Review of:Baker TW, King W, Soto W, et al: "The efficacy of pediatric advanced life support training in emergency medical service providers." Pediatric Emergency Care. 25(8):508 512, 2009.
This study reviews the effectiveness of Pediatric Advanced Life Support (PALS) training in EMS providers by comparing PALS-trained and non-PALS-trained providers' abilities to perform advanced skills and evaluation of shock in pediatric patients. The researchers evaluated whether PALS-trained providers had superior outcomes in out-of-hospital pediatric resuscitation compared to their non-PALS-trained counterparts. The skills measured were:
- Vascular access -- both IV and IO;
- Advanced airway management; and
- Ability to assess and manage hemodynamic stability.
Over a three-year period, a total of 183 EMS runs were were retrospectively reviewed. The results of the study included a significant difference in two areas:
- Success rates in intubation and
- Ability to obtain vascular access in shock/cardiac arrest patients.
PALS-trained providers had an 85% success rate in intubation, compared with a non-PALS-trained success rate of 45%.
PALS-trained providers had a 100% success rate in their ability to obtain vascular access in shock/cardiac arrest, compared with a 70% success rate in their non-PALS-trained counterparts.
The investigators conclude PALS training improves procedural skills among EMS personnel and strongly recommend it be considered part of EMS training.
Our research reviewers disagree on the importance of this study. Read on to understand where they don't see eye to eye.
Medic Marshall:I'm impressed with the researchers' motivation to look critically at the education offered to EMS personnel, specifically on pediatric patients. It's pretty clear we ought to continually improve upon on pediatric education and training. Despite any shortcoming this research may have, the intentions are well placed. The number of cases reviewed over the three-year period was 183 of 338 actual cases handled by 56 EMS squads. But the more interesting number is that almost half the personnel studied were trained in PALS (65 were trained in PALS, as compared to 118 who were not). The authors don't discuss when personnel had their training and when they responded to these calls, which would be an interesting relationship to examine.
What I really took away from reviewing this literature is: EMTs and paramedics are really good at performing hands-on skills when given proper instruction and training. I would be willing to bet a similar study conducted with such courses as ACLS or PHTLS would get very similar results. However, it should not deter from this study's obvious value.
Overall, more studies like this ought to be conducted. Because most of these programs already exist as part of the educational curricula in paramedic schools across the country, it would interesting to evaluate the value of courses like PHTLS and AMLS through similar research to learn what works and what doesn't.
Doc Wesley:I m afraid I couldn't disagree more with Medic Marshall on the value of this study. The researchers did not prove their point. They contend that PALS-trained providers are more proficient that non-PALS trained providers. They go to great lengths to show that the characteristics of the patients cared for by both groups were the same. But that's not the only dependent variable.
They were reviewing the care provided by paramedics from 56 EMS squads across 20 counties. They don't provide us any demographic information on the PALS and non-PALS-trained providers. What, if any, other education have the PALS providers received compared to the non-PALS group? Is there a difference in years or type of service, such as full-time, fire-based, private or volunteer? These are the cohort characteristics that must be accounted for before you can simply state the difference between the two is the presence or absence of PALS training.
I'm not against PALS training, but this study simply doesn't prove the authors' conclusions.