The long simmering debate about the efficacy of advanced life support (ALS) procedures has bubbled up again in response to the results of a recent Harvard University study that links ALS care on cardiac arrest calls to higher rates of death, coma, and brain damage than patients treated with BLS care.
The push for paramedics on every street corner began in the 1990s. The reasoning was that a higher-trained EMS provider would provide better care to the pre-hospital patient, and the community’s health would be better protected. So far, that has failed to materialize in any substantial way.
Most of us know that the vast majority of out-of-hospital patients require basic life support (BLS) care. And an increasing amount of evidence indicates that that percentage will grow.
Yet I’m not depressed over these results. If anything, I’m more excited now than ever that we are seeing evidence of what we actually do to contribute to a patient’s health care. However, this all comes with big caveats.
The Harvard study is a retrospective study that focused only on cardiac arrest, and it doesn’t investigate the effect of poor BLS upon ALS. The study also doesn’t look at the effect of ALS in rural regions. In other words, it is one study looking at one aspect of our practice, and its results can only be limited to that area.
Still, it’s huge.
ALS providers really are the specialists in the out-of-hospital arena. Their knowledge and preparation runs deep in very specific areas. As community paramedicine continues to develop, there may be new roles for EMS providers to make meaningful impacts to overall health care, through either preventive and follow-up care, or even more sophisticated levels of interventions.
Yet before we can move ahead, we’ll need to give the traditions of past practice the heave ho. Let’s provide care that works for the patient, in systems that are fiscally responsible and treat their practitioners with respect. As professionals, we deserve that.
