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Intervention Review

Advanced trauma life support training for ambulance crews

  1. Dinesh D Sethi1,*,
  2. Irene Kwan2,
  3. Anne-Maree Kelly3,
  4. Ian G Roberts4,
  5. Frances Bunn5

Editorial Group: Cochrane Injuries Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 30 JUN 2006

DOI: 10.1002/14651858.CD003109

Database Title

Additional Information

How to Cite

Sethi DD, Kwan I, Kelly AM, Roberts IG, Bunn F. Advanced trauma life support training for ambulance crews. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003109. DOI: 10.1002/14651858.CD003109.

Author Information

  1. 1

    WHO European Centre for Environment and Health, Rome 00187, Italy

  2. 2

    Royal College of Obstetricians & Gynaecologists, National Collaborating Centre For Women's and Children's Health, London, UK

  3. 3

    Western Hospital, Department of Emergency Medicine, Footscray, Australia

  4. 4

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  5. 5

    University of Hertfordshire, Centre for Research in Primary and Community Care, Hatfield, Hertfordshire, UK

*Dinesh D Sethi, WHO European Centre for Environment and Health, Via F Crispi 10, Rome 00187, Italy. din@ecr.euro.who.int .

Publication History

  1. Publication Status: Unchanged
  2. Published Online: 7 OCT 2009

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Abstract

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  2. Abstract
  3. Plain language summary

Background

There is an increasing global burden of disease from injuries. Models of trauma care initially developed in high-income countries are also being adopted in low and middle-income countries (LMIC). Amongst these, ambulance crews with Advanced Life Support (ALS) training are being promoted in LMIC 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 effectiveness of ambulance crews with ALS training versus crews with any other level of training in reducing mortality and morbidity in trauma patients.

Search strategy

We searched CENTRAL (The Cochrane Library issue 2, 2006), the Injuries Group's Specialised Register, MEDLINE, EMBASE, CINAHL, PubMed and the National Research Register. We checked references of background papers and contacted authors to identify additional published and unpublished data. The search was last updated in July 2006.

Selection criteria

Randomised controlled trials, quasi-randomised controlled trials and controlled before-and-after studies comparing effectiveness of ambulance crews with ALS training versus crews with any other levels of training in reducing mortality and morbidity in trauma patients. Studies which compared crews staffed by physicians versus others were excluded.

Data collection and analysis

Two reviewers independently applied eligibility criteria to trial reports for inclusion and extracted data.

Main results

We found one randomised controlled trial from the original search (Nicholl 1998), which included 16 trauma cases. However, outcome data were added to the main non-randomised cohort in the analysis, and data on these 16 cases cannot be included in this review.

Authors' conclusions

In the absence of evidence of the effectiveness of advanced life support, strong argument could be made that it should not be promoted outside the context of a properly concealed and otherwise rigorously conducted randomised controlled trial.

 

Plain language summary

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  2. Abstract
  3. Plain language summary

No evidence to show the effect of advanced trauma life support training for ambulance crews on people with trauma from injury

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) for ambulance officers is believed to have contributed to the reduced number of deaths from injury in countries where this service is available. ALS services are also being adapted for low and middle-income countries. The review of trials found there is no evidence to show the effect of ALS on people with trauma from injury. More research is needed.

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