BACKGROUND: Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. OBJECTIVE: To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. DESIGN: Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. SETTING: Traditional Medicare. PATIENTS: 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. MEASUREMENTS: Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. RESULTS: Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. LIMITATION: Only Medicare beneficiaries from nonrural counties were studied. CONCLUSION: Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS. PRIMARY FUNDING SOURCE: National Science Foundation, Agency for Healthcare Research and Quality, and National Institutes of Health.
BACKGROUND: Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. OBJECTIVE: To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. DESIGN: Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. SETTING: Traditional Medicare. PATIENTS: 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. MEASUREMENTS: Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. RESULTS: Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. LIMITATION: Only Medicare beneficiaries from nonrural counties were studied. CONCLUSION: Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS. PRIMARY FUNDING SOURCE: National Science Foundation, Agency for Healthcare Research and Quality, and National Institutes of Health.
Authors: Ian G Stiell; George A Wells; Brian Field; Daniel W Spaite; Lisa P Nesbitt; Valerie J De Maio; Graham Nichol; Donna Cousineau; Josée Blackburn; Doug Munkley; Lorraine Luinstra-Toohey; Tony Campeau; Eugene Dagnone; Marion Lyver Journal: N Engl J Med Date: 2004-08-12 Impact factor: 91.245
Authors: Ian G Stiell; Daniel W Spaite; Brian Field; Lisa P Nesbitt; Doug Munkley; Justin Maloney; Jon Dreyer; Lorraine Luinstra Toohey; Tony Campeau; Eugene Dagnone; Marion Lyver; George A Wells Journal: N Engl J Med Date: 2007-05-24 Impact factor: 91.245
Authors: Ian G Stiell; Lisa P Nesbitt; William Pickett; Douglas Munkley; Daniel W Spaite; Jane Banek; Brian Field; Lorraine Luinstra-Toohey; Justin Maloney; Jon Dreyer; Marion Lyver; Tony Campeau; George A Wells Journal: CMAJ Date: 2008-04-22 Impact factor: 8.262
Authors: Amresh D Hanchate; Michael K Paasche-Orlow; K Sophia Dyer; William E Baker; Chen Feng; James Feldman Journal: Ann Emerg Med Date: 2017-05-27 Impact factor: 5.721
Authors: Ithan D Peltan; Kristina H Mitchell; Kristina E Rudd; Blake A Mann; David J Carlbom; Thomas D Rea; Allison M Butler; Catherine L Hough; Samuel M Brown Journal: Ann Am Thorac Soc Date: 2018-12