While staying current in EMS/medical research today (OK, I admit it....I was on Facebook), I came across a blogpost by Brooks Walsh, who has a great blog (if you've not seen it, go look at it and subscribe!);
http://millhillavecommand.blogspot.com/2014/03/we-had-lucas-save-no-you-didnt.html
In it, he looks at the LUCAS device, a mechanical CPR device that's gotten a lot of media attention in both local news and trade magazines like JEMS. He then provides info and commentary on a study published in JAMA last year, which evaluated the LUCAS against well-trained human CPR providers and found that there was no clinical benefit to using a LUCAS versus human hands. Here's the abstract in PubMed; you can find some tables from the article in the blogpost above.
http://www.ncbi.nlm.nih.gov/pubmed/24240611
I mostly agree with the conclusions and statements that Dr. Walsh made, particularly his stressing that humans, not technology or advanced treatments, make the difference in cardiac arrest. And I love that several of my Facebook friends were sharing the post and the article so that more EMS providers can become aware of relevant EMS research.
However, I wanted to add a note of caution; your mileage may vary.
Any piece of equipment or medication that an EMS service deploys should be looked at critically periodically; and literature reviews are an important part of that process. If a device or medication can't be proven to benefit patients in meaningful ways, then it's time to take a hard look at whether or not it's worth spending additional money on it. However, the results of a study often mean different things to different people; the LINC trial is a great example of that, I think. Consider the viewpoints of two EMS managers evaluating whether or not to buy the LUCAS for their service:
System A is a large, urban or suburban system with 10-20 units on the road normally, strategically deployed around the service area. They work closely with a paid fire department that automatically responds to cardiac arrest calls. On average, there are between 6-10 medical providers who are dispatched to a cardiac arrest call, and transport times to the hospital are normally 5-10 minutes. Is it worth spending a couple hundred thousand dollars to place a LUCAS on every transporting unit? Probably not!
System B is a small, rural EMS service with 2-3 units in service at a central EMS station. Both 24-hour ambulances will typically respond to a cardiac arrest call (assuming the 2nd truck isn't already on a call), but the local fire departments are 100% volunteer, and medical training isn't required to be a member. On average, there are 2-4 medical providers who are dispatched to a cardiac arrest, and transport times to the local hospital are 30-45 minutes. Is it worth spending a few thousand dollars to place a LUCAS device in the station so an ambulance crew or volunteer firefighter can grab the LUCAS device if a cardiac arrest call comes in? I think it does!
I guess my point is this....good-quality research is absolutely essential in providing quality medical care. However, there are other system-specific considerations like cost, logistics, training, etc. that necessarily play a role in what therapies you stock on your ambulance. Evaluating the results of evidence should always be done with these other factors in mind. In the case of the LUCAS, for my EMS service (service B), "just as good" as human hands is as beneficial as "better" than human hands. At my former service (service A), we would have either not purchased the LUCAS or auctioned off the units we'd already purchased.
With everything that gets studied in medicine--your mileage may vary.
No comments:
Post a Comment