Finally, some positive ACLS data

[itku2er]

Wow OZ thanks for sharing that and thanks for answering my questions in the chat on the study.

I agree I dont think people understand the importance of a study like this and what it means to ems.

Terri

[OzMedic]

Why do people feel that ALS HAS to be beneficial? Should we be focusing on what is best for the pt, not what adds to our skill set?

Sorry I'd like to respond but your post is a bit confusing as you seem to contradict yourself in the next line. I think I know what you are saying but would like you to clarify before I respond

[akroeze]

Sorry I'd like to respond but your post is a bit confusing as you seem to contradict yourself in the next line. I think I know what you are saying but would like you to clarify before I respond

Sorry, I shall try to clarify what I mean... hopefully.

It seems to me that many people seem to be working on the (potentially flawed) assumption that ACLS MUST be better because we're doing more for the patient. It seems to me that people equate more procedures to better outcome just because we're doing more.

Bah, I don't know if I'm explaining this right.

Basically, people want ACLS to work (for whatever reason) so they grab studies like this and say "HA! I told you it worked, see??"

But they need to look at it objectively, scientifically. People seem to let egos get involved.... they're trying to take away my skills, my drugs! But if I'm giving less drugs, I CAN'T be providing better care!

Sorry if this is confusing, I may have just made things even less clear but it's hard for me to explain this. I'm not even sure how I feel on this issue, these are just thoughts I'm having.

[OzMedic]

It seems to me that many people seem to be working on the (potentially flawed) assumption that ACLS MUST be better because we're doing more for the patient. It seems to me that people equate more procedures to better outcome just because we're doing more.

Bah, I don't know if I'm explaining this right.

Basically, people want ACLS to work (for whatever reason) so they grab studies like this and say "HA! I told you it worked, see??"

But they need to look at it objectively, scientifically. People seem to let egos get involved.... they're trying to take away my skills, my drugs! But if I'm giving less drugs, I CAN'T be providing better care!

Sorry if this is confusing, I may have just made things even less clear but it's hard for me to explain this. I'm not even sure how I feel on this issue, these are just thoughts I'm having.

I think I know what you are saying and I could not agree with you more. So many of the interventions we have performed over the years and still currently are questionable. Many of them go back to the early days of EMS when various groups of good people got together and devised the early ALS systems. A lot of the interventions brought in were based on anecdotal experiences, common sense and the misconception that what was working in the ED at the time will work in EMS. I am not criticising these early pioneers as they had no other information to go on. The problem is that the EMS system as a whole never really moved on from that approach even when the opportunity was there to test the real effectiveness of these interventions. Then as time goes on and technology and EMS education improve we implement a whole raft of new drugs and procedures without really examining the ones we already have. I can think of numerous drugs and procedures that I am authorised to perform that I believe that I could do without. On top of that my service announces another 6 or so that they are rolling out this year.

This brings me to why I am happy about the study attached to this post. While it is by no means a radical or definitive study it does examine the benefit of basic ACLS procedures in out of hospital cardiac arrest. When I say basic I mean it is not the examining latest wizz bang device or drug that has landed with a few questionable or flawed studies to be incorporated into our existing ACLS protocols. It is finally demonstrating a positive effect of our core ALS skills in cardiac arrest such as good basic cares, judgement, ETT, adrenaline, ECG recognition etc. While this study in no way quantifies any one of these interventions as an individual it gives us an evidentiary basis for ACLS in the first place which has been sadly lacking. More importantly it proves the benefit of ACLS in areas where rapid access to defibrillation and/or CPR (both of which are poorly available in rural environments). Further studies will try and identify individual contributors to this success but I feel that this original study examining the overall benefit is important as ACLS is more than just an ETT or adrenaline or cardioversion etc.

In short my feelings are that we need to prove the benefits of what we have been doing before we move on to the next big thing. There are so many things out there in EMS that probably have no place being there. Let's find out what does so we can trim the fat and focus on what matters.