Tuesday, March 24, 2009

Evidence Against "Stay and Play" Pre-Hospital Care

Emergency Physicians Monthly published an article in February, 2009.

The article concerned pre hospital patients suffering trauma (car accidents, etc.) The Ontario Pre-hospital Advanced Life Support Study (OPALS) was used as evidence. OPALS is the largest study examining the impact that Advanced Life Support (ALS) has on patient care.

In a before/after analysis OPALS analyzed the effect ALS (paramedic care) had on almost 3000 major trauma patients. The idea was to see how much ALS improved outcomes at the scene of a trauma.

Here is what they concluded:

"When on scene and transport times are considered, Basic Life Support is better than Advanced Life Support. The longer they stay, the worse the patients do.

"So is it time to get rid of Advanced Life Support? Probably not.

"We know that most, if not all, of the skills and procedures that EMT-I and EMT-P providers can perform are beneficial in the hospital setting or we wouldn't have extended such procedures and capabilities to them (pre hospital providers).

"The question is, "At what point in time in the field to we reach the point of diminishing returns on any additional time spent."

"This data tells a compelling story that time is, perhaps, the most critical factor in prehospital care delivery."

So what about Peoria?

In 2004 when my brother and I wrote these Forum articles, Advanced Life Support and rapid transport were considered the gold standard. However, the Peoria Fire Department was not allowed to perform Advanced Life Support or transport patients. The injured patient needed to wait for Advanced Medical Transport to arrive to give Advanced Life Support and transport the patient.

Would it not have made sense to allow the Peoria Fire Department to transport patients and give Advanced Life Support at the same time? The Peoria Fire Department had and has firefighters that are paramedics and work for AMT also. But these same firefighters were not allowed to give their paramedic Advanced Life Support while working for the Peoria Fire Department for trauma patients or any type of patient.

And the Peoria Fire Department still cannot transport trauma patients or ANY type of patient even today. This goes against the OPALS conclusions.

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