‘ALS’ Versus ‘BLS’ Model
1Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144,Paris-Diderot University, France
Prehospital care is classified into ALS- (advanced life support) and BLS- (basic life support) treatment levels according to the methods used. ALS refers to sophisticated prehospital care using invasive methods such as intravenous fluids, drug administration and tracheal intubation. BLS corresponds to the medical care used to assure patient's vital functions until his transport to the appropriate medical care. ALS-level prehospital care is usually implemented by physicians or paramedics, while BLS-level care is given by paramedics or emergency medical technicians. However, in most cases ALS units use the same techniques and vehicles (ground ambulances, helicopters) as BLS units. In emergency care, there are two alternative strategies including 1- the “scoop and run” strategy where the patient is transported to a high level hospital as quickly as possible, with minimal prehospital treatments and 2- the “stay and play” strategy where the patient is stabilized on site before transportation. ALS-level emergency unit employs rapid assessment. When a diagnosis is feasible and definitive, an effective treatment can be started prehospital by using stay and play-tactics, like thrombolysis in myocardial infarct and early defibrillation in cardiac arrest. In contrast, scoop and run-tactics is the choice when a definitive treatment outside the hospital is not possible, like in the case of penetrating injury with bleeding where immediate surgical treatment is imperative. Based on a systematic review , ALS appears to improve survival in patients with myocardial infarction and BLS seems to be the proper level of care for patients with penetrating injuries. Some studies indicate a beneficial effect of ALS among patients with blunt head injuries or multiple injuries. Additionally, there is also some evidence supporting ALS among patients with epileptic seizures and respiratory distress. This lecture will discuss both strategies of pre-hospital care in the light of the French pre-hospital medical services (SAMU) compared to the US paramedics experience.
1- Ryynänen OP, Iirola T, Reitala J, Pälve H, Malmivaara A. Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med 2010;18:62.