Background: The question of whether to use advanced life support (ALS) or b
asic life support (BLS) for trauma patients in the prehospital setting has
been much debated and still lacks a clear answer. The purpose of this study
was to conduct a comprehensive critical review of the literature regarding
this controversy
Methods: A total of 174 articles on prehospital ALS or BLS for trauma were
reviewed. Fifteen of these studies were found to involve mortality statisti
cs for both ALS- and BLS-treated patients. Odds ratios were calculated for
survival in ALS versus BLS and summarized across studies on the basis of mu
ltivariate scoring systems that incorporated both design and methodological
assessment. Overall odds ratios for all studies were calculated on the bas
is of both raw data from the papers, and weighted odds ratios were calculat
ed from the scoring systems.
Results: Six studies were scored as being methodologically average (5 favor
ing BLS and 1 favoring ALS), two were scored as good (1 favoring BLS and 1
favoring ALS), seven as excellent (6 favoring BLS and 1 favoring ALS), Ten
studies had an average study design score (6 favoring BLS and 4 favoring AL
S) and seven had a good study design score (6 favoring BLS and 1 favoring A
LS), Weighted odds ratio for dying was 2.59 for patients receiving ALS comp
ared with those receiving BLS, The crude odds ratio was 2.92.
Conclusion: The aggregated data in the literature have failed to demonstrat
e a benefit for on-site ALS provided to trauma patients and support the sco
op and run approach.