I've seen a lot of research and studies done around ALS for cardiac arrest, most of it seeming to speak against any appreciable benefit.
I was curious though about whether there is conclusive evidence on the effect Paramedics have on patients experiencing chest pain or problematic rythms before they have a heart attack. Or is this too difficult to determine?
It seems that Paramedics often get judged by the effect treatments have on patients in the most dire situations, which makes some sense. But it seems like ALS might be the most effective as it is used to prevent these situations from occuring.
Are you talking ALS or just ACLS? If you are saying ALS has no effect on patients' lives, why bother bringng the patient to the hospital? The ED practices ALS. And, much of what can be done initially in the ED can be done by well educated and trained Paramedic. It is the pre-arrest that the Paramedic should be most effective with.
How many things precipitate the cardiac arrest? Many, many things do. If it is rhythm disturbances, the Paramedic can do something to slow a rapid heart rate to regain cardiac filling. The Paramedic can treat PVCs if they are interfering with the patient's status to avoid a cardiac arrest. A Paramedic should be able to recognize the signs of sepsis to initiate fluids and pressors. However, too often the signs are overlooked because the medical part of the Paramedic's education/training is the weakest and the "its only a fever" call mentality takes over. They are also in a hurry to unload their patient to get back to wait for a "real emergency" they miss their patient going into cardiac arrest or being intubated just as they are pulling out the driveway. A Paramedic should also be able to stabilize a patient that has ROSC. Then we can go into the hypothermia and its effectiveness which is still being studied. However, if you can not go the distance with the hypothermia protocol to include all variables and meds, the outcome may not be as expected. How about the tension pneumothorax? Obstructed airway? Are you also going to say all the things mentioned in PALS are also useless? What about NRP? Isn't ETI of great importance for the preemie? What about maternal emergencies? How about prolonged seizures?
Also, the "ALS" practiced by Flight, some CCTs and Specialty teams has been known to save lives. Yes, Paramedics have the opportunity to increase their education and training to become part of other teams if their ground EMS is stagnant or just suffices for the area they are in. One could also work toward becoming a member of some EMS organization that is progressive and a leader in research such as in Seattle.
As for as research, here's an interesting article from OHSU in Oregon.
Emergency Medical Service Providers' Attitudes and Experiences Regarding Enrolling Patients in Clinical Research Trials
http://www.informaworld.com/smpp/content~db=all~content=a909569374
Here's another article about Paramedics, the 12-lead and door to balloon times.
http://www.informaworld.com/smpp/content~db=all~content=a909570596
There is prehospital research happening but you have to read something besides JEMS to find it. Or, at least pull up the articles in the reference section of the watered down article or personal interpretation done by the JEMS author to see if you get the same information.
Here are some journals which you may be able to read at least the abstracts or if you are in a Paramedic program at a college, they should have access to the full article.
Prehospital Emergency Care
http://www.informaworld.com/smpp/title~content=t713698281
Resuscitation - European Journal - see what other countries are doing. RESUSCITATION is the official Journal of the European Resuscitation Council. It is also interesting to look up what and who makes up EMS in another country when you do find an interesting article.
Signup and you will at least be able to see the abstracts.
http://www.resuscitationjournal.com/
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
http://www.sjtrem.com/
Emergency Medicine Journal (EMJ)- an international peer review journal covering pre-hospital and hospital emergency medicine, and critical care.
http://emj.bmj.com/
Here's an interesting article about studying oxygen and AMIs.
http://emj.bmj.com/content/27/4/283.abstract
Objective To explore the feasibility of conducting an RCT of oxygen versus air in AMI, by exploring the beliefs of UK professionals who treat patients with AMI about oxygen's benefits, and to establish a baseline of reported practice by asking about their use of oxygen.
Conclusion Widespread belief in the benefit of oxygen in AMI may make it difficult to persuade funders of the importance of this issue and health professionals to participate in enrolling patients into a trial in which oxygen would be withheld from half their patients.
We had the same situation in the U.S. when studying how much oxygen to use for neonatal resuscitation. Telling parents their baby won't or didn't get oxygen if resuscitation is or was required can be a little unnerving.
Journal of Emergencies, Trauma, and Shock - another international journal. Some of the articles are available in full as well as abstract.
http://www.onlinejets.org/
The Journal of Emergency Medicine
The official journal of the American Academy of Emergency Medicine
- abstracts can be read
http://www.jem-journal.com/
One of my favorites:
Respiratory and Critical Medicine
http://ajrccm.atsjournals.org/
Abstracts are available for all and full articles are available for older issues.
This will give some an idea about how indepth critical care medicine is.
Another favorite of mine:
Journal of Respiratory Diseases - just when you thought your EMT textbook taught you everything about COPD.
http://jrd.consultantlive.com/home
One more good journal:
Respiratory Care Journal
http://www.rcjournal.com/
One might ask why I included journals from Europe and critical care. The answer is very simple. Advancements in other countries and professions eventually trickle into the U.S. or onto the ambulances. Hypothermia and CPAP as well as all the medications used in prehospital have already be trialed and researched in the hospitals long before they made it to the ambulance. CPAP had been around for over 60 years before Paramedics started using it.
One also has to remember certain authors, like those in JEMS, pick out articles for a dramatic flare or to suit their own personal agenda. An EMT might choose to review all the articles that show "BLS" is the greatest. A Paramedic might choose articles favoring "ALS". It is important to read many different articles from many different authors to get a broader perspective. Some in EMS only like to read one author in JEMS "because he/she thinks just like them". That is not actually reading for the science of medicine but more for entertainment value.
