The golden hour in trauma care: Why Ghana needs ATLS, PHTLS, TNCC/ATCN now more than ever

Reflections from the Charles Amissah Case

The tragic death of Charles Amissah has once again exposed the painful realities of emergency and trauma care delivery in Ghana. Reports from the investigative committee indicate that after sustaining traumatic injuries in a road traffic incident, he was transported between multiple hospitals without receiving timely lifesaving intervention before eventually dying from hemorrhagic shock and exsanguination.

The national outrage that followed has largely focused on the “No Bed Syndrome.” While bed capacity remains a serious issue, the deeper lesson from this tragedy goes beyond beds. The Charles Amissah case highlights the urgent need for structured, standardized, competency-based trauma education for all healthcare professionals involved in emergency care delivery doctors, paramedics, EMTs, and nurses alike.

Understanding the Golden Hour

The concept of the Golden Hour refers to the critical first hour following traumatic injury during which timely assessment, resuscitation, hemorrhage control, airway management, and stabilization significantly improve survival outcomes. Although trauma physiology is more complex than a strict sixty-minute timeline, the principle remains universally accepted: delays in trauma intervention increase mortality.

In the Charles Amissah case, the committee found that simple interventions such as direct pressure to bleeding wounds, wound packing, intravenous fluid administration, effective triage, and early stabilization could potentially have altered the outcome.

This is precisely why internationally standardized trauma training programs exist.

ATLS: Why Every Frontline Doctor Needs Trauma Training

One dangerous misconception in many developing healthcare systems is the assumption that every doctor is automatically competent in trauma management simply because they hold a medical degree. This is inaccurate.

Emergency and trauma care is a highly specialized field requiring structured training in rapid assessment, prioritization, resuscitation, team leadership, and critical decision-making under pressure. A doctor trained primarily in outpatient medicine or elective care may not necessarily possess the competencies required to lead trauma resuscitations effectively.

This is where Advanced Trauma Life Support (ATLS) becomes essential.

Developed by the American College of Surgeons (ACS), ATLS provides a systematic and evidence-based approach to trauma management.

It teaches physicians how to prioritize life-threatening injuries, perform rapid primary surveys, secure airways, control hemorrhage, recognize shock early, coordinate trauma teams, and stabilize patients before definitive care.

As someone who has coordinated ATLS in Ghana for nearly a decade, I have witnessed firsthand how ATLS changes clinical confidence, team coordination, and patient outcomes. Doctors trained in ATLS approach trauma systematically rather than reactively.
Importantly, ATLS reinforces one critical principle often forgotten in overwhelmed systems: “Treat first what kills first.”

PHTLS: The Missing Link in Prehospital Emergency Care

The Charles Amissah case also raises serious questions about prehospital trauma care and ambulance systems in Ghana.

The committee report noted concerns regarding trauma life support competencies among ambulance personnel and described situations where ambulance teams functioned primarily as transport providers rather than emergency responders.

This underscores the urgent national need for Prehospital Trauma Life Support (PHTLS) training for paramedics and EMTs.

PHTLS equips prehospital providers with essential trauma competencies including scene assessment, hemorrhage control, airway management, shock recognition, spinal motion restriction, rapid trauma assessment, trauma decision-making, and destination prioritization.

Modern EMS systems globally recognize that ambulance professionals are not merely transport officers. They are frontline emergency clinicians whose actions within minutes of injury directly influence survival.

TNCC/ATCN: The Critical Role of Emergency Nurses

Emergency nurses remain the backbone of trauma care systems globally. In many emergency departments, nurses are the first professionals to recognize patient deterioration, initiate resuscitation measures, activate trauma responses, and coordinate care.

Trauma Nursing Core Course (TNCC) and or Advanced Trauma Care for Nurses (ATCN) provide internationally recognized frameworks for trauma nursing excellence.

TNCC equips nurses with rapid trauma assessment skills, prioritization of injuries, hemorrhage recognition, airway and breathing assessment, shock management, trauma team communication, and critical thinking in emergencies.

ATCN further advances nurses into expanded trauma resuscitation roles alongside physicians within multidisciplinary trauma teams.

As Course Director for TNCC Ghana, I have seen nurses transform from task-oriented practitioners into highly confident trauma clinicians capable of early recognition and decisive intervention.

Trauma Care Is a System — Not an Individual

One of the greatest mistakes healthcare systems make after tragedies like the Charles Amissah case is reducing complex systemic failures into simplistic blame narratives.

Trauma survival depends on an interconnected chain involving bystander response, EMS activation, ambulance response, prehospital care, hospital triage, trauma leadership, nursing coordination, blood availability, operating room readiness, ICU capacity, and referral systems.

The “No Bed Syndrome” itself is not merely a bed problem. It is a systems problem involving limited emergency care governance, poor communication systems, inadequate trauma training, weak referral coordination, insufficient emergency infrastructure, workforce shortages, burnout, and overcrowding.

Ghana Must Invest in Emergency Care Education

If Ghana is serious about preventing future avoidable trauma deaths, then investment in emergency education must become a national priority.

Every district and tertiary hospital should prioritize:

• ATLS-trained doctors

• PHTLS-trained paramedics and EMTs

• TNCC/ATCN-trained nurses

• Standardized trauma team activation systems

• Mandatory triage protocols

• Simulation-based emergency training

• Continuous emergency competency assessments

Trauma education should not be viewed as optional professional development. It is a patient safety intervention.

Beyond Blame: Building a Safer System

The death of Charles Amissah must become more than another moment of public outrage. It should become a turning point in Ghana’s emergency care evolution.

While accountability matters, sustainable improvement cannot come from disciplinary action alone. Punishing individual clinicians without simultaneously investing in trauma systems, emergency education, infrastructure, and workforce development risks creating fear rather than progress.

Healthcare workers who operate in unsafe, overcrowded, under-resourced systems need support, training, leadership, and functioning systems — not merely public condemnation.

The ultimate question Ghana must ask is not simply: “Who is to blame?” but rather: “What kind of emergency system are we building?”

Because trauma does not wait for policy discussions. Hemorrhage does not pause for bureaucracy. The Golden Hour does not negotiate with systemic inefficiency.

Lives are won or lost in minutes.

And preparedness saves lives.

The writer, Emmanuel Acheampong is the National Coordinator for ATLS Ghana, Course Director for TNCC Ghana, emergency nurse educator, and member of the Global Advisory Council of the Emergency Nurses Association (ENA). He is an advocate for emergency systems strengthening, trauma education, and global emergency nursing development.