Is advanced life support better than basic life support in prehospital care? A systematic review

Abstract

Background -Prehospital care is classified into ALS- (advanced life support) and BLS- (basic life support) levels according to the methods used. ALS-level prehospital care uses invasive methods, such as intravenous fluids, medications and intubation. However, the effectiveness of ALS care compared to BLS has been questionable.Aim -The aim of this systematic review is to compare the effectiveness of ALS- and BLS-level prehospital care.Material and methods -In a systematic review, articles where ALS-level prehospital care was compared to BLS-level or any other treatment were included. The outcome variables were mortality or patient's health-related quality of life or patient's capacity to perform daily activities.Results -We identified 46 articles, mostly retrospective observational studies. The results on the effectiveness of ALS in unselected patient cohorts are contradictory. In cardiac arrest, early cardiopulmonary resuscitation and defibrillation are essential for survival, but prehospital ALS interventions have not improved survival. Prehospital thrombolytic treatment reduces mortality in patients having a myocardial infarction. The majority of research into trauma favours BLS in the case of penetrating trauma and also in cases of short distance to a hospital. In patients with severe head injuries, ALS provided by paramedics and intubation without anaesthesia can even be harmful. If the prehospital care is provided by an experienced physician and by a HEMS organisation (Helicopter Emergency Medical Service), ALS interventions may be beneficial for patients with multiple injuries and severe brain injuries. However, the results are contradictory.Conclusions -ALS seems to improve survival in patients with myocardial infarction and BLS seems to be the proper level of care for patients with penetrating injuries. Some studies indicate a beneficial effect of ALS among patients with blunt head injuries or multiple injuries. There is also some evidence in favour of ALS among patients with epileptic seizures as well as those with a respiratory distress.

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies

“…We did several sensitivity analyses (Appendixes 9 to 16 of the Supplement), none of which changed the direction or significance of our main findings. Our findings are consistent with other evidence for cardiac arrest (Appendix 17 of the Supplement) and trauma (4,5,7,(10)(11)(12)(13)(14)(15)(16)(17)(18). Little prior evidence, however, exists for patients with stroke, AMI, and respiratory failure.…”

“…Advanced life support accounts for 65% of emergency medical care among Medicare beneficiaries (1) and even more among patients with high-acuity conditions, such as stroke. Ambulance crews using ALS are trained and equipped to provide sophisticated care on site ("stay and play"), whereas BLS emphasizes rapid transport to the hospital, so BLS ambulance crews provide only minimal treatment at the scene ("scoop and run") (2)(3)(4). Whereas ALS providers can use invasive interventions, such as endotracheal intubation for airway management and intravenous catheters for drug and fluid delivery, BLS providers use noninvasive interventions, such as bag valve masks for respiratory support.…”

Präklinische Einschätzung der Verletzungsart und –schwere beim Schwerverletzten durch den Notarzt

“…Die derzeitige Datenlage belegt jedenfalls keineswegs einen allgemeinen Vorteil der präklinischen Versorgung von Schwerverletzten durch den Notarzt oder Advanced Life Support (ALS [23,25,36,38,39]). In einer aktuellen Arbeit von Huber-Wagner et al [20] wurde u. a. der vorhersagbare Effekt der präklinischen Phase auf die Mortalität schwerverletzter Patienten berechnet.…”

Background and Advantages of a Tiered EMS Response in a Large, Fire-Based EMS Model

“…One study in 1992 reported that less than twenty percent of 911 medical calls required paramedic level care [10]. A systematic review conducted in 2010 suggested that out of all presentations, epileptic patients and those in respiratory distress benefitted from ALS interventions, however the quality of the literature was poor [11]. Curka et al demonstrated that out of BLS units dispatched in the observational period, only 1.6% of calls required ALS treatment prehospital [12].…”

“…Targeted response provides efficient use of ALS resources [10][11][12]. In order to implement a tiered model, dispatch personnel require algorithms to determine if a caller needs BLS or ALS [19].…”