Is Basic Life Support Better Than Advanced Life Support?

Is Basic Life Support Better Than Advanced Life Support?
A recent Chicago research paper, “Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies,” analyzed the outcomes of patients who received advanced life (ALS) support versus basic life support (BLS) and the impact on mortality. It’s certainly created an uproar in the EMS community. 
 
Before we reject the report as preposterous, outrageous, contemptable and worthy of burning at the stake, ask yourself three questions:
 
1. Have you read the actual study? 
Not just the abstract. Not just the newspaper reports. Not just the multitude of opinions that have been and continue to be written about it…the actual research report. 
 
2. Do you know how to critically analyze research? 
For many years, EMS has taken the position that we don’t need to know about research. This lack of knowledge has placed us in a poor position to defend against “bad” research especially if we can’t identify it. Simply saying “Nuh uh” to something is not a defensible position.
 
3. What if it’s true?  
What if BLS is superior to ALS? Could we be up in arms, not because we look upon this as poor research but because this threatens the existence of many paramedics?  
 
The critical reader of a research report expects the writer to provide logical and coherent rationales for conducting the study, concrete descriptions of methods, procedures, design, and analyses, accurate and clear reports of the findings, and plausible interpretations and conclusions based on the findings. 
 
The literature review is generally focused on providing two rationales. The first is a rationale for the research question or hypothesis – that the author’s purpose is to generate evidence to answer an important research question. These questions might reflect an addition of knowledge to a field by filling a gap in understanding, a resolution of some controversy, or a practical application of some body of knowledge to remedy some problem. 
 
Thus, the first rationale serves to persuade the reader that the author’s selection of a research question is nontrivial and follows from the existing literature on the topic. The second rationale is intended to justify the methods used in the study and their appropriateness for generating valid and reliable evidence to answer the research question posed.
 
I have read the paper and agree that some of its conclusions are flawed. For example, it was done in Chicago. There are almost as many hospitals in downtown Chicago as there are Starbucks. Getting patients to definitive treatment not available in our ambulances, as quickly but safely as possible, is always an important goal.
 
We have known for many years that rapid transport to the appropriate facility was the best treatment for shock. For most trauma patients, we render little beyond BLS care. Perhaps the Chicago study shows that BLS is better for patients in a large urban setting. However, many patients are outside of the metro areas. Take a deep breath and read the report. Learn more about research and its interpretation. You’ll be glad you did!
 
Here are some links to read and compare:
 
Author Bill Young teaches at Eastern Kentucky University. He is the coordinator of the EKU Online Emergency Medical Care program.  

Published on October 19, 2015