Advanced trauma life support training for ambulance crews

Area of Science:

• Emergency medicine
• Trauma care systems
• Public health interventions

Background:

• Global injury burden is rising, particularly in low- and middle-income countries (LMICs).
• Trauma care models from high-income countries are being adopted in LMICs.
• Advanced life support (ALS) trained ambulance crews are promoted in LMICs to improve trauma outcomes, but evidence is debated.

Purpose of the Study:

• To evaluate the effectiveness of ALS-trained ambulance crews compared to non-ALS trained crews in reducing trauma patient mortality and morbidity.

Main Methods:

• Comprehensive literature search across multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL, PubMed) up to July 2009.
• Included randomized controlled trials, quasi-randomized trials, and non-randomized studies (before-and-after, interrupted time series).
• Data extraction and eligibility criteria applied by a single reviewer.

Main Results:

• Three studies (one RCT, one controlled before-and-after, one uncontrolled before-and-after) met inclusion criteria.
• No evidence was found to support ALS training for pre-hospital personnel.
• An uncontrolled before-and-after study indicated increased mortality in severely injured patients (Glasgow Coma Scale < 9) treated by ALS crews.

Conclusions:

• Current evidence suggests no benefit from ALS training for ambulance crews in trauma care.
• Findings indicate a potential increase in mortality for critically injured patients receiving ALS care.
• The effectiveness of ALS interventions in pre-hospital trauma settings requires further rigorous investigation.