Pinnacle EMS Quick Take: Does ALS really matter?

Advanced life support measures exist on a spectrum, shifting the definition of ALS vs BLS


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ORLANDO — The traditional definition of ALS is based on procedures, but over time, many of those procedures become available to basic life support providers and, in some cases, to lay people. Ed Racht, MD, asked “Does ALS really matter?” in a thought-provoking session for the EMS leaders and paramedic chiefs attending the Pinnacle EMS conference.  

Racht, chief medical officer for AMR, challenged attendees to think differently about old assumptions and the meaning of ALS and BLS.  

Ed Racht, MD, asked “Does ALS really matter?” in a thought-provoking session for the EMS leaders and paramedic chiefs attending the Pinnacle EMS conference. (Photo/Ed Racht)
Ed Racht, MD, asked “Does ALS really matter?” in a thought-provoking session for the EMS leaders and paramedic chiefs attending the Pinnacle EMS conference. (Photo/Ed Racht)

Memorable quotes on the effectiveness of ALS  

Here are some memorable quotes from Racht’s presentation: 

“We have got to solve some of these evolving [EMS] issues and we want to be part of driving that change.”  

“There are massive things on the horizon [for EMS]. We just don’t know what they are.” 

“We’ve evolved advanced life support to be the tip of the spear in large part because of the word ‘advanced.’” 

“Advanced isn’t gone [from patient care]. It has just shifted.”  

“It’s so important for us to study the things applicable to our world. We need to look at what EMS is doing and evolve it ourselves based on the science.” 

“To say that ALS doesn’t matter is false. ‘Advanced’ interventions can and do make a difference in patient outcomes.” 

Top takeaways on the provision of life support 

Advanced life support, as a collection of interventions provided to patients that exist on a continuum, has shifted the differentiation of advanced versus basic. Here are four takeaways from Racht’s presentation.  

1. The answer to “Does ALS matter?” impacts many things 

The provision of ALS impacts all facets of emergency medical services. Racht described the wide-ranging implications of ALS, including  

  • Patient outcome system design 

  • Initial and continuing education 

  • Credentialing of EMS providers 

  • Cost of equipment, medications and other disposables 

  • Workforce availability, specifically paramedics  

  • Downstream influence on ongoing patient care and costs 

  • Status and competition  

“These are good reasons to discuss ALS, BLS and something in between for patient care in the out-of-hospital setting,” Racht said.  

2. ALS is ingrained in our culture  

Racht reminded attendees that EMS is in a state of remarkable, continuous and rapid change. “The old days of ALS were driven by interesting things,” Racht said. “‘Emergency!’ helped drive the impression of what EMS is.” The opening credits of the program showed multiple ALS procedures.  

In 1990, Racht and Jay Fitch wrote an Annals of Emergency Medicine editorial calling for ALS to be the standard in every community. Part of their argument was that the provision of ALS was only a few dollars more expensive than BLS care.  

3. The question begets more questions 

The question, “Does ALS really matter?” is not easily answered. The starting point is agreeing on a definition of advanced life support. Racht shared a definition for ALS that included “defibrillation, airway management and use of drugs and medications,” many of which BLS providers are trained and authorized to provide.  

Patients need life support on a continuum. Racht explored transferring what were once advanced procedures to BLS providers, as well as how some interventions, like naloxone for an overdose or epinephrine for anaphylaxis, have become available to lay people. He noted what matters most to patient outcomes is getting the life support they need from the right person, at the right time, in the right place.  

4. EMS is in a state of continuous, rapid change 

Research, reimbursement, recruitment and provider retention, and the changing healthcare needs of an aging population are having a tremendous impact on EMS. As highlighted by the announcement of ET3, the EMS Agenda 2050 and the EMS Trend Report, EMS is in a state of continuous rapid change.  

“As we sort out the difference between ALS and BLS, there are implications for our profession,” Racht said.  

The shift in advanced to basic is likely to continue. Racht concluded his presentation by noting how some patient care practices, like blood administrationantibiotic administration and CT imaging for stroke, have shifted from in-hospital care to out-of-hospital care in recent years.  

Learn more about ALS, BLS and patient outcomes 

To learn more about the importance of ALS, BLS and patient outcomes, read the articles in the Fitch & Associates Leadership Edge column on EMS1, as well as these articles: 

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