Advanced Ems Practices ALS

EMS and Advanced Quality Management Metrics It would be difficult to deny that EMS systems place a great deal of emphasis on responses time and this often serves as one of the primary metrics for performance. Such a metric is entirely reasonable given the importance of reaching someone in critical condition sooner, as opposed to later, can potentially save their lives or at least improve their outcomes. This is an intuitive concept that people have believed for several generations.

Previous generations of heuristics in regards to response time and survival rates represented concepts such as the "golden hour" in which is the most important for mitigating mortality and improving health outcomes in critically injured patients (Lerner, 2001). Furthermore, in the modern EMS system, there be more factors that are also important to consider. For example, if advanced life support (ALS) is really need in a situation, and only basic life support (BLS) is dispatched, then there may be other considerations that are necessary to gauge performance than simply response time.

Yet, evidence-based clinical measures of emergency medical services (EMS) system performance have been few in number, largely due to the limited quantity and quality of research committed to the prehospital arena (Myers, Slovis, Eckstein, Goodloe, & Isaacs, 2008). Much of the research that has been produced has only focused on a small number of conditions or with a small population size. For example, although treatment of cardiac arrest represents a major function of most EMS systems, it only constitutes a small fraction (1-2%) of all EMS responses.

Therefore, the evidence for the importance of response time is heavily debated (Myers, Slovis, Eckstein, Goodloe, & Isaacs, 2008). Another study has found that response time that exceeded five minutes showed a significantly higher rate of mortality than a response time under the five-minute benchmark; yet did not show significant differences for longer response durations (Blackwell & Kaufman, 2002). Since the five-minute mark is virtually impossible for even the most sophisticated EMS systems, this research seems to suggest that response time might not be as important as once thought.

Furthermore, now that basic life support (BLS) providers and lay rescuers can provide rapid automated defibrillation as well as basic CPR, the relative importance of the ALS response-time interval has been challenged, both for cardiac arrest as well as for other clinical conditions (Myers, Slovis, Eckstein, Goodloe, & Isaacs, 2008). While some have argued that there is no evidence to suggest such tiered responses have any influence on outcomes, there does seem to be some evidence that they do; at least in regards to some specific conditions.

One meta-analysis found that between 1966 through 1995 reviewed fifty-one studies and found that in a majority of cases ALS-level care demonstrated effectiveness (Bissel, Eslinger, & Zimmerman, 1998). However, in tiered response systems a more comprehensive approach to quality management metrics is definitely need. Some systems, such as King County EMS, offer different tiers of responses that might be more or less appropriate in certain situations. Therefore, even if response time is not as crucial as previously thought, there are many other metrics that can take its place or at least supplement it.

Furthermore, even if the evidence does not fully support the importance of response time, it is reasonable to suspect that faster response time.