emergency medical service

Tashkandi 13

Does advanced life support (ALS) improve patient outcome?

Nezar Tashkandi

Creighton university

EMS

The research highlights on the use of ALS as an intervention care approach during emergency responses. The predominant use of the approach in the United States further indicates its potential to improve the patient outcomes. The article acmes the use of noninvasive interventions, for instance, endotracheal intubation to improve the outcomes of patients while on the scene before being transported to the hospital. Identifying the services provided by ALS while being compared to other intervention approaches portrays its ability to provide positive patient outcomes. Significantly, the article discusses how the research articles were selected with the help of electronic medical research databases and online Google Scholar engine to identify the vast research conducted in the field of ALS and emergency care. A selection criterion was adopted to facilitate ease in the identification of the informative research articles to be used in the paper. The research article provides a comprehensive discussion of the findings regarding the use of ALS as an intervention to improve the outcomes of the patients. ALS has proven vital to improving the outcomes of patients with multiple injuries and trauma. ALS has been identified as being inferior when dealing with many serious conditions such as cardiac arrest, a finding that depicts its inability to improve patient outcomes. Both the opponents and the proponents highlight their concerns on the use of ALS, a fact that calls for additional research on the intervention approach.

The role of advanced life support amongst pre-hospital patients is a controversial issue that has drawn mixed reactions on its ability to improve the patient’s outcome. Several studies have indicated that the efficiency of out of hospital intervention provided by the paramedics is yet to be clear. The leading emergency response of out of hospital medical treatment provided by ambulance paramedics in the United States is the advanced life support (Sanghavi et al., 2016). Significantly, advanced life support accounts for approximately 65% of emergency medical care amongst the Medicare beneficiaries with the inclusion of patients with high-acuity conditions for instance stroke (Sanghavi et al., 2016). Occasionally, ambulance crews use ALS. Thus they are trained and provided with sophisticated equipment’s that enables them to provide comprehensive care while on site. The looming controversy on the efficiency of this approach is highlighted by the fact that basic life support (BSL) emphasizes on the transportation of the patients to the medical care facilities rather than being treated on site (Sanghavi et al., 2016). Therefore, the BLS treatment crew often provide minimal treatment while on scene whereby the primary objective is to rush the patient to the hospital, an approach that is often referred to as “scoop and runs”. Often, the ALS providers deployed the use of noninvasive interventions, for instance, endotracheal intubation to facilitate airway management and intravenous catheters for fluid delivery. The services provided by the ALS paramedics require them to spend more time at the scene that is translated to an average of 5-7 minutes (Sanghavi et al., 2016). Despite the existing predominance of ALS treatment in the United States, several studies conducted in other countries have highlighted significant aspects that do not support its value. Primarily, the studies pinpoint that BLS is associated with a longer survival or positive patient outcomes compared to ALS. This fact portrays the presumption that ALS treatment approach is not related to positive patient outcomes. However, the benefits of ALS intervention cannot be sidelined including dextrose and thrombolytics. Additionally, studies have indicated that there exist no differences in outcome when BLS and ALS are used to intervene myocardial infarction. Despite this, both the proponent and the opponents of advanced life support call for additional research to ascertain the particular interventions that might be deemed probable for using ALS

The electronic medical research databases that are available through Grand Canyon University, University of Maryland-Baltimore County and Tulane University School of Medicine libraries were searched. These databases comprise of MD Consult, Lexis-Nexus, and PubMed. Additional research was conducted through the Google Scholar online platform whereby peer-reviewed journals were identified with other websites that had resourceful information relating to the use of advanced life support as an intervention approach outside the hospital. Both the databases and Google Scholar were searched with the use of a combination of terms including “advanced life support,” “emergency medical services,” “advanced cardiac life support,” “thrombolytic therapy,” “emergency treatment,” “out of hospital medical treatment” and “basic life support.” Significantly, the research included articles that were published after 2000.

The systematic review was mainly focused on patient’s secondary survival whereby the studies allowed incorporated a follow-up of the patient until his/her discharge from the healthcare facility. The research considered that studies which use survival until arrival at the healthcare facility were sensitive to the distance and the transport system that was used. Therefore, the study did not include studies that focused on treatment delays. Additionally, the articles whose foundation were based on the geographical epidemiology were not used for research.

Articles identified in the research process were excluded for a number of reasons including; BLS response was discussed as the intervention approach that is used in out of hospital treatment, the article was written in a different langue rather than English, it was identified as an aeromedical response and an emergency medical technician was included to be part of the ALS response. The eight articles that met the inclusion criteria of the research were included in the reference section. The main findings of each article were discussed to provide a broader scope on the significance of the topic.

According to Callaham, 2014, patients with cardiac arrest outside the hospital portrayed less survival to hospital discharge if they receive advanced life support from the ambulance personnel (Shuster, Keller and Shannon, 2004). According to the study, the survival rate of patients who received ALS was approximately 9.2% which was lower compared to patients that received BLS which stood at an estimate of 13.2% (Callaham, 2014). The findings of the research study indicate the fact that ALS is not associated with greater patient outcomes when used during emergency situations. The less significance posed by ALS as a response can be based on the fact that its efficiency is much lower when responding to emergency issues that are of importance (Sanghavi et al., 2016).

The sophisticated methods used by the paramedics and the ambulance personnel are less efficient thus the main reason behind its inability to improve patient outcome significantly. Callaham, 2014 shares the perspective that, despite the vast amount of resources reserved for the use of ALS, the high mortality rates is an indication of its inefficiency. The ALS provides a fundamental component of the response during emergency situations. However, its inability to provide improved positive outcome is an indication of its shortcomings. Mostly, ALS has been associated with much less positive outcomes when dealing with sophisticated conditions such as cardiac arrest, an aspect that might be linked to the training capacity of the ambulance personnel and the paramedics who offer services at the emergency scenes (Callaham, 2014). The study has called into question the widespread perception that advanced life support has provided positive patient outcomes amongst out of hospital cardiac arrest patients through its interventions. The new finding calls for evaluation of the use of ALS in other diagnosis groups to ascertain its capacity to provide positive patient outcomes. Notably, the clinical mechanisms associated with advanced life support should be assessed. This facet facilitates the identification of out of hospital care strategies that can be adopted to ensure that ALS not only saves a life but also improves the quality of services offered to patients in different diagnosis groups.

Research conducted amongst trauma patients has indicated various benefits regarding the use of ALS as an intervention during emergency responses (Liberman and Roudsari, 2007). According to Isenberg & Bissell, 2005, patients with trauma who receive ALS care on the scene show a significant improvement on the trauma scores. During the study, no mortality cases amongst the patients who received ALS care was reported. Primarily, the study highlighted the fact that trauma patients who received ALS care portrayed a lower mortality rate within the first 24 hours, an aspect that further indicates the efficiency of using ALS as an intervention approach during emergency situations (Eckstein et al., 2000). Notably, ALS has significant reduction of pulmonary failure amongst the trauma patients. The research findings is an indication that the provision of ALS during emergency response is associated with lower mortality rates and increased injury scores (Liberman and Roudsari, 2007).

The research by Isenberg & Bissell, 2005, is an indication that ALS is associated with improved trauma scores based on the fact that patients are provided with sophisticated care on the scene. The ambulance personnel’s and the paramedics are equipped with sufficient training and equipment’s that continually enhance their ability to provide advanced care amongst the trauma patients thus reduce the mortality rates significantly (Eckstein et al., 2000). Despite this, the trauma patients who received ALS treatment showed no reduction in the length of stay within the intensive care unit. Additionally, opponents of the findings share the perception that the study was focused on blunt trauma while sidelining penetrating trauma. According to research, ALS is associated with positive patient outcome amongst blunt trauma patients. However, the results are not the same amongst penetrated trauma patients as it decreased the survival of the victims. However, this new finding is sidelined by the fact that statistics from motor vehicle crashes indicate the fact that patients who received ALS illustrated an increased improvement in blood pressure and trauma scores (Eckstein et al., 2000). The findings by the researchers portray the need for additional research to identify the actual outcomes of trauma patients who received ALS care. Despite the fact that ALS is associated with positive care amongst blunt trauma patients, its efficiency on penetrated trauma patients is still a controversial issue that calls for additional research. The findings by Isenberg & Bissell, 2005, indicate the fact that ALS is associated with positive outcome amongst trauma patients by improving its scores.

Studies that concern unselected patient groups have highlight ALS a being an inferior treatment intervention approach (Ryynänen et al., 2010). Studies that cover the efficiency of ALS on all injuries further indicates that ALS is less superior when compared to BLS. Notably, the treatment offered by ALS paramedics and ambulance personnel has been identified das being harmful due to the lack of an experienced personnel (Jayaraman and Sethi, 2010). However, when the patient material is concentrated to an array of severe cases, ALS is associated with some beneficial aspects due to the services offered on the scene (Ryynänen et al., 2010). For example, studies indicate that patients with multiple injuries benefit highly from ALS intervention. This aspect is based on the perception that both the paramedics and the ambulance personnel can provide comprehensive care to the patient while on the scene such as stopping of excessive bleeding after car crashes thus providing the patient with a better chance of survival. This finding is an indication that ALS is associated with positive patient outcomes. However, not all studies confirm to this conclusion with some highlighting the need of an experienced physician to support the provision of the required services (Ryynänen et al., 2010). Mainly, the opponents of ALS highlight the fact that the delivery of care while at the site by the paramedics can be harmful due to their limited experience thus might result in adverse patient outcomes. Despite the concern on the lack of an experienced physician, no studies have indicated the existence of positive patient outcomes in the events that an experienced personnel was present when providing ALS care (Jayaraman and Sethi, 2010). This indicates significant shortcomings in the study of the effectiveness of ALS care when compared to other intervention approaches (Ryynänen et al., 2010).

ALS intervention care has portrayed positive patient outcomes amongst trauma patients, an aspect that indicates its ability to provide positive patient outcomes. Notably, patients with multiple injuries fare well with ALS intervention as it is associated with improved scores. However, an overall perspective that concerns unselected patient groups illustrates ALS as being an inferior intervention during emergency response. Mostly, the huge chunks of resources vested in the intervention approach should enhance its ability to improve patient outcomes. The approach is linked with insignificant patient outcomes, especially when dealing with serious conditions such as cardiac arrest (Shuster, Keller and Shannon, 2004). The finding on its inability to provide positive patient outcomes amongst cardiac arrest and penetrated trauma patients is a further indication of its inefficiency. Despite the fact that additional research is still needed in the field, ALS is an inferior intervention approach when compared to other care delivery services. This intuition is associated with the lack of an experienced personnel within the team that provides intervention care on the scene.

ALS intervention is undoubtedly the predominant response that is used in emergency situations. Despite this, the efficiency of the approach is still questioned based on its inability to provide positive patient outcomes in different patient groups. ALS care professions such as the paramedics provide sophisticated care on the scene before transporting the patient to the hospital. This approach has resulted in a massive amount of resources being channeled into the approach on the presumption that it enhances the positive outcome of the patient. However, studies have indicated that the fact that ALS is superior compared to other intervention approaches such as BLS when dealing with specific patient groups. Despite this, limited research on its inefficiency is a point of concern whereby some researchers differ on its capacity to provide positive patient outcomes amongst the trauma patients (Eckstein et al., 2000). This calls for additional research on the use of ALS as an intervention approach during emergency responses.

Callaham, M. (2014). Basic vs. Advanced Life Support Outcomes after Out-of-Hospital Cardiac Arrest - For the Media - JAMA Network. Media.jamanetwork.com. Retrieved 20 April 2017, from http://media.jamanetwork.com/news-item/basic-vs-advanced-life-support- outcomes-after-out-of-hospital-cardiac-arrest/

Eckstein, M., Chan, L., Schneir, A., & Palmer, R. (2000). Effect of Pre-hospital Advanced Life Support on Outcomes of Major Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care, 48(4), 643-648. http://dx.doi.org/10.1097/00005373- 200004000-00010

Isenberg, D., & Bissell, R. (2005). Does Advanced Life Support Provide Benefits to Patients? A Literature Review. Pre-hospital and Disaster Medicine, 20(04), 265-270. http://dx.doi.org/10.1017/s1049023x0000265x

Jayaraman, S., & Sethi, D. (2010). Advanced trauma life support training for ambulance crews. Cochrane Database of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd003109.pub2

Liberman, M., & Roudsari, B. (2007). Pre-hospital trauma care: what do we really know? Current Opinion in Critical Care, 13(6), 691-696. http://dx.doi.org/10.1097/mcc.0b013e3282f1e77e

Ryynänen, O., Iirola, T., Reitala, J., Pälve, H., & Malmivaara, A. (2010). Is advanced life support better than basic life support in pre-hospital care? A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 18(1), 62. http://dx.doi.org/10.1186/1757-7241-18-62

Sanghavi, P., Jena, A., Newhouse, J., & Zaslavsky, A. (2016). Outcomes of Basic versus Advanced Life Support for Out-of-Hospital Medical Emergencies. Annals of Internal Medicine, 165(1), 69. http://dx.doi.org/10.7326/l15-0628

Shuster, M., Keller, J., & Shannon, H. (2004). Effects of Pre-hospital Care on Outcome in Patients with Cardiac Illness. Annals of Emergency Medicine, 26(2), 138-145. http://dx.doi.org/10.1016/s0196-0644(95)70143-5