Limitations with research (Where the Eagles fail!)

[Guest guest]

For several years now, the EBM folks have challenged many of our assumptions

about EMS. This isn't necessarily a bad thing. It's good to challenge our

assumptions. However, as bad as it is to accept the status quo, it's equally

bad to accept research just because some celebrity EMS physicians have their

names on it.

Many of the recent studies focus on BLS measures producing the same or better

outcomes than ALS procedures. It's important to remember something about these

studies. Namely, the majority of these studies are performed in urban areas

with relatively short transport times to definitive care. In other words, with

an unstable patient, it's probably just as good in an urban area to load and go

to a trauma center while you do BLS. By the time you completed BLS procedures

to begin ALS procedures, you're probably backing the rig into the ambulance

entrance of a Level I trauma center anyways.

It remains to be seen whether these conclusions are as applicable to suburban

and rural EMS with longer transport times (and typically more progressive

protocols).

Regarding intubation studies: Most of these studies involve head injury

patients or cardiac arrest patients. There are other patients who are intubated

besides these two limited populations.

It's also important to recognize that many of these urban medical directors work

in systems where the sheer numbers of medics and/or lack of organizational

commitment make it difficult to have the advanced protocols, training, and CQI

programs that they would like to have. (Remember, the Eagles represent the

largest EMS systems in the country.)

These are great studies, particularly when you critically examine how they MIGHT

apply to your locale.

Those of us in suburban and rural EMS need to step up and attempt to prove what

we instinctively know: that well-trained, critically thinking ALS providers make

a difference in patient care in our setting.

-Wes Ogilvie

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