The debate about the impact of paramedics on patient outcomes has been around since the beginning. I remember how advanced life support was resented by the BLS crews; certainly the research surrounding the effectiveness of ALS has not tilted in support of its use.
A study just published in the Annals of Internal Medicine looks at the Medicare patient population and how well they survived specific illnesses and injuries when transported by BLS or ALS units. The researchers concluded that BLS was better when it came to surviving trauma, stroke and respiratory failure.
The challenge with studies, such as this one, are the vast number of variables that can influence the outcomes of patients, many of which are outside the control of the population studied. These are questions that many of us are asking:
- How sick were the patients?
- What specialty receiving centers were involved?
- What was the distance traveled?
- When did the patient’s illness begin?
- What condition the patients were in prior to 911 activation?
The answers to these questions can influence what happens to patients after their EMS encounter. What was the level of care provided after transfer? Was it consistent from one center to the next?
No study is able to look at all of the factors or variables; the analysis and correlations would be nearly impossible for researchers.
On the other hand, a broad population and outcome analysis like this one can help other researchers refine the questions they are asking to formulate studies that can better control many of the variables, and generate data that is more meaningful and relevant. Prospective studies that can compare populations side by side and strictly define interventions can better draw conclusions about the efficacy of specific procedures, medications or techniques.
So what does it all mean? As I like to say, stand by to stand by. Look at all of the research and consider how it might apply in your response area’s patient population and practice environment. Even if you don’t agree with a conclusion, that’s fine — you are thinking about how it might apply and that level of critical reflection is important to any professional practice.
