Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-22T00:16:31.103Z Has data issue: false hasContentIssue false

Does the Level of Prehospital Care Influence the Outcome of Patients with Altered Levels of Consciousness?

Published online by Cambridge University Press:  28 June 2012

James Adams
Affiliation:
University of Illinois College of Medicine at Peoria, Peoria, Illinois
Gene Aldag
Affiliation:
University of Illinois College of Medicine at Peoria, Peoria, Illinois
Robert Wolford*
Affiliation:
University of Illinois College of Medicine at Peoria, Peoria, Illinois Central Illinois Center for Emergency Medicine, St. Francis Medical Center, Peoria, Illinois
*
Department of Emergency Medicine, Saginaw Cooperative Hospitals Inc., 1000 Houghton Ave., Saginaw, MI 48602USA

Abstract

Hypothesis:

Significant differences exist in the outcome of patients with altered level of consciousness (ALOC) cared for by advanced life support (ALS) compared with basic life support (BLS) prehospital providers.

Methods:

Patients transported by ambulance to a community teaching hospital during an 11-month period were studied retrospectively. Study patients were those considered not alert by prehospital personnel. Exclusion criteria included: trauma, intoxication, drowning, shock, and cardiac arrest. Data were abstracted from the ambulance reports and hospital records.

Results:

Two hundred three patients with an ALOC were identified; 113 were transported by ALS providers (56%) and 90 (44%) by BLS providers. Prehospital levels of consciousness, according to the “alert, verbal, painful, unresponsive” scale (ALS vs BLS) were: “verbal” (40% vs 51%), “painful” (23% vs 23%), and “unresponsive” (37% vs 25%). The mean value for scene time was 15±6 minutes for ALS versus 10±4 minutes for BLS (p <0.001). On arrival in the emergency department, the LOC of 72 (64 %) ALS patients and 58 (64%) BLS patients had improved to “alert.” The level of consciousness in one ALS patient worsened. Fifty-two ALS (46%) and 38 (42%) BLS patients were admitted. Principal final diagnoses were seizure (27% ALS vs 38% BLS), hypoglycemia (23% ALS vs 23% BLS), and stroke (22% ALS vs 20% BLS). Remaining diagnoses each constituted less than 7% of total discharge diagnoses. No statistically significant differences in measures of outcome were noted between ALS or BLS patients. Diagnoses of seizure, stroke, and hypoglycemia were studied individually. No differences in admission rate, mortality rate, or disposition were identified. Hypoglycemic patients conveyed by ALS provider had significantly shorter emergency department treatment times than did those transported by BLS providers (160±62 minutes ALS vs 229±67 minutes BLS [p <0.005]).

Conclusion:

Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care with the exception of shorter emergency department treatment times for hypoglycemic patients.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*Presented at the Scientific Assembly of the National Association of EMS Physicians, 1992

References

1. Moss, RL, Kolaric, D, Watts, A: Therapeutic agents utilized in urban/rural prehospital care. Prehospital and Disaster Mediant 1993;8:161164.CrossRefGoogle ScholarPubMed
2. Smith, JP, Bodai, BI: The urban paramedic's scope of practice. JAMA 1985;253:544548.Google Scholar
3. Shuster, M, Chong, J: Pharmacologic intervention in prehospital care: A critical appraisal. Ann Emerg Med 1989;18:192196.Google Scholar
4. MacLeod, BA, Seaberg, DC, Paris, PM: Prehospital therapy, past, present, and future. Emerg Med Clin North Am 1990;8:5774.CrossRefGoogle ScholarPubMed