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In order to provide the best possible care to our patients, we have to put more emphasis on BLS basics. When the significance of actual hands-on BLS experience isn't considered, students enter paramedic programs without a mastery of the fundamentals of patient care. It's important to remember that it's not only ALS care that can save lives.
As we revisit the role BLS plays in our patient assessment and care, let's consider the foundation of everything we do in emergency medicine: perfusion. Although our service is wide-ranging, and we sometimes provide care that's not always necessarily lifesaving (i.e., such comfort measures as analgesia), when life or health hangs in the balance, the restoration and maintenance of perfusion is our desired goal.
Perfusion can be understood as the circulation of oxygenated blood and nutrients and the removal of wastes from the body's organs, tissues and cells for the purpose of maintaining homeostasis; that is, the body's normal state of good health. In order to accomplish this, we assist the body's natural compensatory mechanisms with interventions designed to optimize perfusion.
A good example is supplemental oxygen: We use oxygen therapy liberally because it's one way to get more oxygen to the cells. Another example is the shock position: Placing a patient supine with legs slightly elevated maximizes return of blood to the body core, where it's most vital. Together, these two BLS interventions can be lifesaving, working with the compensatory mechanisms of tachycardia and peripheral vasoconstriction to prevent the progression of shock from the reversible stage to the irreversible stage until definitive, hospital-based therapy (surgery, blood transfusions) can be initiated.
Perfusion is a prime example of how BLS care can save a patient's life, which is why these critical opportunities can't be overlooked. Recognizing the need for BLS care and acknowledging its importance makes us better paramedics, and, all things considered, that should be our goal.
Mark Rock,BA, NREMT-P, is a graduate of the University of Oregon and did post-graduate work at Portland_s Neurological Sciences Institute. A member of the JEMS EMT and Paramedic Advisory Committee (EPAC), Rock practices as a paramedic in Ventura, Calif. Contact him atems4usa@gmail.com
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