Advanced trauma life support training for ambulance crews

 

Abstract

Background

There is an increasing global burden of injury especially in low- and middle-income countries (LMICs). To address this, models of trauma care initially developed in high income countries are being adopted in LMIC settings. In particular, ambulance crews with advanced life support (ALS) training are being promoted in LMICs as a strategy for improving outcomes for victims of trauma. However, there is controversy as to the effectiveness of this health service intervention and the evidence has yet to be rigorously appraised.

Objectives

To quantify the impact of ALS-trained ambulance crews versus crews without ALS training on reducing mortality and morbidity in trauma patients.

Search methods

Searches were not restricted by date, language or publication status. We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid SP), EMBASE (Ovid SP), CINAHL (EBSCO) and PubMed in all years up to July 2009. We also searched the reference lists of relevant studies and reviews in order to identify unpublished material.

Selection criteria

Randomised controlled trials, quasi-randomised controlled trials and non-randomised studies, including before-and-after studies and interrupted time series studies, comparing the impact of ALS-trained ambulance crews versus crews without ALS training on the reduction of mortality and morbidity in trauma patients.

Data collection and analysis

One review author applied eligibility criteria to trial reports for inclusion and extracted data.

Main results

We found one controlled before-and-after trial, one uncontrolled before-and-after study, and one randomised controlled trial that met the inclusion criteria. None demonstrated evidence to support ALS training for pre-hospital personnel. In the uncontrolled before-and-after study, 'a priori' sub-group analysis showed an increase in mortality among patients who had a Glasgow Coma Scale score of less than nine and received care from ALS trained ambulance crews. Additionally, when the pre-hospital trauma score was taken into account in logistic regression analysis, mortality in the patients receiving care from ALS trained crews increased significantly.

Authors' conclusions

At this time, the evidence indicates that there is no benefit of advanced life support training for ambulance crews.

 

Plain language summary

No evidence to suggest that advanced life support training for ambulance crews cuts death rates or decreases disability in injured people

Injury is one of the top ten causes of death and disability worldwide. It results in an early loss of life for many young people and ongoing high medical care costs. Advanced life support (ALS) training for ambulance crews is believed to have contributed to a reduction in the number of deaths from injury in predominantly high-income countries where this service is available. ALS services are also being adapted for low- and middle-income countries. This review of trials found there is no evidence to suggest that ALS training for ambulance personnel improves the outcomes for injured people.

 

摘要

背景

救護隊員的高級創傷救命術訓練

因為受傷造成的全球疾病負擔日益增加，尤其是在中低收入國家(low and middleincome countries (LMICs))。為了解決這個問題，最初在高收入國家發展的創傷照護模式被中低收入國家的機構所採用。尤其，中低收入國家中提倡這些受過高級救命術(Advanced Life Support (ALS))訓練的救護隊員作為改善創傷受害者健康結果的策略。然而，這種健康服務介入措施是具有爭議的，且證據尚未被嚴謹地評估。

目標

量化受過ALS訓練對照沒有受過ALS訓練的救護隊員對於減少創傷病患死亡率及發病率的影響。

搜尋策略

檢索條件不限制日期，語言或發表狀態 。我們檢索the Cochrane Injuries Group Specialised Register，CENTRAL (考科藍圖書館，2009年，第3期)，MEDLINE (Ovid SP)，EMBASE (Ovid SP)，CINAHL (EBSCO)及PubMed至2009年7月。我們也檢索相關研究與回顧的參考文獻以確定未發表的資料。

選擇標準

比較受過ALS訓練對照沒有受過ALS訓練之救護隊員對於減少創傷病患死亡率及發病率影響的隨機對照試驗，類隨機對照試驗及非隨機研究，包或前後對照研究與間斷時間序列研究。

資料收集與分析

一名回顧作者採用合格標準來評估試驗報告以納入本篇回顧並摘錄資料。

主要結論

我們發現一篇前後對照試驗，一篇前後非對照研究，與一篇隨機對照試驗符合納入標準。沒有一篇研究有證據證明支持到院前人員接受ALS訓練。在前後非對照研究研究中，邏輯推理的子群體分析結果顯示Glasgow Coma Scale分數在9以下的病患並接受ALS訓練救護隊員照護者其死亡率增加。此外，當邏輯斯迴歸分析考量到院前創傷分數時，接受ALS訓練救護隊員照護的病患其死亡率顯著增加。

作者結論

在這種情況下，證據顯示救護隊員接受高級創傷救命術訓練不具有效益。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據顯示救護隊員的高級創傷救命術訓練可以降低受傷患者的死亡率或減少其失能：受傷是全世界前十大死亡及失能的原因。它造成許多年輕人提早失去生活及高成本的醫療照護。在可獲得ALS這種服務的高收入國家相信，救護人員的高級救命術(ALS)訓練可以減少受傷者的死亡人數。ALS的服務也被中低收入國家所採用。回顧試驗後發現沒有證據顯示救護隊員的ALS訓練可以改善受傷者的結果。