EMS A to Z: BLS and ALS Transports

Show Notes:

From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn

 

What does our Administrative Guideline state regarding ALS v BLS transports? Simply, patients to be transported via BLS must meet all of the BLS criteria and NOT meet any of the ALS criteria.

 

BLS Criteria: 

- Minimal risk of airway compromise during transport  

- Normal work of breathing  

- No acute neurologic deficit  

- GCS >13 - No significant environmental exposure or trauma  

- Not more than one vital sign out of BLS range 

 

NOT meet any ALS Criteria:  

- Receiving IV fluids or medications  

- Receiving cardiac monitoring (all patients greater than 35 years old with non-traumatic chest pain should receive cardiac monitoring)  

- Severe pain requiring repeat doses of pain medication  

- At risk of rapid deterioration (impending chidlbirth or HTN >160 SBP in pregnancy, life-threatening OD, angioedema, anaphylaxis etc.)  

- Patient meets SAEMS anatomic or physiologic trauma criteria (http://saemscouncil.com/wp-content/uploads/2018/12/BLS-Transport-SO-SAEMS-approved-10-16-18.pdf): 

 

 

Why do we require these patients to be transported ALS? 

Simply, these conditions may benefit from interventions such as: IV placement and medication administration, IV fluid administration, procedures such as cardiac monitoring, cardioversion, pacing, etc. 

 

What does the evidence say? 

The OPALS study is one of the largest studies examining the outcomes between BLS and ALS transport. 

After the introduction of ALS transport in Ontario, Canada the outcomes of cardiac arrest, trauma, and respiratory distress did not improve.

 

That doesn’t sound like any patients should be transported ALS!  

Not so fast...

There are actually benefits to ALS evaluation and management:

The ability to perform and interpret an EKG, identify a critical arrhythmia and treat it, recognize a STEMI and notify & transport to an appropriate receiving facility can shorten time to reperfusion therapy, which does improve outcomes. 

Recognizing and treating sepsis with early fluid resuscitation can also improve mortality.

Stabilizing a critically ill patient with IV access, fluid resuscitation, oxygen application, etc. May help prevent the dreaded “EMS witnessed cardiac arrest”

 

The key here is to recognize the importance of great BLS care in critical conditions like cardiac arrest and trauma, as well as to utilize the addition of ALS interventions to identify and treat the conditions that benefit from them. 

 

That’s really our goal with these ALS criteria – to screen for conditions that may benefit from ALS care. 

 

Music provided by: Scott Holmes Music, “Brit Pop”