Prehospital Advanced Versus Basic Life Support: A Cohort Study Comparing Survival to Hospital for Major Trauma Patients in New Zealand
Date
Authors
Campbell, Nicola
Lilley, Rebbecca
Davie, Gabrielle
Morgaine, Kate
Dicker, Bridget
Kool, Bridget
Supervisor
Item type
Journal Article
Degree name
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
OBJECTIVE: To examine the relationship between prehospital Advanced Life Support (ALS) and survival to hospital for major trauma patients in New Zealand and explore its implications for Emergency Medical Service (EMS) practice. METHODS: A mixed-methods explanatory design was used. Data on major trauma patients attended by road EMS (December 2016-November 2018) was analysed. A multivariable model with propensity scores estimated the odds of survival for patients receiving Advanced versus Basic Life Support (BLS). Semi-structured interviews conducted with EMS stakeholders were analysed using thematic analysis. RESULTS: Among 1118 patients, 661 (59 %) received ALS. Only 52 (5 %) did not survive to hospital. Multivariable modeling estimated ALS recipients had 1.5 times higher odds of survival than BLS-only recipients (OR 1.49, 95 % CI 0.66-3.35). Interviews with five EMS clinical leaders highlighted two likely influences: clinical judgment and evidence use. Despite imprecise quantitative findings, stakeholders supported ALS based on clinical judgment. CONCLUSIONS: A tension between population-level results and provision of care based on clinical judgement exists. Quantitative analysis found no evidence that ALS offers a survival benefit, although considerable uncertainty exists, whereas stakeholders perceive ALS has clinical and equity benefits. Future research should assess equity, disability, and quality of life outcomes of ALS.Description
Keywords
Emergency care, Emergency medical services, Emergency paramedicine, Evidence based practice, Life support care, New Zealand, Prehospital, 4203 Health Services and Systems, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 42 Health Sciences, Emergency Care, Clinical Research, 1110 Nursing, 1117 Public Health and Health Services, Nursing, 3202 Clinical sciences, 4203 Health services and systems, 4205 Nursing
Source
Australasian Emergency Care, ISSN: 2589-1375 (Print); 2588-994X (Online), Elsevier, 29(2), 138-145. doi: 10.1016/j.auec.2025.09.008
Publisher's version
Rights statement
© 2025 The Authors. Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).