Brandon O
Puzzled by facies
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The traditional model of the cardiac Chain of Survival runs:
Early Access -> Early CPR -> Early Defibrillation -> Early ACLS
We all more or less recognize the importance of the second and third, and the first is generally a necessary step to reach them. But increasingly the recent trend in the research and recommendations seems to be a de-emphasizing of the tools and resources specific to ACLS, and a suggestion that the gamut of skills an ALS responder or even an ER can throw at a cardiac arrest may not be of much additional benefit, if any. Better to push like a piston than worry about intubation, if you had to choose -- that sort of thing.
We could argue all day about how far to take this trend, and I'm sure we'll all be excited to see what the AHA feeds us next year, but there's an important aspect of this that's relevant now and not just navel-gazing. If advanced airways, drugs, and so on aren't really that important, is "Early ACLS" still an important part of the Chain of Survival?
This is not merely theoretical, because in many cases BLS providers are going to need to make a decision whether or not to pay some BLS coin in order to get advanced-level care for their patient sooner rather than later. If you're working a patient with CPR, basic airways, and the AED, is it clinically wise to attempt an intercept with an ALS unit? Or try to reach the definitive care of the ER? These things aren't for free, because your basic resuscitation gamut will suffer if you're loading people onto stretchers and so on.
There are some cases which seem obvious, such as if the cause of arrest is a pathology readily addressed by advanced care but not by your scope (say, a completely obstructed upper airway); and if the AED is simply failing to convert over and over, at some point we'd probably all agree something else needs to be tried. But on the other hand in most systems a medic will eventually show up anyway, so the issue here is time -- do we trade some BLS to obtain ALS sooner rather than later, or not?
Thoughts?
Early Access -> Early CPR -> Early Defibrillation -> Early ACLS
We all more or less recognize the importance of the second and third, and the first is generally a necessary step to reach them. But increasingly the recent trend in the research and recommendations seems to be a de-emphasizing of the tools and resources specific to ACLS, and a suggestion that the gamut of skills an ALS responder or even an ER can throw at a cardiac arrest may not be of much additional benefit, if any. Better to push like a piston than worry about intubation, if you had to choose -- that sort of thing.
We could argue all day about how far to take this trend, and I'm sure we'll all be excited to see what the AHA feeds us next year, but there's an important aspect of this that's relevant now and not just navel-gazing. If advanced airways, drugs, and so on aren't really that important, is "Early ACLS" still an important part of the Chain of Survival?
This is not merely theoretical, because in many cases BLS providers are going to need to make a decision whether or not to pay some BLS coin in order to get advanced-level care for their patient sooner rather than later. If you're working a patient with CPR, basic airways, and the AED, is it clinically wise to attempt an intercept with an ALS unit? Or try to reach the definitive care of the ER? These things aren't for free, because your basic resuscitation gamut will suffer if you're loading people onto stretchers and so on.
There are some cases which seem obvious, such as if the cause of arrest is a pathology readily addressed by advanced care but not by your scope (say, a completely obstructed upper airway); and if the AED is simply failing to convert over and over, at some point we'd probably all agree something else needs to be tried. But on the other hand in most systems a medic will eventually show up anyway, so the issue here is time -- do we trade some BLS to obtain ALS sooner rather than later, or not?
Thoughts?
