Advanced training in trauma life support 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 to improve trauma outcomes in LMICs, but effectiveness is debated.

Purpose of the Study:

• To evaluate the impact of ALS-trained ambulance crews versus non-ALS trained crews on trauma patient mortality and morbidity.

Main Methods:

• Searched multiple databases (Cochrane, MEDLINE, Embase, Web of Science, CINAHL, PubMed) up to May 2014.
• Included randomized controlled trials, controlled trials, and non-randomized studies (before-and-after, interrupted time series).
• Two reviewers assessed eligibility and extracted data.

Main Results:

• Included one controlled before-and-after trial, one uncontrolled before-and-after study, and one randomized controlled trial.
• No studies demonstrated evidence supporting ALS training for pre-hospital personnel.
• One study showed increased mortality in patients with Glasgow Coma Scale <9 receiving ALS care; logistic regression also indicated increased mortality with ALS care.

Conclusions:

• Current evidence indicates no benefit from ALS training for ambulance crews on patient outcomes.
• Further rigorous appraisal is needed to confirm these findings.
• The promotion of ALS training in LMICs requires re-evaluation based on existing evidence.