immediate evaluation and resuscitation to prevent mortality and morbidity after trauma. Trauma centers dedicated to the care of these injured patients are promoted as models to improve care overall and have been documented to have done so in developed nations. However, basic initial management has the potential to save more lives globally than the advanced care at specialized centers.

The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons is the gold standard for teaching initial trauma management and evaluation. The course began in the 1970s in the United States and has since spread around the globe. It clearly emphasizes the importance of the initial resuscitation. ATLS is taught based on the premise that the student may be the only physician treating an injured patient in a small rural hospital. Although not initially designed to do so, this major premise is easily extrapolated to trauma in remote and extreme environments. Although not all diagnostic tools and therapeutic options will be available, the same emphasis on the primary and secondary surveys, therapeutic adjuncts, and a plan for transfer (or evacuation) apply to austere environments. Improvisation and thinking on one's feet are clearly important tools for management of trauma in a nonhospital setting.