I found this a very surprising result as one would expect that many urgent medical problems need treatment immediately and can’t wait another 10 minutes to reach the emergency room.
Could someone look at the paper and verify that the better results are NOT because the Basic Life Support patients were in better medical condition.
Interesting article, thanks for posting it. I will read the paper later, but per the article the major difference was time to hospital. BLS average 13 minutes, ALS average 27 minutes.
Without reading the paper, (so WAG), this was in non-rural counties so the dispatcher had a choice of ALS or BLS. The dispatcher is relying on the caller for info.
You can have all kinds of symptoms for a heart attack, but in general , outcomes are worse for some one who falls down unconscious vs. someone who says I feel a little short of breath. Perhaps, (remember WAG), leading to more BLS dispatched to less serious versions of the same condition. I can think of several ways to objectively measure this. Will f/u .
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Are they doing triage during the dispatch and deciding what kind of vehicle to send? Because it wouldn’t be surprising if the mortality rate was worse for the situations that were known in advance to be terrible.
Possibly the ALS ambulances are dispatched to the most severe cases. That would immediately put their survival rate lower.
I’m reminded of my friend who told me that his surgeon brother had a 75% mortality rate on his patients. I was appalled until he told me that the brother was the last resort for those patients whose condition was so severe that no other surgeon would touch them. The other surgeons would refer those cases to the brother as a last ditch attempt.
Yes.
Though every 911 center is a bit unique, they generally operate based upon guidelines pre-approved by a medical doctor. Those guidelines are used to sort patients into three categories: Priority, Critical, or Urgent.
For chest pain/ heart related symptoms those categories broadly correspond to ALS, BLS, and a scaled down BLS response
As it relates to chest pain/heart problems Priority might include:
[ul]
[li]Patient is unconscious/not breathing normally[/li][li]Decreased level of consciousness[/li][li]Male over a certain age (35 in our center)[/li][li]Female over a different age (40 in our center)[/li][li]Age 15-40 with Shortness of Breath, Nausea, or Excessive sweating[/li][li]Rapid heart rate with 1. chest pain or 2. history of rapid heart rate[/li][li]Fainting[/li][li]Chest Pain associated with use of cocaine/crack[/li][/ul]
Critical might include:
[ul]
[li]Male under age 35, no critical symptoms[/li][li]Female under age 40 with no critical symptoms[/li][li]Rapid heart rate without critical symptoms[/li][/ul]
And Urgent:
[ul]
[li]Male under age 35, or Female under age 40, with chest wall trauma but no critical symptoms.[/li][/ul]
Worth noting that the authors, being smart people too, were aware of the possibility of selection bias.
The press write-up says: “The authors studied survival differences between patients who received ALS in counties that use more ALS and patients who received BLS in counties that use less ALS. In order to overcome any potential selection biases that might have been inherent in either model, the researchers used two distinct statistical approaches to measuring the differences between ALS and BLS outcomes. Both approaches generally found that BLS patients for the studied conditions had better survival rates than ALS patients.”
I don’t have the math chops to speak to whether their efforts to control for the selection bias worked.
I seem to recall from taking EMT training a while back that the main ways that medics treat STEMIs are through trying to inhibit the clotting and (more importantly) rapid delivery to a catheter lab. Depending on protocols, calling ALS instead of stepping on the gas could slow that delivery.