I often hear paramedics express concern about published studies being anti-ALS. Some fear that the authors are seeking to take away their ALS skills. In an age where prehospital care providers want to be counted as professionals, eliminating that skill set appears threatening.
However, there s no need to fear research. It challenges us to improve our performance and use our skills to better patient care. In the end, it will bring us to the professional level we want to perform at and be recognized for. Let s review what we re learning from research and what it means to the future of our practice.
Airway & Ventilation
Recent studies looking at prehospital airway and ventilation management have been stark in their depiction of the practice of intubation and patient outcomes. Studies have shown that patients intubated in the field aren’t doing as well as patients that aren’t intubated.
Researchers also found that we were ventilating at rates that were too fast. Not only were the standards for ventilations too fast to prevent hypoxia, but we were ventilating faster than we thought we were.
When you analyze these study results, you should come away with two strong messages. First off, we need to ensure our basic and advanced airway management skills are sharp–the airway should be adequately supported before, during and after intubation. The second message from these studies, whether we have a basic or an advanced airway in place, is that we need a secure airway placed in a timely manner and ventilations that provide adequate oxygenation. This will be more attainable as mechanical ventilators get smaller and more affordable. Pulse oximetry and capnography will allow us to adjust the ventilation rate to a patient s specific needs.
As far as high ventilation rates go, this problem isn’t unique to prehospital care providers. Doctors and nurses aren’t immune to being driven by caffeine and adrenaline and distracted by what’s happening with the patient. Time anyone bagging a patient, and it s likely you ll find the rates are too fast.
If we act upon this feedback, I think our practice will become more advanced. By taking command of evaluating our performance and making adjustments to it, we grow professionally, and our patients have a better chance at a positive outcome.
Circulation
The results of studies looking at resuscitation and bleeding control have enabled us to alter our practice to ensure we save every blood cell possible. We ve learned to infuse less fluid to avoid popping clots and washing out bleeding patients dwindling red blood cells. We’ve learned that tourniquets are safe and effective, that elevation and pressure points aren’t productive and that direct pressure is still the most productive.
Better Days Ahead
Besides improving patient care, conducting research keeps us from spending our scarce dollars on devices that will have little or no benefit to our patients. Studies that compare patient outcomes with or without new devices allow us to make wise decisions about whether we should change our practice and add certain devices and treatment.
As we embrace the results of scientific study, our practice will grow more professional and our perception more keen. Our skill base will probably grow, and we’ll move forward with the knowledge that what we do for our patients is good for them and us. Fear not.
Editor’s Note: Learn about the results of recent EMS research by reading Dr. Keith Wesley’s weekly JEMS.com column or Elizabeth Criss’ bi-monthly column in JEMS entitled “Research Review.”
