A question posted recently on Quora asked, “Is prehospital advanced life support really necessary?”
The question pointed to two studies that have raised doubts about ALS in EMS. The first, Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers, concludes: “This comprehensive meta-analysis suggests that physicians have significantly fewer pre-hospital ETI failures overall than non-physicians.
The second, Emergency medical systems in low- and middle-income countries: recommendations for action, states: “Some evidence has shown that training paramedics in basic life-saving skills improves patients’ outcomes. There is no evidence to support training paramedics in advanced life-saving skills.”
Paramedic Anderson Moorer gave his opinion on the topic. Check it out, and add your own thoughts in the comments.
Is prehospital ALS really necessary? No, not really; field paramedics and advanced life support (ALS) care is actually very new after all, largely not having existed even 50 years ago. Before then those countries were fine, they just had more people needlessly die.
By all means, shove critically injured patients into the back of a truck and drive like hell to a doctor if you wish. If they aren’t breathing, well you see there’s this study saying doctors intubate patients better than paramedics ... and from this you may conclude that it is better to not try at all, I guess?
You say some studies cast doubt on the efficacy of field ALS level care? Then by all means, if your mother is down gasping for air and about to code from pulmonary edema please feel free to tell the nice medics not to treat her with anything other than first aid, because some studies say it won’t help her. Besides it will cost some money. She’s old, anyway.
(By the way regarding the second study you cite, most paramedics would point out that a critical-care physician will tend to be more skilled at intubation. And most other medical skills. As long as they don’t have to use those skills while hanging from a harness upside down inside wreckage while gasoline drips down the back of their neck ... or they haven’t spent the last 20 years as a podiatrist.)
Paramedics are not meant to replace medical doctors. They are meant to be the alternative between an impossible “everything” and an intolerable “nothing.”
We can’t afford to put a trauma surgeon on every street corner, but neither can we afford to let mommy die simply because we didn’t want to spend enough to invest in actual treatment and instead equip “medics” with little more than a bit of trumped up CPR training and a joke of a first aid kit.
But is it necessary to think like this? No. Place what value you wish on human life.
