title: Is advanced life support better than basic life support in prehospital care? A systematic review.
abstract: BACKGROUND
  Prehospital care is classified into ALS- (advanced life support) and BLS- (basic life support) levels according to the methods used. ALS-level prehospital care uses invasive methods, such as intravenous fluids, medications and intubation. However, the effectiveness of ALS care compared to BLS has been questionable.
  
  
  OBJECTIVE
  The aim of this systematic review is to compare the effectiveness of ALS- and BLS-level prehospital care.
  
  
  METHODS
  In a systematic review, articles where ALS-level prehospital care was compared to BLS-level or any other treatment were included. The outcome variables were mortality or patient's health-related quality of life or patient's capacity to perform daily activities.
  
  
  RESULTS
  We identified 46 articles, mostly retrospective observational studies. The results on the effectiveness of ALS in unselected patient cohorts are contradictory. In cardiac arrest, early cardiopulmonary resuscitation and defibrillation are essential for survival, but prehospital ALS interventions have not improved survival. Prehospital thrombolytic treatment reduces mortality in patients having a myocardial infarction. The majority of research into trauma favours BLS in the case of penetrating trauma and also in cases of short distance to a hospital. In patients with severe head injuries, ALS provided by paramedics and intubation without anaesthesia can even be harmful. If the prehospital care is provided by an experienced physician and by a HEMS organisation (Helicopter Emergency Medical Service), ALS interventions may be beneficial for patients with multiple injuries and severe brain injuries. However, the results are contradictory.
  
  
  CONCLUSIONS
  ALS seems 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. There is also some evidence in favour of ALS among patients with epileptic seizures as well as those with a respiratory distress.
authors.affiliation: University of Eastern Finland, Department of Public Health and Clinical Nutrition, P.O. Box 1627, 70211 Kuopio, Finland.
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Ryynänen
authors.forename: Timo
authors.initials: T
authors.lastname: Iirola
authors.forename: Janne
authors.initials: J
authors.lastname: Reitala
authors.forename: Heikki
authors.initials: H
authors.lastname: Pälve
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
mesh_terms: D022561:Advanced Cardiac Life Support; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D006801:Humans; D008020:Life Support Care; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis