The economic downturn has resulted in many looking for ways to cut costs. In Columbus, Ohio an economic advisory committee suggested comparing the costs and benefits of returning to a basic emergency medical system as opposed to sticking with the advanced support that has been provided for more than forty years.
Basic Life Support (BLS) primarily consists of patient stabilization before a patient is transferred to a hospital. This includes stabilizing a broken bones or using an automatic external defibrillator (AED) on cardiac-arrest patients.
Advanced Life Support (ALS) allows highly trained paramedics to administer lifesaving drugs, create airways in patients who aren’t able to breathe and shock heart attack patients on the way to the hospital.
In order to support their ideas the economic advisory committee, led by lawyer Robert F. Howarth, refers to a 2005 study (based on previous studies, the majority over a decade old) published in the Journal of Prehospital and Disaster Medics that concluded patients fared about the same whether receiving BLS or ALS.
While most would view going from ALS to BLS as a step backward the economic advisory committee seriously considering taking that step back in time all the way to 1968 (the last time the Columbus Division of Fire provided only BLS).
Jack Reall, president of the Columbus Firefighters Union commented, “I can’t see the citizens of our community changing from an (advanced) system to a (basic) system in order to save 3 percent of the budget.”
This past Wednesday the San Antonio Fire Department incorporated a new program in order to save time and money. It’s a similar concept to the BLS vs. ALS however instead of taking away a whole service they added to it. In addition to the 32 ambulances ready to respond there are six more ambulances called Basic Life Support Ambulances geared towards minor emergency responses.
The 9-1-1 dispatchers (whom are all trained paramedics) will carefully screen calls to determine whether or not an ALS trained paramedics responds to a call.
Chief Charles Hood commented that of the 170 people taken daily to the hospital, about 80 only need basic life support.
What do you think? Is it better to cut corners and save some money since a 2005 study leads readers to conclude that whether a patient receives advanced or basic life support there won’t be much difference in the outcome. Or, would it be better to have both BLS and ALS ambulances and not take a chance on saving someone’s life that really needs ALS?
Sources: Dispatch Politics, WOAI.com
{ 2 comments… read them below or add one }
Your question of whether “(is) it better to have both BLS and ALS ambulances and not take a chance on saving someone’s life that really needs ALS?” is in itself a flawed question. Your question makes assumptions that ALS will save someone’s life over BLS. The fact is that multiple retrospective, prospective meta-analysis and clinical trials have shown that in fact outcomes are essentially the same if not improved with BLS intervention vs. ALS.
We would like to think that having individuals with additional training and resources would provide an advantage in regards to pre-hospital patient outcomes. However, the facts clearly show otherwise. Therefore the answer is clear; BLS is the solution to both budgetary responsibilities without compromise on patient outcomes. I think Dr Richard Saitz summed it up best by saying “Social psychology literature suggests that people cling to belief even in the face of mountains of evidence to the contrary. But, as physicians and scientists, we should embrace change when new evidence consistently contradicts our prior beliefs and clinical practice.”
Edward Ye
Emergency Medicine
Boston MA
I disagree that ALS providers don’t make a difference. My station is 1.5 hrs from any ED by ground, 30 min by air. We make a huge difference in CHF, COPD, chest pain, etc. We do not transport cardiac arrest patients. We work them for 20-25 minutes, and then contact med control for permission to cease efforts.
In an urban area with an ED 5 minutes away, I can see your point. But then again, if you have an asthma attack on the 4th floor, wouldn’t you want a treatment while you were being carried to the unit?
I agree with using BLS units for BLS calls, but don’t eliminate all ALS units.