Related Experiment Videos
Can basic life support personnel safely determine that advanced life support is not needed?
1Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA. david.cone@yale.edu
Prehospital Emergency Care
|October 20, 2001
Summary
Firefighter/emergency medical technicians-basic (FF/EMT-Bs) cannot reliably determine when advanced life support (ALS) is not needed. This study found that FF/EMT-Bs often incorrectly canceled ALS, potentially compromising patient care in emergency medical services (EMS).
Area of Science:
- Emergency Medicine
- Public Health
- Health Services Research
Background:
- Two-tiered emergency medical services (EMS) systems utilize both basic life support (BLS) and advanced life support (ALS) ambulances.
- Firefighter/emergency medical technicians-basic (FF/EMT-Bs) staff BLS ambulances and have the discretion to cancel responding ALS units.
- The safety and efficacy of FF/EMT-B decisions to cancel ALS without established protocols are not well understood.
Purpose of the Study:
- To evaluate the safety of FF/EMT-B decisions to cancel advanced life support (ALS) in a tiered emergency medical services (EMS) system.
- To determine if FF/EMT-Bs can accurately identify situations where ALS is not required.
- To examine patient outcomes based on FF/EMT-B ALS cancellation decisions.
Main Methods:
- Prospective, observational study in two academic emergency departments (EDs) within a large urban fire-based EMS system.
- Analysis of 69 emergency runs where both ALS and BLS ambulances were dispatched, but only BLS transported the patient.
- Assessment of FF/EMT-B decisions against pre-defined criteria for potential ALS need and examination of patient disposition and outcomes.
Main Results:
- In 75% of cases (52/69), BLS providers canceled ALS, believing it unnecessary.
- Of those canceled, 77% (40/52) met criteria indicating a potential need for ALS, including serious chief complaints and abnormal vital signs.
- Many patients (87%) received interventions in the ED that could have been provided by ALS in the field; 31% were admitted, and one patient died.
Conclusions:
- FF/EMT-Bs, without specific protocols or medical criteria, are not consistently safe in determining when ALS is not needed.
- The current system allows for potentially unsafe cancellations of ALS, which may delay critical interventions.
- Further research and protocol development are needed to ensure appropriate ALS utilization in tiered EMS systems.