Injury, Int. J.

Care Injured 44 (2013) 634–638

Contents lists available at SciVerse ScienceDirect

Injury
journal homepage: www.elsevier.com/locate/injury

Prehospital interventions for penetrating trauma victims: A prospective

comparison between Advanced Life Support and Basic Life Support
Mark J. Seamon a,*, Stephen M. Doane b, John P. Gaughan c, Heather Kulp a, Anthony P. D’Andrea a,
Abhijit S. Pathak b, Thomas A. Santora b, Amy J. Goldberg b, Gerald C. Wydro d
a
Department of Surgery, Cooper University Hospital, United States
b
Department of Surgery, Temple University Hospital, United States
c
Department of Physiology, Temple University School of Medicine, United States
d
Department of Emergency Medicine, Temple University Hospital, United States

A R T I C L E I N F O A B S T R A C T

Article history: Background: Advanced Life Support (ALS) providers may perform more invasive prehospital procedures,
Accepted 28 December 2012 while Basic Life Support (BLS) providers offer stabilisation care and often ‘‘scoop and run’’. We
hypothesised that prehospital interventions by urban ALS providers prolong prehospital time and
Keywords: decrease survival in penetrating trauma victims.
Advanced Life Support Study design: We prospectively analysed 236 consecutive ambulance-transported, penetrating trauma
Basic Life Support patients an our urban Level-1 trauma centre (6/2008–12/2009). Inclusion criteria included ICU
Penetrating trauma
admission, length of stay >/=2 days, or in-hospital death. Demographics, clinical characteristics, and
Prehospital care
outcomes were compared between ALS and BLS patients. Single and multiple variable logistic regression
analysis determined predictors of hospital survival.
Results: Of 236 patients, 71% were transported by ALS and 29% by BLS. When ALS and BLS patients were
compared, no differences in age, penetrating mechanism, scene GCS score, Injury Severity Score, or need
for emergency surgery were detected (p > 0.05). Patients transported by ALS units more often
underwent prehospital interventions (97% vs. 17%; p < 0.01), including endotracheal intubation, needle
thoracostomy, cervical collar, IV placement, and crystalloid resuscitation. While ALS ambulance on-
scene time was significantly longer than that of BLS (p < 0.01), total prehospital time was not (p = 0.98)
despite these prehospital interventions (1.8  1.0 per ALS patient vs. 0.2  0.5 per BLS patient; p < 0.01).
Overall, 69.5% ALS patients and 88.4% of BLS patients (p < 0.01) survived to hospital discharge.
Conclusion: Prehospital resuscitative interventions by ALS units performed on penetrating trauma
patients may lengthen on-scene time but do not significantly increase total prehospital time. Regardless,
these interventions did not appear to benefit our rapidly transported, urban penetrating trauma patients.
ß 2013 Elsevier Ltd. All rights reserved.

Introduction patients. Researchers have sought to define the potential benefit of

Since the development of Advanced Life Support (ALS) training
for emergency medical technicians (EMT) in the 1970s and 1980s,
there has been substantial debate regarding the scope of prehospital
trauma care. While Basic Life Support (BLS) personnel are trained to
perform essential stabilisation for injury victims (bag-valve-mask
ventilation, external defibrillation, spinal immobilisation, etc.), ALS
providers receive additional training in more advanced interven-
tions (advanced airway placement, vascular access, etc.) for these
* Corresponding author at: Division of Trauma and Surgical Critical Care,
Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite #411,
Camden, NJ 08103, United States. Tel.: +1 856 342 3341; fax: +1 856 342 2817.
E-mail address: seamon-mark@cooperhealth.edu (M.J. Seamon).
these prehospital procedures as well as the potential risks associated
with these procedures, including possible delay in transport to
definitive care at a regional trauma centre.
Previous reports suggest that the prehospital transport of urban,
penetrating trauma victims by police or private vehicle yields
equivalent or superior outcomes to those transported by Emergency
Medical Services (EMS).1–4 These reports have supported the
argument that EMTs should minimise prehospital interventions
for penetrating trauma patients rather than perform advanced
procedures on scene. Few studies have directly compared ALS with
BLS prehospital care in penetrating trauma patients.
We hypothesised that prehospital care by ALS providers is
associated with prolonged prehospital times and decreased
survival in our urban, penetrating trauma population. Our primary
study objective was to compare hospital survival in penetrating

0020–1383/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.injury.2012.12.020
 M.J. Seamon et al. / Injury, Int. J. Care Injured 44 (2013) 634–638 635

trauma victims transported by ALS and BLS units. Our secondary
objectives were to compare prehospital procedures and prehos-
pital times based on the type of EMS unit.
Methods
Temple University Hospital is a Level I trauma centre accredited
by the Pennsylvania Trauma Systems Foundation located in the
inner city of North Philadelphia. Most trauma patients arrive from
within a 2-mile radius of the hospital. The Philadelphia Fire
Department (PFD) is the sole provider of Emergency Medical
Services for the city. The PFD is a two-tier EMS system utilising 50
ambulances (72% ALS in 2008, 80% ALS at present) augmented by a
robust first-responder programme utilising engine and ladder
companies. The PFD responded to over 220,000 requests for EMS
service in 2009. There are no formal triage criteria to decide EMS
tier. Instead, local policy dictates that assignment of ALS or BLS
units to the injury scene is determined by geographical proximity.
After institutional review board approval, we conducted a
prospective, observational cohort study of all penetrating trauma
patients brought by EMS to Temple University Hospital from June
2008 through December 2009. Of 1098 penetrating trauma victims
treated during the study period, 494 with minor injuries who were
disqualified from the Pennsylvania Trauma Outcome Study (PTOS)
were excluded from study analysis. PTOS criteria include all trauma
deaths and hospital admissions either to an intensive care unit or
lasting greater than 48 h. Further exclusion criteria included absent
scene signs of life (n = 16) or means of transport other than EMS
(n = 304), including police (n = 147), private vehicle or walk-in
(n = 138), helicopter (n = 4), suburban ambulance (n = 3), or
unknown (n = 12). Patients were also excluded from the study if
they sustained injuries caused by a penetrating mechanism other
than gun shot wounds or stab wounds (e.g. animal bites, lacerations
from shattered glass, etc. [n = 35]). Lastly, 13 patients with
unavailable EMS trip sheets were excluded from the study analysis,
yielding a final study group of 236 injured patients.
EMS prehospital ‘‘trip sheets’’ were used to provide prehospital
data regarding transport method, signs of life, cardiac rhythm,
blood pressure, GCS score, prehospital time intervals, and the type
and number of prehospital procedures performed. Total prehospital
time was defined as the time from the initial request to 911 for
assistance until arrival in the emergency department (ED). Total
prehospital time was comprised of time from the initial call until
arrival at scene (response time), time from arrival at scene until
departure from scene (on-scene time), and time from scene
departure until arrival in the ED (transport time). Prehospital
procedures recorded included placement of an intravenous (IV)
catheter, needle thoracostomy, endotracheal intubation, and cervical
collar immobilisation. Failed procedure attempts were included as a
prehospital ‘‘procedure’’. The approximate volume of prehospital
intravenous fluid administered was recorded when available.
Demographic and clinical characteristics collected in the ED
record included patient age, ethnicity, gender, injury mechanism,
initial signs of life, initial cardiac rhythm, initial vital signs, initial
GCS (Glasgow Coma Scale) score, and procedures performed in the
ED. Procedures included tube thoracostomy, central venous
catheter (CVC) placement, venous cutdown, local wound explora-
tion, cricothyroidotomy, and emergency thoracotomy. Time from
ED arrival until the operating room was calculated for all patients
requiring an emergent operation. Emergent surgery was defined as
any procedure performed in the operating room immediately
following the initial trauma resuscitation. The Injury Severity Score
(ISS) was calculated for all patients.
Study patients were compared on the basis of prehospital
transportation mode (ALS or BLS) for the primary outcome of
survival to hospital discharge and the secondary outcomes of
prehospital times and procedures performed. Descriptive statistics
and post hoc analysis of all numeric variables were applied (two-
sided Fisher’s exact test, Wilcoxon rank sum test). Continuous data
were expressed as means with accompanying standard deviations
(SD) and categorical data were expressed as proportions (%). The
variables that were significantly associated with survival until
hospital discharge (p < 0.05) in the univariate analysis were
retained for the multiple variable regression model. Odds ratios
(ORs) with 95% confidence intervals (CIs) for survival and
prehospital times were calculated for each measured variable. A
p value less than or equal to 0.05 was considered statistically
significant.

Table 1
Prehospital demographics and clinical characteristics by advanced life support and basic life support transport method.

Patient characteristics All patients (n = 236) ALS (n = 167) BLS (n = 69) p-Value

Age (years) 31.1 (11.5)a 30.9 (11.5) 31.5 (11.5) 0.72

Gender
Male 217 (92%) 153 (92%) 64 (93%) 1.00
Mechanism of injury 0.12
Gun shot wounds 165 (70%) 122 (73%) 43 (62%)
Stab wounds 71 (30%) 45 (27%) 26 (38%)
Scene cardiac rhythm <0.01
Asystole 2 (1%) 1 (1%) 1 (1%)
Pulseless electrical activity 31 (13%) 28 (17%) 3 (4%)
Sinus rhythms 203 (86%) 138 (83%) 65 (94%)
Scene systolic blood pressure (mmHg) 100.9 (50.8)a 95.3 (53.5) 118.1 (36.9) 0.01
Scene Glasgow Coma Scale 12.1 (4.8)a 11.7 (5.0) 13.2 (4.0) 0.11
Prehospital IV fluid (mL) 154.7 (252.3)a 210.8 (275.8) 18.8 (89.2) <0.01
Prehospital procedures (yes/no) 174 (74%) 162 (97%) 12 (17%) <0.01
Successful IV placement 158 (67%) 154 (92%) 4 (6%) <0.01
Failed IV placement 15 (6%) 15 (9%) 0 <0.01
Endotracheal intubation 31 (13%) 31 (19%) 0 <0.01
Failed endotracheal intubation 9 (4%) 9 (5%) 0 0.06
Needle thoracostomy 5 (2%) 4 (2%) 1 (1%) 1.00
Cervical collar 50 (21%) 41 (25%) 9 (13%) 0.06
Prehospital procedures per patient 1.3 (1.2)a 1.8 (1.0) 0.2 (0.5) <0.01
Response time (min) 5.1 (3.6)a 4.7 (2.6) 5.9 (5.1) 0.40
On-scene time (min) 8.9 (3.7)a 9.4 (3.2) 7.7 (4.3) <0.01
Transport time (min) 7.4 (3.7)a 7.2 (3.6) 7.9 (3.9) 0.08
Total prehospital time (min) 21.3 (6.2)a 21.1 (5.4) 21.7 (8.0) 0.98
a
Mean  standard deviation.
636 M.J. Seamon et al. / Injury, Int. J. Care Injured 44 (2013) 634–638

Table 2
In-hospital clinical characteristics and outcomes by Advanced Life Support and Basic Life Support transport method.

Patient characteristics All patients (n = 236) ALS (n = 167) BLS (n = 69) p-Value

ED signs of life present 219 (93%) 154 (92%) 65 (94%) 0.78

ED cardiac rhythm 0.05
Asystole 18 (8%) 14 (8%) 4 (6%)
Pulseless electrical activity 22 (9%) 21 (13%) 1 (1%)
Ventricular fibrillation 1 (0.4%) 1 (0.6%) 0
Sinus bradycardia 7 (3%) 4 (2%) 3 (4%)
Normal sinus rhythm 105 (45%) 73 (44%) 32 (46%)
Sinus tachycardia 83 (35%) 54 (32%) 29 (42%)
ED heart rate 84.5 (42.0)a 81.6 (45.3) 91.7 (32.0) 0.19
ED systolic blood pressure (mmHg) 100.1 (53.9)a 95.5 (57.6) 111.1 (41.8) 0.15
ED Glasgow Coma Scale 11.8 (5.1)a 11.3 (5.4) 13.2 (4.1) 0.01
ED procedures 114 (48%) 85 (51%) 29 (42%) 0.25
Thoracotomy Tube 80 (34%) 63 (38%) 17 (25%) 0.07
Emergent thoracostomy 34 (14%) 31 (19%) 3 (4%) <0.01
Venous accessb 80 (34%) 60 (36%) 20 (29%) 0.37
Otherc 3 (1%) 2 (1%) 1 (1%) 1.00
ED IV fluid (mL) 1526 (1377)a 1542 (1510) 1486 (997) 0.20
Injury Severity Score (ISS) 20.8 (19.1)a 22.1 (20.0) 17.6 (16.2) 0.16
Emergent surgery 120 (51%) 87 (52%) 33 (48%) 0.57
Time to operating room (min) 41.1 (43.9)a 42.0 (49.2) 38.9 (25.8) 0.83
ED survival 197 (84%) 133 (80%) 64 (93%) 0.01
OR death 10 (4%) 8 (5%) 2 (3%) 0.73
Hospital survival 177 (75%) 116 (70%) 61 (88%) <0.01
a
Mean  standard deviation.
b
Central venous catheters and peripheral venous cutdowns.
c
Including diagnostic peritoneal lavage, local wound exploration, and cricothyroidotomy.

Results Univariate and multivariate logistic regression analyses (Tables

4 and 5) were performed for our primary outcome of survival to
Of the 236 study patients, 167 (71%) were transported by ALS discharge. Normal sinus rhythm, higher blood pressure, higher GCS
and 69 (29%) by BLS. Clinical characteristics of the two groups are scores at the scene and in the ED, and the performance of
shown in Tables 1 and 2. Although no differences between study emergency surgery were all significantly associated with increased
groups with respect to age, gender, mechanism of injury, ISS score, survival to hospital discharge (p < 0.01). ALS transport method (OR
and GCS score at the scene were detected, 162 ALS patients (97%) 0.30; 0.13–0.67, p < 0.01) and the performance of prehospital
received a total of 298 prehospital procedures (mean 1.8, SD 1.0; procedures (OR 0.36; 0.16–0.80, p = 0.01) were associated with
median 2 per patient), while 12 BLS patients (17%) received a total decreased survival to hospital discharge (Fig. 1). After adjusting for
of 17 prehospital procedures (mean 0.2, SD 0.5; median 0 per mechanism of injury, scene systolic blood pressure and GCS score,
patient). Also between the two cohorts there were no differences in presence or absence of scene normal sinus rhythm, prehospital
the need for emergency surgery and time from hospital arrival time, prehospital procedures, ISS score, and need for emergency
until the operating room. The ALS group had a significantly lower surgery, patients transported by BLS were more likely to survive
systolic blood pressure at the scene, but there was no significant than ALS patients (0.006; 0.001–0.363; p = 0.01).
difference by the time of arrival to the ED. ALS prehospital care did
not correspond to a significant improvement between the scene
and the ED in blood pressure (95.3, SD 53.5 vs. 95.5, SD Table 4
Univariate regression analysis for survival to hospital discharge.
57.6 mmHg) or GCS score (11.7, SD 5.0 vs. 11.3, SD 5.4).
Total prehospital time was similar between patients arriving via Parameter OR (95% CI) p-Value
ALS unit (21.1, SD 5.4 min) and BLS unit (21.7, SD 8.0 min), as Transport method (ALS) 0.30 (0.13–0.67) <0.01
shown in Table 1, but ALS paramedics had a significantly longer Age (years) 1.00 (0.98–1.03) 0.84
time on-scene (9.4, SD 3.2 min, BLS 7.7, SD 4.3 min; p < 0.01). The Mechanism of injury (GSW) 0.16 (0.06–0.41) <0.01
relationship of prehospital procedures with time spent at the scene Scene normal sinus rhythm 6.98 (3.32–14.68) <0.01
Scene SBP (mmHg) 1.04 (1.03–1.06) <0.01
is shown in Table 3. Notably, the performance of procedures was
Scene GCS 1.64 (1.47–1.84) <0.01
associated with an increase in on-scene time of 1.6 min, with each On-scene time (min) 0.96 (0.88–1.04) 0.29
procedure contributing an additional 0.7 min. Prehospital time (min) 1.01 (0.96–1.06) 0.69
Prehospital procedures (yes) 0.36 (0.16–0.80) 0.01
IV attempts 0.65 (0.46–0.93) 0.02
Table 3 Cervical collar 1.23 (0.59–2.60) 0.58
Univariate relationship between prehospital procedures and on-scene time. Needle thoracostomy 0.49 (0.08–3.01) 0.44
ET intubation attempt 0.01 (0.00–0.04) <0.01
Parameter Associated on-scene p-Value # of prehospital procedures 0.49 (0.37–0.65) <0.01
time (95% CI) Prehospital IVF (mL) 1.00 (0.99–1.01) 0.85
Prehospital procedures (yes/no) 1.6 min (0.5–2.7) <0.01 ED normal sinus rhythm 14.02 (5.35–36.74) <0.01
# of prehospital procedures (each) 0.7 min (0.3–1.1) <0.01 ED HR 1.04 (1.03–1.06) <0.01
IV placement attempt 2.1 min (1.1–3.1) <0.01 ED SBP (mmHg) 1.04 (1.03–1.05) <0.01
Attempted ET intubation 0.9 min ( 0.4 to 2.2) 0.19 ED GCS 1.58 (1.43–1.75) <0.01
Cervical collar placementa 0.6 min ( 1.8 to 0.6) 0.31 ED procedure 0.12 (0.06–0.25) <0.01
Needle thoracostomya 0.3 min ( 3.6 to 2.9) 0.84 ISS 0.93 (0.91–0.95) <0.01
Time to operation (min) 1.00 (0.99–1.01) 0.59
a
Cervical collar and needle thoracostomy were associated with shorter on-scene Emergent surgery 3.83 (2.00–7.31) <0.01
times.
 M.J. Seamon et al. / Injury, Int. J. Care Injured 44 (2013) 634–638
Table 5
Multiple variable logistic regression analysis for survival to hospital discharge.
Parameter OR (95% CI)
Transport method (ALS) 0.006 (0.001–0.363)
Mechanism of injury (GSW) 0.254 (0.029–2.212)
Scene normal sinus rhythm 1.53 (0.26–9.14)
Scene SBP (mmHg) 1.03 (1.003–1.05)
Scene GCS 1.66 (1.32–2.09)
Prehospital time (min) 0.91 (0.80–1.04
# of prehospital procedures 2.57 (1.02–6.50)
ISS 0.97 (0.92–1.02)
Emergent surgery 3.28 (0.68–15.87)
Fig. 1. Survival by transport method and performance of prehospital procedures.
Discussion
ALS commonly performed resuscitative interventions in the
prehospital setting, but these procedures did not appear to
increase either prehospital times or hospital survival in our
rapidly transported, urban penetrating trauma victims. After
accounting for heterogeneity between the patient cohorts in our
multivariate model, patients transported by BLS units were more
likely to survive. These findings have been corroborated in other
studies of prehospital care for trauma patients. Liberman et al.5
presented a large prospective study of trauma patients in which
ALS prehospital care had significantly worse survival compared
with BLS care. Increased scene time in that study was correlated
with worse outcomes. Recently published extensive literature
reviews on prehospital care for trauma have all concluded that
evidence to support the routine use of ALS prehospital care for
victims of urban trauma is lacking.6–9 A meta-analysis of 15 studies
of prehospital trauma care showed a highly increased mortality
with ALS compared with BLS care.10
While these data suggest a negative impact of ALS prehospital
care on outcomes in penetrating trauma, causes for these effects
are incompletely understood. Many authors have associated
prehospital interventions with increased prehospital times and
poor outcomes. Feero et al.11 documented a relationship between
decreased out-of-hospital time and unexpected survival in urban
trauma. Carr et al.12 analysed a large sample of trauma patients
showing an average increase of 5 min of scene time for IV
placement and 2 1/2 min of scene time for endotracheal
intubation. In a study analysing regionalisation of a trauma system
with prehospital times from 42 to 76 min, Sampalis et al.13
estimated a 5% increased risk of mortality for each additional
minute of prehospital time. Although increased prehospital time
trended towards an association with decreased survival, in our
study of relatively quick inner-city transports of penetrating
trauma victims, neither prehospital time nor on-scene time were
significantly related to survival. The increase in travel time for BLS
637
patients likely represents that these scenes were farther from the
hospital geographically.
p-Value Of the four prehospital procedures measured, cervical immo-
0.01 bilisation and needle thoracostomy did not affect survival, while
0.22 endotracheal intubation and attempted IV placement were
0.64 associated with decreased survival. Two large retrospective
0.03 reviews of urban trauma patients found a greater mortality among
<0.01
patients receiving prehospital endotracheal intubation compared
0.17
0.05 with bag-valve mask ventilation en route.14,15 The OPALS Major
0.18 Trauma Study,16 a prospective crossover trial of ALS prehospital
0.14 care, demonstrated decreased survival in ALS patients intubated at
the scene. In patients with a GCS < 8 and ISS > 16, Shafi and
Gentilello17 showed that patients intubated in the prehospital
setting were half as likely to survive and 70% more likely to arrive
in the ED hypotensive. Wang and Yealy18 have documented
extensive shortcomings with out-of-hospital intubation for any
indication and question whether it should be performed at all.
While further research may clarify the role of endotracheal
intubation in other conditions or with prolonged transport times,
our results call into question the value of prehospital intubation for
urban patients with penetrating trauma.
Establishment of vascular access occurred in the vast majority
of ALS patients without apparent survival benefit. Neither did IV
placement in ALS patients result in decreased time to the operating
room. The mean amount of prehospital IV fluid infused (211 mL)
was clinically insignificant in the context of hypovolaemia and
haemorrhage, even if the volumes were underestimated. Bickell
et al.19 refuted the paradigm of large volume isotonic crystalloid
infusion for prehospital resuscitation by showing improved
survival outcomes from prehospital fluid restriction in urban
patients with penetrating trauma. Haut et al.20 recently highlight-
ed a significant relationship in the National Trauma Data Bank
between prehospital IV fluid and increased mortality. Neverthe-
less, IV placement remains a commonly accepted practice in
prehospital care for urban trauma. In our study, prehospital IV
placement was associated with an additional 2.1 min of on-scene
time. If IV catheters are placed (without large volume infusion) en
route to the ED without prolonging on-scene time, there is likely no
detriment to patient outcomes. However, this has not been shown
to improve outcomes compared to BLS transport without routine
IV placement and does not justify ALS prehospital care for urban
penetrating trauma.
Cervical immobilisation was performed in 21% of our penetrat-
ing trauma patients, with no statistical difference between ALS and
BLS providers. Although modified in the latest guidelines, this is
perhaps because older ATLS21 and BTLS guidelines22 instructed
that spinal protection should be maintained until a cervical spine
injury is excluded, without differentiating between blunt and
penetrating mechanisms. However, the presence of a cervical
collar can impede emergent airway management, obscure impor-
tant clinical findings such as an expanding haematoma or
subcutaneous emphysema in the neck, and may increase mortality
in penetrating trauma.23 Multiple recent large studies24–27 have
not shown any ability of cervical immobilisation to improve long-
term neurological outcomes in penetrating trauma, and its routine
application should be reconsidered.
Prehospital thoracic decompression for presumed pneumotho-
rax was performed in only 5 patients (2.1%). 2 of these died soon
after arrival to the hospital, 2 of these did not gain any clinical
benefit from needle thoracostomy, and 1 patient needed thoracic
decompression on the opposite side of the chest instead. Major
pitfalls with needle thoracostomy are well documented, including
ineffective positioning, risk of pulmonary or cardiovascular injury,
and inaccurate prehospital diagnosis of traumatic pneumotho-
rax.28,29 Needle thoracostomy placement can be safe and
successful in small percentages of urban trauma patients,30,31
638 M.J. Seamon et al. / Injury, Int. J. Care Injured 44 (2013) 634–638
but there is not good evidence to support the superiority of
prehospital needle decompression over tube thoracostomy in the
ED for patients with short prehospital times.
Although our study was prospective, one limitation is that
patient assignment to the two transport groups was non-
randomised, and there may have been implicit triage of more
severely injured patients into the ALS group. While the ALS and BLS
groups in our study had similar age, Injury Severity Scores, and
injury mechanisms, some studied variables in the ALS cohort did
show greater physiologic compromise than BLS transported
patients. This heterogeneity cannot be ascribed to detriment from
ALS care on-scene or in-transit, and thus may represent an
assignment by EMS of more severely injured trauma patients to
ALS units. However, our ALS:BLS patient ratio of 71–29% closely
resembles the ALS:BLS ratio of Philadelphia EMS ambulances and
the BLS survival advantage persisted after controlling for these
physiologic differences in our multivariate logistic regression.
Another limitation was a small percentage (<5%) of incomplete
data in the EMS trip sheets regarding prehospital times, on-scene
vital signs, or intravenous fluid administered.
Conclusion
In summary, prehospital resuscitative interventions by ALS
units performed on our urban penetrating trauma patients
lengthened on-scene time but did not increase overall prehospital
time. Despite these rapidly performed interventions, patients
brought by ALS ambulance survived less often than those brought
by BLS units. Our results suggest that the advanced care provided
by ALS does not benefit urban penetrating trauma victims who are
rapidly transported to definitive care.
Conflict of interest
None.
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