Trauma Care

[ERDoc]

I just read today that the OPALS (Ontario Prehospital Advanced Life Support) Study has shown that there is no difference in several survival endpoints for trauma pts that are treated by BLS vs ALS units. The only difference was that in pts who were intubated the outcomes were worse (although the article did not say if these pts were sicker). I'm not trying to start an ALS vs. BLS war, I was just curious as to everyone's thoughts on it.

[Asysin2leads]

Well, of course, in someone's infinite wisdom, unless there are extenuating circumstances, trauma calls here in NYC are BLS jobs. I've had this arguement many times, mostly with BLS providers. There refrain is "What can ALS do for trauma? NOTHING!" I turn this around on them by asking them what BLS can do for major trauma, do which I answer "Even less than ALS can."

I still beleive in having ALS on critical traumas, if for no other reason than a good ALS provider can bring their knowledge of the injuries to the scene, along with airway maintenance, fluid rescusitation, and chest decompression. Traumas are load and go jobs. But that doesn't mean ALS doesn't have its place. Anyway, if you are counting survivability for intubated patients, I am sure that many of them were trauma arrests, which of course rarely turn out well. This doesn't mean that intubating a patient lowers their survival chances.

[Ridryder 911]

I have read the OPALS study too, & I found it to be an interesting study. But I see political motivation in it & find it to be a flawed study. The study did not just state for trauma but basically all ALS .. no increase in outcome. Of course the study did not address, a solution other than increasing BLS units, to reduce time line.

Be safe,

Ridryder 911

[emt_hound]

Lies, Damn Lies, and Statistics.

I'd like to see the variables they used as factors and how they measured performance before I made any conclusions from studies such as this one.

[canuckEMT]

I would like to know the reason why someone is always doing a study in the ALS vs BLS survival rates on a given situation or Pt presentation. Is there a body out there somewhere that has an axe to grind with Paramedics? All of the studies I have read recently are saying that BLS survival rates are better for this or that, so why then are we training so many paramedics?

I believe that to have a successful system we have to combine the two. Sure there are geographical and monitary reasons for different levels of service that are provided across the continent, but that is one of the things that makes EMS interesting.

As for the survival rates of the trauma aspect, it is more likely that a BLS unit is going to "scoop and run". I have seen this in my area that sometimes an ALS unit will stay on scene longer than BLS but, yes there are more interventions that they can perform than BLS can.

Also we utilize our Air-Medivac here quite frequently in trauma situations. So during the response ALS will remain on scene to stbilize, intubate, decompress if needed before arrival of the chopper. Whereas the BLS unit would load and go and have the chopper respond to the hosp if travel time warranted, and there was no prolonged extrication required.

I try to guage my traumas to do my utmost in attaining the golden hour. That way I can feel good that I have given my Pt the best chance at surviving.

[Summit]

"What can ALS do for trauma? NOTHING!"

What BLS can do for major trauma? "Even less than ALS can."

Pretty much the way I see it.

Diesel Macro Drip

Anyway, if you are counting survivability for intubated patients, I am sure that many of them were trauma arrests, which of course rarely turn out well. This doesn't mean that intubating a patient lowers their survival chances.

I'd wager you are right about that is the reason for that statistic.

Information absent.

---

On a trauma here, BLS can get a decent airway (CT) if they need that and IVs for trauma, ALS only adds chest decomp and then ET. I guess ALS can give Lido in a CHI /w intubation to help prevent ICP spikes (IIRC, not my level).

Is this study going towards the same end as showing that ALS cardiac arrests have some negligable fraction higher survival rate than BLS cardiac arrests?

Does this study really mean we should change our treatment???

I don't see how it does.

[Ridryder 911]

This reminds of the Houston PASG study. All of EMS knee jerked after "hearing" about it, but never really read it. Still today, people quote it as "showing MAST/PASG... caused harm"... actually what it did say there was no change in outcome.. no increasing in mortality or survivability.. If you look at patient injuries that the study was performed on, there was no chance of survivability, no matter what you did. Even if there was a trauma surgeon standing over them. the outcome would had been poor.

I always finding it amusing that "studies show EMS, lacking or need to do less".. etc...& the scientific community never address local ER, or tietary centers lack of stabilization & rapid packaging to send patients to appropriate facilities in timely manner.

There also has been studies showing the difference in having a surgeon in house compared with one on call (<15 minute response) no change in outcome difference, but several of thousands of dollars in costs. Yet, we do not hear about that very often, or continuous studies on it...

I believe it way to easy, for resident & fellowship students to look for a need to be published. When researching a topic, it easier to set your sites on "outside" the arena, there is way less political retaliation, & stepping on toes of fellow comrades.

I worked in Trauma Research & development for over 3 yrs full time, I was thoroughly discouraged & disgusted in the play of numbers & stats, & inaccurate scientific methodologies needed to make the study interesting. Some of these studies was published & hailed upon. My opinion of scientific studies & data was forever changed, & now believe very little when the studies are first published, I now wait for a comparison study to verify or dispute previous study, before I make an official opinion.

Be safe,

Ridryder 911

[Asysin2leads]

I'd really like to have someone who is against ALS for trauma sit down, and explain to me one more time exactly how having a person with a better knowledge and understanding of physiology and medicine will make it worse for the patient. No, really, explain to how knowing more and being able to do more is a bad thing? I mean, heck, if we want to continue with that rationale, why don't we just say the less training the better, and go back to the old days of firefighters wrapping people to pineboards with gauze and throwing them in the back of hearses. That should improve patient out come.

[ERDoc]

I don't think anyone is saying they are against ALS. This particular study shows that there is no difference in outcomes when pts are treated by ALS vs BLS. They are not saying that ALS kills the pt. I feel that the difference in the intubated pts is probably due to the fact that those who are being tubed are sicker in general and less likely to make it anyway. From a practical standpoint, if a pt comes into the ER with an IV line in already it frees up a nurse or two to move on to other things.

[1aCe3]

I've heard this from people / my instructor that trauma's are BLS jobs too..

I see the intubation argument,

and also, 'scuse my ignorance on the ALS side but don't early IV lines replenish the lost blood/hydration quickly and ensure a higher survival rate? Or does this not make that much of a dif.