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Advanced Life Support in Field Not Beneficial in Trauma Cases (April 22 CMAJ - Interview with Dr. Ian Stiell)
Advanced Life Support in Field Not Beneficial in Trauma Cases (April 22 CMAJ - Interview with Dr. Ian Stiell)

(April 21, 2008 - Insidermedicine) Thank you for joining us for Insidermedicine’s in Depth analysis of the OPALS Study, published in this week’s issue of the Canadian Medical Association Journal.

It does not appear to be beneficial and may even be harmful for paramedics to perform advanced life support techniques on trauma patients, rather than waiting for these techniques to be performed when the patients reach the hospital, according to research published today in the Canadian Medical Association Journal.

Over half a million Americans experience severe trauma -- defined as an injury causing death or loss of a limb -- every year.

If you are the first person to arrive at an emergency medical scene, St. John Ambulance recommends that you take the following steps:

-       1. Take control of the situation. This involves, assessing the scene for immediate risks, like impending explosions, calling out for bystanders to help, assessing casualties, and calling for medical help.

-       2. Call 911 immediately and always let the dispatcher hang up the phone first. Getting experienced emergency personnel to the scene is crucial.

-       3. Perform a primary survey, which means you need to assess for life-threatening injuries and give life-saving first aid when necessary. When you are assessing for life-threatening injuries, first do the “ABCs”: assess the patient’s airway, breathing, and circulation by finding a pulse. If qualified to do so, administer CPR, if necessary.

-       If you are the second to arrive to an accident scene and a first aider has already taken control of the scene ensure steps 1-3 have taken place. Then, ask the person in charge if you can be of assistance.

In many trauma centers, paramedics perform advanced procedures as soon as they reach a severely injured patient, such as inserting an airway tube down the throat and establishing IV access. Some question the value of these practices, however, arguing that they may actually delay definitive treatment.

In the present study, researchers from 17 Canadian hospitals compared the effect of paramedics' using advanced techniques, such as airway tube insertion and IV placement, in 1500 trauma patients with the effects of using more basic life support techniques, such as using oxygen bags and dressings, in about another 1400 patients before they reached the hospital.

While nearly four out of five patients survived their trauma, advanced techniques did not improve survival rates. In fact, placing a tube in the airway of a patient appeared to raise the risk of death, and use of advanced techniques in general appeared to raise the risk of death in those with severe head injuries.

We had a chance to talk to Dr. Ian Stiell, the main medial researcher behind the study, about the results and implications of the study.

In a related editorial, Dr. Davis an expert in Emergency Medicine from San Diego, cautions against concluding that advanced life support in general, or placing an airway into a patient before they reach hospital in particular, is harmful in all patients. Instead, he recommends attempting to better understand the mechanisms that explain these associations and work towards optimizing pre-hospital support.

Given the results of this study, the concept of advanced life support by paramedics in patients who have suffered severe trauma may need to be re-evaluated. If you witness a severe trauma, you should immediately call 911 and be prepared to assist as needed.

For Insidermedicine’s In Depth analysis of the OPALS study published in this week’s issue of the CMAJ, I’m Dr. Susan Sharma.

 
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