Prehospital interventions for penetrating trauma victims: ALS or BLS, who knows?
Hi folks! Journal reading time again!
This gem is from Injury journal 2013
Here is the article link :
Prehospital interventions for penetrating trauma victims: A prospective comparison between Advanced Life Support and Basic Life Support
OKay this is similar to another study called OPALS, where ALS vs BLS care for cardiac arrest and trauma were compared with the suggestion that BLS care was as good if not better than ALS care in terms of outcomes like mortality.
This study was just examining penetrating trauma patients though and was prospective cohort observational design.
They matched for injury severity scores and demographics.
Bottom line : BLS care had statistically greater number of survivors than ALS care.
Some interesting findings : Cervical spine immobilisation and IV access conferred no outcome benefit. Prehospital needle thoracostomy seemed to show no benefit and in one case was done on the wrong side. Prehospital intubation seemed to confer worse outcomes.
Caveats : Prehospital total times were really short , 20 min average across both groups! Transport distances in general were 2 mile radius from the study hospital.
THIS WAS AN URBAN SETTING STUDY!
There probably was some selection bias between the groups as non randomised ie apparently more injured patients selected for ALS care.
My take home learning:
This reminds me of the lessons from the trauma death of Princess Diana in Paris and the shooting case of Senator Giffords in USA . If short transport distances and times, BLS care may well suffice for penetrating trauma and several common prehospital interventions may well confer little to no benefit, if not indeed harm.
Next article will highlight when ALS care by HEMS paramedic crew can save lives against all odds
Sadly I cannot access the full article, but this seems somewhat of a no brainer given the amazingly short distances to hospital involved. It’s very hard to generalise American EMS to Australian pre-hospital care due to factors such as distance, case load, crew mix, exposure to sick patients and educational requirements when paramedics only are involved. Things only really start getting interesting in trauma (as with most pre-hospital care) when the distances and thus times start getting longer.
It is important we recognise “BLS” and “ALS” are not actual things, they are made up American terms that exist nowhere else in medicine and are like some mythical creature that exists only in imagination land.
These findings come as no surprise to me personally and are consistent with what the evidence has been showing consistently for a few years now.
I often wonder if the only thing helped by the so called “ALS” interventions is the ego or do-gooder-feelings of the people doing them?