Advanced life support training in trauma life support for ambulance crews might possibly have no effect on patient outcomes, although the evidence is insufficient.
A Cochrane review 1 included one controlled before-and-after trial (n = 1880), one uncontrolled before-and-after study (n = 2867), and one randomised controlled trial (n = 16) examining the impact of advanced life support (ALS)-trained ambulance crews versus crews without ALS training on reducing mortality and morbidity in trauma patients. None demonstrated evidence to support ALS training in trauma life support 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.
Comment: The quality of evidence is downgraded by severe study limitations (non-RCT design, poor protocol compliance, selective outcome reporting).
1. Jayaraman S, Sethi D, Wong R. Advanced training in trauma life support for ambulance crews. Cochrane Database Syst Rev 2014;(8):CD003109. [PMID:25144654]
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"Advanced Life Support Training in Trauma Life Support for Ambulance Crews." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/455243/all/Advanced_life_support_training_in_trauma_life_support_for_ambulance_crews.
Advanced life support training in trauma life support for ambulance crews. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/455243/all/Advanced_life_support_training_in_trauma_life_support_for_ambulance_crews. Accessed July 16, 2020.
Advanced life support training in trauma life support for ambulance crews. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved July 16, 2020, from https://evidence.unboundmedicine.com/evidence/view/EBMG/455243/all/Advanced_life_support_training_in_trauma_life_support_for_ambulance_crews
Advanced Life Support Training in Trauma Life Support for Ambulance Crews [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 July 16]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/455243/all/Advanced_life_support_training_in_trauma_life_support_for_ambulance_crews.
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