A man clutches his chest and collapses on the sidewalk. Call 911. Surely we want the most advanced life support (ALS) available—paramedics capable of intubating, administering intravenous medications, and managing complex arrhythmias, as well as transport to the hospital. Or do we?
Is it possible that he might do better with less-intensive interventions, especially if they were done more skillfully and safely (face mask bagging instead of intubation) as well as more quickly, so he would arrive faster to the hospital for definitive care? The value of advanced interventions might be especially small in urban areas where they prolong the normally short travel times to hospital. In sum, is it possible that basic life support (BLS)—using automatic defibrillators, cardiopulmonary resuscitation, and airway management without intubation—could be as good or better? (The term BLS in this commentary is used to describe units with basic emergency medical technicians who are also trained to use semiautomatic defibrillators but do not use advanced airway techniques or administer intravenous drugs.)
Callaham M. Evidence in Support of a Back-to-Basics Approach in Out-of-Hospital Cardiopulmonary Resuscitation vs "Advanced" Treatment. JAMA Intern Med. 2015;175(2):205-206. doi:10.1001/jamainternmed.2014.6590