Can somebody please tell me what ALS means?

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Veneficus

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Seems like I should know the answer to this.

But I have come to the realization that while I can describe what can constitute advanced life support, I cannot define it.

So I consulted the internet.

The only place I could find a definition was on wikipedia. No dictionary had it.

Even the Ontario ALS patient care standards which claims in the table of contents that the definition of ALS is on page 1. No such definition exists in the 114 page document. I looked.


I would like to preface this by saying that the article has no sources cited for the definition and looks like it was written either by an American paramedic or a 6th grader looking at the American system.

So let's hear what Wikipedia has to say shall we?

"Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation (breathing)."

Ok, well, now I need to know what basic life support is.

Now while also found on wikipedia, (again with abysmal citings)

"Basic life support (BLS) is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who have received BLS training. BLS is generally used in the pre-hospital setting, and can be provided without medical equipment."

freedictionary.com states:

"basic life support n.
Emergency procedures performed to sustain life that include cardiopulmonary resuscitation, control of bleeding, treatment of shock, stabilization of injuries and wounds, and first aid."



Does anybody else see the conundrum here?

ALS is a set of lifesaving protocols and skills? Really? By that definition, pain control is not ALS. Chemotherapy is ALS. Why do paramedics have morphine and not antibiotics or other chemotheraputics?

The later definition of "basic" life support is far more inclusive than ALS is.

So where does that leave us?

If you took wikipedia out of the equation, ALS does not seem to exist or does not hold true to its definition.

So I'll ask again. "What is ALS?"

Now this is not just about semantics. We are paying a lot of real money for it. We claim that it is preferable to the more encompassing BLS.

Without simply describing parts of it, can anyone offer some sort of substantial definition that shows ALS is superior to the medical definition of BLS?

The common accepted pecking order seems to be: BLS<ALS<"definitve care"

Definitive care according again without equal, by freedictionary.com
"definitive care,
n the completion of recommended treatment."

Now it has occured to me in reading the Ontario document that ALS really describes a "who" not a "what."

But then, one of the most effective life saving treatments supports circulation and opens airways. Which is of course done by BLS providers. So back to square 0.

I need some help on this one.
 
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ALS and BLS are labels, holdouts from the good old days when people were satisfied with skills and protocols defining the professions.

I think "prehospital emergency medicine" is more appropriate now, and would help explain why we don't deal in chemotherapeutics.

Then we can have then we can have basic and intensive care paramedics. Or whatever they call them at Brown's house. I like that system, and loath the EMT label on the whole lot of us.
 
abckidsmom said:
ALS and BLS are labels, holdouts from the good old days when people were satisfied with skills and protocols defining the professions.

I think "prehospital medicine" is more appropriate now, and would help explain why we don't deal in chemotherapeutics.

Then we can have then we can have basic and intensive care paramedics. Or whatever they call them at Brown's house. I like that system, and loath the EMT label on the whole lot of us.
Click to expand...

Fixed it for you!
 
reaper said:
Fixed it for you!
Click to expand...

What do physicians who practice outside of hospitals do, then, if not prehospital medical care?
 
reaper said:
Fixed it for you!
Click to expand...


If you take the emergency out of the name, and leave just the prehospital, what, then, makes it truly prehospital? How 'bout "out of hospital" or just "paramedicine."
 
Those work too. But, Emergency is not accurate. Most medicine is not emergent
 
...but EMS barely touches (not even enough to scratch) the surface of non-emergent, non-transport medicine.
 
Go to the Dept Of Transportation description.

They originated it. Various states decided to make their own versions.
Heck yeah various levels need descriptions! If skills are not described and enumerated, then you only have one category. If not enumerated, how to you train, regulate, define, license? Otherwise, then everyone is a paramedic, only some are less well trained than others.

You know me...back to EMT-A and EMT-P. Stop handing more and more missions to people with inadequate training or permissions, then jack up their training and permissions, then raise their missions, raise their training..until even EMT-B has irrelevant stuff tossed in because they might need to know the Krebbs Cycle or Moh's Law someday.

Yeah, if they get on Jeopardy.
 
Just remember, BLS before ALS (unless you are using a dictionary or Wikipedia)
 
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Martyn said:
Just remember, BLS before ALS (unless you are using a dictionary or Wikipedia)
Click to expand...

madj.jpg

I award you no points, and my God have mercy on your soul.
 
Martyn said:
Just remember, BLS before ALS (unless you are using a dictionary or Wikipedia)
Click to expand...

That was quite random....

Many of us don't think in terms of BLS and ALS. It's simply pt care. For example, it's good form to check L/S before hooking up a monitor. Not too many people will skip bagging a pt and just get the tube real quick instead. I may choose, under certain circumstances, to give epi 1:000 IM for an obvious case of anaphylaxis (per the pt's presentation and Hx obtained in the first minute or so), where the pt is crashing, before getting a BP or O2 if I'm short handed (my EMT may be spiking a bag, or be pulling out the BVM and tube kit for me or something). I may check a BGL right off the bat for the suspected hypoglycemic w/ AMS and give D50 right afterward, provided their L/S ands SpO2 are adequate, along with their pulse. The BP can wait two minutes in that instance.
 
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46Young said:
That was quite random....

Many of us don't think in terms of BLS and ALS. It's simply pt care. For example, it's good form to check L/S before hooking up a monitor. Not too many people will skip bagging a pt and just get the tube real quick instead. I may choose, under certain circumstances, to give epi 1:000 IM for an obvious case of anaphylaxis (per the pt's presentation and Hx obtained in the first minute or so), where the pt is crashing, before getting a BP or O2 if I'm short handed (my EMT may be spiking a bag, or be pulling out the BVM and tube kit for me or something). I may check a BGL right off the bat for the suspected hypoglycemic w/ AMS and give D50 right afterward, provided their L/S ands SpO2 are adequate, along with their pulse. The BP can wait two minutes in that instance.
Click to expand...

I may be dense.....but refresh me....L/S? :unsure:
 
Those work too. But, Emergency is not accurate. Most medicine is not emergent
Click to expand...

Neither is most emergency medicine. Even in busy EDs, it's primary care without the continuity of care and something interesting actually thrown in every so often.
 
Veneficus said:
Seems like I should know the answer to this.

But I have come to the realization that while I can describe what can constitute advanced life support, I cannot define it.

So I consulted the internet.

The only place I could find a definition was on wikipedia. No dictionary had it.

Even the Ontario ALS patient care standards which claims in the table of contents that the definition of ALS is on page 1. No such definition exists in the 114 page document. I looked.


I would like to preface this by saying that the article has no sources cited for the definition and looks like it was written either by an American paramedic or a 6th grader looking at the American system.

So let's hear what Wikipedia has to say shall we?

"Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation (breathing)."

Ok, well, now I need to know what basic life support is.

Now while also found on wikipedia, (again with abysmal citings)

"Basic life support (BLS) is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by laypersons who have received BLS training. BLS is generally used in the pre-hospital setting, and can be provided without medical equipment."

freedictionary.com states:

"basic life support n.
Emergency procedures performed to sustain life that include cardiopulmonary resuscitation, control of bleeding, treatment of shock, stabilization of injuries and wounds, and first aid."



Does anybody else see the conundrum here?

ALS is a set of lifesaving protocols and skills? Really? By that definition, pain control is not ALS. Chemotherapy is ALS. Why do paramedics have morphine and not antibiotics or other chemotheraputics?

The later definition of "basic" life support is far more inclusive than ALS is.

So where does that leave us?

If you took wikipedia out of the equation, ALS does not seem to exist or does not hold true to its definition.

So I'll ask again. "What is ALS?"

Now this is not just about semantics. We are paying a lot of real money for it. We claim that it is preferable to the more encompassing BLS.

Without simply describing parts of it, can anyone offer some sort of substantial definition that shows ALS is superior to the medical definition of BLS?

The common accepted pecking order seems to be: BLS<ALS<"definitve care"

Definitive care according again without equal, by freedictionary.com
"definitive care,
n the completion of recommended treatment."

Now it has occured to me in reading the Ontario document that ALS really describes a "who" not a "what."

But then, one of the most effective life saving treatments supports circulation and opens airways. Which is of course done by BLS providers. So back to square 0.

I need some help on this one.
Click to expand...
Perhaps we can reshape the paradigm. BLS is care thy is rendered when non-lifethreatening situations arrive. Excepting CPR an traumatic amputations. While basic life support does save lives... It does so without advanced/invasive/ or sterile techniques. So unfortunately ALS really is just about skills...
 
Maybe ALS includes advanced assessment.
 
Brown is unsure of the exacting definition but something like this is how we do it

BLS - a scope of practice that does not include IV cannulation or intravenous medications or cardiac interventions that rely on practitioner interpretation of an ECG (eg manual defibrilation and cardioversion) but does require a delegated authority from a medical director

ILS - a scope of practice that includes IV cannulation and intravenous medications (Brown knows it specifically mentions adrenaline and IV pain relief) and cardiac interventions that rely on provider ECG analysis but does not include intubation, chest decompression etc

ALS - a scope of practice that includes everything else not mentioned above
 
tl/dr - Blah blah blah..

With all due respect, Ven (& there's plenty), I feel like Basic & Advanced gives a pretty good starting point for conveying the differences between the BLS&ALS, anybody who needs clarification can just delve into the capabilities of the providers are under each one.

As far as an umbrella term for the services we provide?

abckidsmom said:
I think "prehospital emergency medicine" is more appropriate now...
Click to expand...

This. Yeah sure, there are patients who don't get transported to the hospital, but I think Prehospital Emergency Medicine is the most accurate term for the system I work in. & although there are a few calls that fall outside that definition (non-emergent IFT's & patients transported in protective custody for psych evaluation, etc) I doubt we're going to find an accurate all-encompassing term that fits better.. idk who would expect our field title to be all-encompassing!

Firefighter/EMT's aren't going to be called firefighter/emt/MVA-extrication-tech/custodial/cook/tour-guide/chauffeur/cat-retrieval/PR-specialist/report-writer-extraordinaire. Comprehensive? Almost.. but still not there.

The public will still see a "Firefighter" in uniform, look around & think, I don't see a fire.. Where are our taxpayer dollars going!

Alright I'm done. That was fun though. :blush:
 
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