Accidents are the leading cause of death in adults prior to middle age . A patient collective is concerned which could particularly benefit from rapid recovery after an accident. In addition to the personal suffering and loss of so-called human capital (in work and leisure activities), the economic costs are relevant and have an effect on the gross national product . The economic costs of traffic accidents in Germany amount to 31 billion euros per year .
In recent years, there have been a number of indications of the importance of study findings concerning trauma care, including the following: 1) the introduction of regional trauma-networks [4, 5]; 2) a White Paper from the German Trauma Society [6, 7]; 3) increased training of emergency department teams  and training programs in emergency medical services ; 4) the establishment of the TraumaRegister DGU® of the German Trauma Society ; and 5) the German S3 – Guideline on Treatment of Patients with Severe and Multiple Injuries (2011) .
In the 1970s, “Advanced Trauma Life Support” (ATLS) introduced standardized treatment of trauma patients in emergency departments. Probable total of approximately 2 million physicians are trained in the program worldwide . The global ATLS program is a condition for certification for trauma centers in Germany . Münzberg et al. showed that since 2003, ATLS has performed with high ratings based on evaluation by the participants . Based on the “lowest common denominator”, ATLS is a concept for training the physicians dealing with severe injured patients in the emergency departments in Germany . Ruchholtz et al. showed in the 1990s that procedures based on the guidelines could improve the care of emergency room patients . Evidence of the effect on patient outcome is lacking .
The interface between emergency medical services (EMS) and emergency departments in the treatment of seriously injured patients benefits from uniform standards of care based on identical medical-scientific knowledge and communication with a “common language” to avoid errors and to improve priority-based patient care .
The treatment of severely injured patients is particularly challenging because these injuries are rare  and require multi-disciplinary team work and complex and comprehensive therapy . Pre-hospital care is in parts associated with considerable technical effort.
The pre-hospital care of severely injured patients was essentially characterized in the past by the two following systems: “stay and play” or “load and go” . In recent decades, pre-hospital trauma care has been supplemented by the findings of military medical treatment  and appear to approach each other .
Pre-hospital treatment has to establish the initial treatment strategies and be priority-oriented. The available data are inadequate, although field experiences and expert opinions are extensive.
The existing trauma care training programs such as the Pre-Hospital Trauma Life Support (PHTLS) or ATLS programs lead to more subjective safety levels of the participants regarding the care of trauma patients [22, 23]. The extent of the effect of this training on the quality of the process and especially on the quality of the primary outcomes of modern EMS systems is not clear . The introduction of a training program such as PHTLS in less developed systems results in a measurable change . Studies that evaluated the outcome of patients after rescue and treatment according to the PHTLS standards have shown no significant advantage over currently established principles of trauma care [26, 27]. Standardized training programs such as PHTLS are increasingly integrated into the training or education of EMS staff [28, 29]; however, the differences in the current standard of care from the recommendations of PHTLS are unknown. A concrete comparison of the PHTLS content with the current guidelines for the treatment of multiple traumas is pending.
The participants evaluate PHTLS courses very positively, although there are no published evaluations. A subjective assessment by the participants was collected after the PHTLS TEAM (PHTLS at medical school) training, which suggests an improvement in the scenario based on the care of severely injured patients . Particularly in the area of “non-technical skills”, various assessment instruments have been developed that assess communication, team interaction, and decision making [30–34].
There is no suitable measuring instrument to ensure the effect of training objectively like the processes, strategic decisions, skills and medical aspects of treatment.
This study will evaluate the effect of PHTLS courses on the participants because its effect on patient outcome as known is not measurable.
Using a novel assessment tool (2.4.1), the following hypotheses will be tested:
▪ The introduction of PHTLS leads to improved quality of the documentation of actual field operations.
▪ The introduction of PHTLS leads to structured patient care by the ABCDE scheme , with priority-based interventions in case-based scenario training.
▪ The introduction of PHTLS leads the participants to a subjectively better and safer application of the principles.
This trial is designed as an interventional, single arm – uncontrolled, open study. It is a single-center, prospective, semi-qualitative observational trial.