I see on the LMRFD minutes Larry Tennant was demanding a paramedic in Meadview.. WHY

Studies show Paramedic vs EMT Survival Rate Your chances may be better with an EMT and rapid transport...

Over 80% of calls are EMS calls and 80% of those BLS calls.

Truth is There is little difference between the survival rate of patients treated by an EMT using Basic Life Support or a Paramedic using Advanced Life Support.'

If fact the study says you have a 2.51-fold increased odds of dying if treated with ALS care rather than BLS

Cardiac Arrest Survival

The findings from the OPALS trial are consistent with those of an observational cohort study of a sample of Medicare beneficiaries who experienced OHCA done by Sanghavi et al. from 2009 – 2011

[7]. The authors found that survival to hospital discharge was greater in those treated by BLS (13.1% v 9.2%) [7]. Ninety-day survival (8.0% vs 5.4% ) and neurologic function among hospitalized patients (21.8% vs 44.8%) were also found to be greater in the BLS group [7].

MAJOR TRAUMA

They found no substantial difference in survival to hospital discharge between BLS an ALS care (81.8% for BLS v 81.1% for ALS). In fact, in those with GCS <9 ALS care increased mortality (60.1% v 51.2%).

The reasoning for this may be due to delayed hospital transport while ALS interventions are performed on scene or complications of endotracheal intubation. A meta-analysis by Lieberman et al performed before the publication of the OPALS trauma study came to the same conclusion – there is no benefit to on-site ALS intervention for patients with major trauma [12].

The authors also postulate that the delay in definitive care to perform ALS interventions on scene is the underlying cause of the findings. A more recent study by Rappold et al evaluated survival in patients with penetrating trauma in an urban environment who were transported via ALS, BLS or police [13]. Their findings are consistent with previous data. They found the overall adjusted OR identified a 2.51-fold increased odds of dying if treated with ALS care. The outcomes of these studies emphasize that definitive care for severely injured trauma patients is most likely to be in the operating room rather than on the side of the highway.
Additionally, as our knowledge evolves about the effect of permissive hypotension in trauma patients, the findings supporting BLS care as optimal make more and more sense [14,15].

TAKE HOME POINTS ON ALS VS. BLS CARE

The standard of EMS care has evolved over time towards ALS level care in many communities around the world. To justify the cost of maintaining this level of care and skill for providers there should be considerable improvements in patient-oriented outcomes, such as neurologically intact survival after out of hospital cardiac arrest and decreased morbidity and mortality after major trauma.

The results of several large studies question the benefit to ALS interventions when BLS care is optimized. Review of the literature suggests that an understanding by EMS systems and providers of what interventions lead optimal outcomes is more complex than just the distinction between BLS and ALS care.

Some patients will benefit from advanced interventions such as fluid resuscitation and dysrhythmia management, while others require rapid transport to definitive care in the operative suite. While the issue of what level of care is best for each individual patient is far from settled, it is clear that the prehospital phase of care for all patients is critically important for outcome.

BLS is more than basic, it’s fundamental to good care

MAIN OUTCOMES AND MEASURES

Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year.

Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3–5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2–4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6–27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154 333.

Just My Opinion

The ability to rapidly transport patients to definitive care has a lot to do with survivability. Waiting an hour or calling a medical helicopter because we lack resources isn't right.

Why should a taxpayer in the LMRFD pay a $25,000 medical helicopter bill because their ambulance was transporting a dehydrated hitchhiker at milepost 5 on US93?

It would be better to have several backup ambulances staffed by paid volunteer EMTs and EMRs with good Basic Life Support skills who can do rapid transport to KRMC.

If a patient has trauma and needs a Level I Trauma Center, call a medical helicopter. But KRMC can handle respiratory, heat stroke, cardiac, stroke, and most other calls not requiring a trauma surgeon right now.

Rapid Transit $2500 vs Medical Helicopter $25,000

Dolan Springs to KRMC is 38 miles, it would take 28 minutes to get to KRMC at 80mph

Meadview to KRMC is 58 miles, it would take 49 minutes to get to KRMC at 70mph.

In Dolan Springs paramedics routinely call for a medical helicopter with a 30 minute flight time from Vegas for calls KRMC can handle. Then they load the patient in the ambulance and drive to the fire station where they sit and wait for 30 minutes.

When the helicopter gets there it takes10-15 minutes to land, shutdown the helicopter, load the patient, and take off.

Then it's another 30 minutes flight time back to the hospital where it takes 5 minutes to land and off load the patient.

That's 75 minutes rather than 28 minutes to get to definitive care.

LINKS to More Info