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Fri May 27 08:10:27 BST 2005

That's all very well but, if survival is your only measure you could also 
send a private car and do nearly as well.
Why would you think that survival or discharge independence would be 
significantly different ?- let's face it, if the trauma occured in your ED 
the outcome would not be much different either - it's not lack of science, 
it's lack of depth of science -it's the lack of ability to resuscitate dead 
tissue that is the problem - not who attempts it or why - there is no 
evidence that ALS in the ED is any better - why do anything ? Why not just 
drive off - In fact here's an idea - why don't all you trauma professors 
take your private cars out and do the work ? think of the cost savings in 
removing the expense of EMS systems altogether - Just a bunch to 'top 
knives' in Mercedes 500's

Cheers
Simon Houstoun
Paramedic QAS Toowoomba QLD

----- Original Message ----- 
From: "Charles Brault" <c_brault at yahoo.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Friday, May 27, 2005 12:56 AM
Subject: OPALS Trauma.... preliminary

> The first "plenary" presentation at the Society for
> Academic Emergency Medicine meeting in NYC this past week
> was the trauma portion of the OPALS study.  To summarize:
> ALS (endotracheal intubation, IV fluids and drugs) was
> added to the BLS systems in 17 Ontario cities with
> populations ranging from 20K to 750K.  There were 1276
> major trauma (ISS>12) pts treated by BLS in the "before"
> phase, and 1474 pts treated by ALS in the "after" phase.
> The mean ISS was 22, and the mean GCS was less than 8.  The
> groups were similar - the patients treated by ALS had
> the same distribution of injury types, ages, gender, etc as
> those treated by BLS.
>
> Time on scene increased a bit (median 15 min BLS vs 17 min
> ALS), but survival was the same for the total group (82.1%
> BLS vs 81.1% ALS), and was also the same for every
> sub-group analyzed (stratifying by ISS, GCS, or mechanism).
> In other words, no type of pt could be found for which
> ALS provided any benefit.  There was also no difference in
> a standard functional independence measure at discharge for
> those who survived.
>
> This is definitely the largest and best-done study of the
> role of ALS in trauma, but is not the first - and all of
> the other fairly large, fairly well-done studies similarly
> show no benefit to ALS in major trauma.  So here is the
> question: how many systems will change their response
> configurations for major trauma calls?  I'm very tempted to
> do so in my system, as this is better scientific evidence
> than we have for most of what we do in EMS.  It is my
> understanding that in NYC, major trauma is a "closest
> available" and not a "closest available + closest ALS"
> configuration.  The science supports this.
>
> Dave
> -- 
> David C. Cone, MD
> Associate Professor of Emergency Medicine and Public Health
> Chief, Division of EMS, Section of Emergency Medicine
> Yale University School of Medicine, New Haven CT
>
> --- Robert Ball <bobball at emt-p.org> wrote:
>> Overalll, I suspect very few. For one thing, it will
>> likely only affect those agencies that run a tiered
>> system, where there are BLS units available to handle
>> those calls. In those cases, it would make sense.
>> For systems that run all ALS, there won't be any real
>> difference. I don't see anyone spending the money to
>> add/alter infrastructure for a subset of calls that makes
>
>> no difference either way.
>>
>> Again, in a tiered system, this study should have
>> significant impact.
>
> Only comments I may add
>
> -Ontario has less penetrating trauma then the States
> Due to historical circonstances
> -These systems all have "new" paramedics and
> - are smaller cities (Major centers have had Medics for a
> long while and where thus not included in the research
>
> Otherwise
> ALS units have been BLSing Trauma call
> For what seems like forever
> So I do not see how practices are going to change much
> I merely see a change of prioritization of ALS dispatching
> But effectively
> This will be emasculated by the still real fact that BLS
> units are not permitted to bypass closer hospital(s) to
> transport to Trauma centers (I speaking of scenario where
> the differences in transport times exceeds 5-10 mins +/-)
>
> I think the OPALS study
> Is going to have more significance for our European friends
> But
> Then
> The research on Trauma Systems seemed pretty conclusive
> And those conclusions are still widely discarded in the
> latin countries (Europe)
>
> Charles
>
> --
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