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PHTLS Session Reveals Text Updates

The Prehospital Trauma Life Support Update (PHTLS): Seventh Edition Instructor Update speakers all emphasized that the goal of the PHTLS committee isn’t to create protocols, rather to provide a science-based text that services and agencies can use to draft their protocols. In that vein, the new textbook emphasizes the principles instead of the preferences, said Dr. Peter Pons, the speaker who addressed textbook changes at the Wednesday morning update session.

Principles are things that need to be accomplished for the patient, while preferences are how to do those things. “We basically are emphasizing the principles in the book. We will explain one or more ways to accomplish the principle,” he said. “But we’re not here to tell you that a particular device or a particular technique is the only way to do something.”

The seventh edition of the PHTLS textbook, the website and the course has undergone a major overhaul, said speaker Will Chapleau. He said the website now has a wider range of scenarios to be used, and more content is available online. “The idea is to make as much of this stuff electronic as possible,” he said, adding that content can be downloaded via the website using a secure link for instructors.

Instructors will note major revisions and additions to most sections in the seventh edition. The book is divided into six sections, including the introduction; assessment and management, which has a new chapter on the art and science of medicine; specific injuries, a summary; an expanded section on mass casualty incidents and terrorism; and one on other content that’s appropriate for the text but doesn’t fit in any of the other sections.

He said several sections were edited to improve readability, including the kinematics of trauma, musculoskeletal, and heat and cold chapters. The burn chapter has been expanded to include discussions on the Rule of Palms, which the authors researched to determine it does include the palm and the fingers, and the Rule of 10 for fluid resuscitation.

The Rule of 10, which was created by the military, is a great way to make calculation of fluids easier. “The Rule of 10 works very nicely,” Pons said, explaining that a provider takes the percent of the patient’s body surface area that has been burned and multiplies it by 10. “That is the hourly rate of administration,” he said. “This is a lot faster, a lot easier, and a very good approximation of the fluid requirements needed.”

Another section that underwent significant change is the airway chapter, which deemphasizes intubation and stresses starting with basic airway maneuvers. “There are times when intubation is appropriate. There are other times when it is not,” he said, adding that the text does not endorse any products.

The section on pneumatic anti-shock garments was also moved to a box note for a historical reference.

Additions to the head trauma chapter include facial and eye injuries, while the spinal trauma chapter deemphasizes the need for spinal immobilization in patients with penetrating trauma if they have no neurological deficit on first contact.

Pons said the disaster management chapter has been expanded to include on-scene and site control, explosions and explosives, triage methods, patient destination assignment, importance of EMS activation and even the role of media.

“You’ve got to deal with the media, and we have a discussion on that as well,” Pons said.

He said the PHTLS committee wants feedback to continue to improve the course and text. “We think it is essential that we get feedback from you all as you take a look at the book,” Pons said. “We encourage criticism.” Typos and clarifications are listed on the website under “Seventh Edition Errata.” Changes will be made with subsequent printings.

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