Massive Ontario paramedic study shows Basic Life Support as good as Advanced Life Support for patients with major trauma

April 21, 2008

Patients with major traumatic injuries fare just as well if they are given Basic Life Support (BLS) by paramedics than if they are given Advanced Life Support (ALS), according to the Ontario Prehospital Advanced Life Support (OPALS) study. The results, published in the April 22, 2008 edition of the Canadian Medical Association Journal, also suggest that BLS is better than ALS for a subset of patients with the most severe injuries.

ALS training for paramedics was introduced into many Ontario cities between 1994 and 1998 and OPALS was initiated as a before-and-after controlled study to determine the impact in 17 cities. Paramedics with ALS training (Advanced Care Paramedics) are able to insert breathing tubes and administer intravenous drugs while those without ALS training (Primary Care Paramedics) provide basic breathing support and stabilize wounds.

The results published today show that survival of patients with major trauma did not improve after implementation of ALS training in Ontario. In addition, survival for those with the most severe traumatic injuries dropped from 60 per cent to 51 per cent. The study is the largest of its kind in the world, including 2,867 major trauma patients, with approximately 21 per cent in the severe injury category.

The major trauma study is the third of four OPALS studies. The first study, focusing on cardiac arrest patients, showed that survival did not change after implementation of ALS. The second study, focusing on patients with respiratory distress (shortness of breath), showed that survival increased after implementation of ALS. The fourth study, focusing on chest pain, is not yet complete.

“Taken together, our results show that the impact of Advanced Life Support depends on the type and severity of the injury,” said Dr. Ian Stiell, lead OPALS investigator and Senior Scientist at the Ottawa Hospital Research Institute (OHRI). “This has been suggested by several smaller studies, and some paramedic services have already restricted the use of ALS in severely injured patients. With the definitive OPALS results now in, I would expect that all paramedic services will carefully examine ALS procedures to ensure that patients get the best possible care.” Dr. Stiell is also an Emergency Medicine Physician at The Ottawa Hospital and Chair of the Department of Emergency Medicine at the University of Ottawa.

'This is not an issue in Ottawa,” said Pierre Poirier, Deputy Chief of the Ottawa Paramedic Service. “We have an organized trauma system in Ottawa that emphasizes rapid transport of seriously injured patients to the trauma centre.”

Paramedics in Canada and the US treat more than 500,000 major trauma patients each year. Major trauma is defined as life- or limb-threatening injury due to a blunt force, penetrating wound or burn.

OPALS is the largest study of ALS in the world, with more than 30,000 patients included in all four arms. It was funded by the Ontario Ministry of Health and Long-Term Care.

About the Ottawa Hospital Research Institute
The Ottawa Hospital Research Institute (OHRI) is the research arm of The Ottawa Hospital and is an affiliated institute of the University of Ottawa, closely associated with the University’s Faculties of Medicine and Health Sciences. The OHRI includes more than 1,300 scientists, clinical investigators, graduate students, postdoctoral fellows, and staff conducting research to improve the understanding, prevention, diagnosis and treatment of human disease. For more information visit

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Ottawa Hospital Research Institute
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