Evaluating the Impact of Advanced Trauma Life Support (ATLS) Training in Reducing Preventable and Potentially Preventable Deaths: A Mixed-Methods Cohort Study

Background Trauma remains a leading global cause of mortality, particularly in low-resource settings. Advanced Trauma Life Support (ATLS) training offers a standardized approach to trauma care, yet its impact in India remains underexplored. This study evaluates the effectiveness of ATLS training in reducing preventable trauma-related deaths and improving clinical decision-making at a tertiary care center in Bihar, India. Methods This mixed-methods cohort study was conducted from October 2021 to December 2024 and included 200 trauma patients aged ≥18 years. Patients were divided into two groups: pre-ATLS (retrospective; October 2021 to July 2024) and post-ATLS (prospective; August 2024 to December 2024). Mortality rates, trauma management errors, and survival outcomes were analyzed using Kaplan-Meier survival curves, chi-square tests, logistic regression models, and Cox proportional hazards regression. Additionally, structured interviews with healthcare providers supplemented the quantitative findings. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2019; IBM Corp., Armonk, NY, USA) and R software, Version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria), with significance set at p < 0.05. Results ATLS training significantly reduced preventable deaths (from 30% to 15%) and potentially preventable deaths (from 40% to 25%). Trauma management errors, including delayed diagnoses and protocol deviations, also decreased post-training. Kaplan-Meier analysis demonstrated improved survival, while Cox regression identified ATLS training as an independent predictor of survival (HR = 0.62, 95% CI: 0.45-0.85, p = 0.003). Healthcare providers reported greater confidence in trauma assessment but highlighted concerns regarding accessibility, cost, and the need for refresher courses. Conclusions ATLS training enhances trauma care by reducing preventable mortality, minimizing errors, and boosting provider confidence. Expanding ATLS programs, particularly in resource-limited settings, is recommended. Future research should focus on long-term patient outcomes and the cost-effectiveness of ATLS implementation.