Personal copy of Patrick45neves@gmail.

com [25709]

The European Trauma Course Manual

Edition 4.0
Personal copy of Patrick45neves@gmail.com [25709]

The ETC Course Management Committee would like to express their gratitude to the following organisations for
their support in the development of both the ETC and this manual:
European Resuscitation Council (ERC)
European Society for Trauma and Emergency Surgery (ESTES)
European Society for Emergency Medicine (EuSEM)
European Society of Anaesthesiology (ESA)

Editorial team
Karl-Christian Thies, Greifswald, Germany
Al Mountain, Stoke-on-Trent, UK
Peter Goode, Newcastle, UK

Disclaimer
No responsibility is assumed or accepted by the authors or publisher for any injury and/or damage to persons
or property as a matter of product liability, negligence or otherwise, or from use or operation of any methods,
products, instructions or ideas implied or contained in the material herein. Because of the rapid advances in
medical science and practice, the editors recommend that independent verification of diagnosis should be made.

© European Trauma Course Organisation ivzw. All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of the ETCO.

4 | EUROPEAN TRAUMA COURSE

Personal copy of Patrick45neves@gmail.com [25709]

Contributors

Elonka Bergmans Monika Grunfeld Carsten Lott

Consultant in Anaesthesiology and Specialist in Emergency and General Consultant in Anaesthesia, Intensive
Medical Education Medicine Care and Pre-hospital Medicine
Heart Centre Kranj Health Center University Medical Center
Karlsburg Slovenia Johannes Gutenberg University
Germany Mainz
Carl Gwinnutt Germany
Alistair Billington Emeritus Consultant
Consultant in Emergency Medicine Salford Royal Hospital NHS Foundation David Luke
Musgrove Park Hospital Trust Consultant General Surgeon
Taunton Salford RSUH & UHNM NHS Trust, North
UK UK Midlands MTC
UK
Markus Brucke Stuart Harrisson
Consultant in Anaesthesiology. Consultant, Department of Adam Low
Alb-Donau-Klinikum, Neurosurgery Consultant in Anaesthesia and Pre-
Ehingen Royal Stoke University Hospital hospital Care
Germany UK Queen Elizabeth University Hospital
Birmingham
Walter Busuttil Jochen Hinkelbein UK
Consultant in Cardiothoracic Surgery Consultant in Anaesthesia
Mater Dei Hospital University Hospital of Cologne Ileana Lulic
Malta Cologne Consultant in Anaesthesiology,
Germany re-animatology and intensive care
Mike Davis medicine
Consultant in Medical Education Michael Hüpfl Zagreb
Blackpool Consultant Anaesthesia, Intensive Croatia
UK Care, Emergency medicine
Landesklinikum Stefan Mattyasovszky
Christopher Day Neunkirchen Specialist in Orthopaedic and Trauma
Consultant Vascular and Austria Surgery
Interventional Radiologist University Medical Center
RSUH & UHNM NHS Trust, North Fabian O. Kooij Johannes Gutenberg University
Midlands MTC Anesthesiologist and HEMS Physician Mainz
UK Department of Anesthesiology Germany
Amsterdam UMC
Peter Driscoll Amsterdam Netherlands Carl McQueen
Senior Clinical Teaching Fellow Specialist Registrar in Emergency
University of St Andrews School of Sebastian Kuhn Medicine
Medicine Consultant in Orthopaedics and University Hospitals
St Andrews Trauma Surgery Coventry and Warwickshire NHS
UK University Medical Center Trust
Johannes Gutenberg-University
Stuart Durham UK
Mainz
Consultant in Emergency Medicine Germany Al Mountain
Royal Preston Hospital Consultant Orthopaedic & Trauma
Preston Caroline Leech
Surgeon
UK Consultant in Emergency Medicine
RSUH & UHNM NHS Trust, North
and Pre-hospital Care
Peter Goode Midlands MTC
University Hospitals
Consultant in Emergency Medicine UK
Coventry and Warwickshire NHS
Newcastle upon Tyne and Carlisle. Trust UK Mahmoud Tageldin Mustafa
UK
Consultant in Emergency Medicine
Simon Leigh-Smith
Julie Grice Burjeel Hospital - Abu Dhabi
Consultant in Emergency Medicine
Consultant in Paediatric Emergency United Arab Emirates
Edinburgh Royal Infirmary
Medicine Edinburgh
Alderhay Children’s Foundation Trust UK
Liverpool
UK

CONTRIBUTORS | 5
Personal copy of Patrick45neves@gmail.com [25709]

Paola Perfetti Markus Roessler Eshan Senanayake

Consultant in Emergency Medicine Lead Clinician for Prehospital Specialist Registrar in Cardiothoracic
Ospedale Civile Maggiore Emergency Medicine Surgery
University Hospital of Verona Department of Anaesthesia University Hospital Birmingham
Verona University of Goettingen Birmingham
Italy Goettingen UK
Germany
Peter A. Oakley Karl C. Thies
Retired Consultant in Anaesthesia and Simon Scott Consultant in Anaesthesia and
Trauma Consultant Orthopaedic & Trauma Critical Emergency Medicine
Royal Stoke University Hospital Surgeon University Medical Center
Major Trauma Centre Aintree University Hospital & MTC, Greifswald
United Kingdom Liverpool Germany
UK
Marcus Rall Eric Voiglio
Consultant in Human Factors, CRM, Dare Seriki Médecin Inspecteur
Emergency Medicine Consultant in Vascular Radiology Direction de l’Action Sanitaire
InPASS University Hospitals of South Division de Santé
Reutlingen Manchester Monaco
Germany Manchester
UK Hany V. Zaki, 
David Robinson Lecturer in Critical Care 
Consultant in Anaesthesia Patrick Schramm Core Faculty of Emergency
Warwick Hospital Consultant in Anaesthesia and Medicine 
South Warwickshire NHS Intensive Care Medicine Ain Shams University 
Foundation Trust University Medical Center Cairo
Warwick Johannes Gutenberg University Egypt 
UK Mainz
Germany
Pol M Rommens
Professor of Orthopaedics and Oliver Spelten
Traumatology Consultant in Anaesthesiology,
University Medical Center Schoen-Clinic
Johannes Gutenberg University Düsseldorf
Mainz Germany
Germany

6 | EUROPEAN TRAUMA COURSE

Personal copy of Patrick45neves@gmail.com [25709]
Foreword to the 4th Edition of the ETC Manual:
This edition of the ETC manual, on the 10th anniversary
of the formal introduction of the course, has been an
opportunity to build on the previous good work of
a number of contributors and revise the information
and guidance in line with up to date practice.
This would not have been possible without a lot of
hard work by a number of members of the Course
Management Committee of the ETC and the editors
are grateful for their contributions. We would also
like to express our thanks to Ingrid Van der Haegen of
Studio Grid for undertaking the layout and formatting
of the manual. Many thanks to Camilla and Bibiana
Metelmann for cross-reading and correcting the
manuscript. Copyright Landesklinikum Neunkirchen.
We thank YourView (www.yourview.at) and the
emergency team of LK Neunkirchen for the cover
photographs.
This is an opportunity to also thank the ETC
Course Directors, Course organisers and the
Peter Goode
Al Mountain
Karl Thies
instructors in providing an ever increasing
number of courses for candidates. At the time
of writing, ETC is now being offered in over
20 countries with 120 courses annually.
The editors are grateful to their families for their
support over the last few months as they spent
time reviewing submissions, editing, re-editing and
discussing the content in numerous conference calls.
We hope that the ETC manual and subsequent course
will provide you with the confidence and skills (both
technical and non-technical) to maximise your ability
to look after trauma patients and provide a strong link
in the chain of survival from serious injury.
This manual is dedicated to the victims of trauma
and their families who entrust us with their care at a
difficult and stressful point in their lives and to the ETC
instructors who freely give of their time to improve
trauma care in Europe and beyond.
INTRODUCTION | 7
Personal copy of Patrick45neves@gmail.com [25709]

Glossary

Throughout this manual, the male gender is used generically

ABG Arterial blood gas IV Intravenous

AMPLE A – Allergies, M – Medications, P – Past kPa kilo Pascal
Illnesses, L – Last Oral Intake (also Last LMA Laryngeal mask airway
Menstrual Cycle), E – Events Leading Up LT Laryngeal tube
To Present Illness / Injury
MAP Mean arterial pressure
aPPT Activated partial thromboplastin time
MHP Major haemorrhage protocol
ASIA American Spinal Injury Association
MILS Manual in-line stabilisation
ATMIST A - Age, T - Timing, M - Mechanism,
mmHg Millimeters of mercury
I - Injuries, S - Signs, T - Treatment
mmol/l Millimoles per litre
BM Blood Glucose Level
MRI Magnetic resonance imaging
BP Blood pressure
NEXUS National Emergency X-radiography
CICO can’t intubate, can’t oxygenate situation
Utilisation Study
cmH2O Centimeters of water
NTS Non-technical skills
CO Cardiac output
PaCO2 Arterial partial pressure of carbon dioxide
CO2 Carbon dioxide
PaO2 Arterial partial pressure of oxygen
CPP Cerebral perfusion pressure
PEEP Positive end-expiratory pressure
CPR Cardiopulmonary resuscitation
PRBCs Packed red blood cells
CRT Capillary refill time
REBOA Resuscitative Endovascular Balloon
CSF Cerebrospinal fluid Occlusion of the Aorta
CT Computerised tomography Rh Rhesus
CXR Chest x-ray ROTEM Rotational thromboelastometry
DPL Diagnostic peritoneal lavage RT Resuscitative thoracotomy
ECG Electrocardiogram RTC Road traffic collison
EEG Electroencephalogram SaO2 Arterial oxygen saturation
eFAST Extended focused assessment with SBP Systolic blood pressure
sonography in trauma
SCI Spinal cord injury
ETC European Trauma Course
SGA Supraglottic airway
EVAR Endovascular aneurysm repair
SCIWORA Spinal cord injury without radiological
FAST Focused assessment with abnormality
sonography in trauma
SIRS systemic inflammatory response
FFP Fresh frozen plasma syndrome
FiO2 Fractional inspired oxygen concentration SpO2 Peripheral oxygen saturation
GCS Glasgow coma scale TBI Traumatic brain injury
HR Heart rate % TBSA Percentage of total body surface area
hrs Hours TEG Thromboelastography
ICP Intracranial pressure TTL Trauma team leader
ICU Intensive care unit TTM Trauma team member
IN Intranasal VCI Vertebral column injury
IO Intraosseous

8 | EUROPEAN TRAUMA COURSE

Personal copy of Patrick45neves@gmail.com [25709]
Trauma Care - the Team Approach
The World Health Organisation (WHO) has identified
trauma as the major health care challenge of our
century; worldwide, trauma claims more productive
life years than any other disease. Although prevention
is key to tackling this problem, the WHO estimates
that the mortality of major trauma in Europe could
be decreased 30% by improving the chain of care for
major trauma patients. The European Trauma Course
(ETC) has been developed to address this problem
and teaches a system of care for managing trauma
victims that reflects the reality we experience on a
daily basis. As a person dealing with these patients,
you may already have some knowledge and skills,
and experience of working in a team. However, these
attributes might differ from those of other people
that you are working with, and this can impair the
efficiency of the team. The ETC aims to address this by
enhancing your clinical skills, whilst at the same time
enabling you to become effective both as a trauma
team member and team leader.
The contents of the ETC are based upon the working
practices of the relevant specialties that treat
trauma patients within Europe (European Society of
Anaesthesiology (ESA), European Society for Trauma
and Emergency Surgery (ESTES), European Society for
Emergency Medicine (EuSEM), European Resuscitation
Council (ERC)) and, where it exists, evidence of best
practice. In addition, the authors have tried to take
a pragmatic approach to improving trauma care by
recognizing that across Europe there are areas of
both commonality and differences in clinical practice.
The latter can be a result of variations in resources
and geography, the spectrum of responses and a
lack of scientific data. These are addressed by the
course retaining an element of flexibility; where
effective local variations in management exist, they
are acknowledged and recognized as an alternative
approach.
On the course, you will be expected to work through
a series of trauma cases of varying complexity; in the
majority of cases, the patient’s survival is dependent
on the trauma team working effectively rather than
the abilities of any one individual. As in real life, your
role in the team will change depending on the needs
of the patient. Our goals are that by the end of the
course you will have improved your knowledge, skills
and abilities as a team member and team leader. In
turn you will then understand how all of these enhance
team performance and ultimately contribute to
improving patient outcome. To maximise the learning
opportunities available to you as a participant on the
ETC, it is essential that you read this manual; it contains
the very essence of what we are trying to achieve. Each
chapter explains the processes that form the basis of
the workshops and the final chapter explains the roles
you will be expected to play. Prior assimilation of this
information will enable you to gain a great deal more
from the course than if you arrive unprepared.
Finally, we sincerely hope you enjoy your time as a
participant on the ETC. If you have, tell your friends and
colleagues, if you have not, tell us so we can continue
to improve for future participants.
INTRODUCTION | 9