News

Allowing paramedics to treat people suffering from severe respiratory problems by inserting breathing tubes and administering intravenous drugs could save 20,000 lives a year in North America, according to new Canadian research.

"The issue is time," says Ian Stiell, chair of emergency medicine at the University of Ottawa and lead author of the study.

"When paramedics provide advanced care to people in respiratory distress, the patient is treated 20 to 30 minutes sooner," he said in an interview.

The research, published in today's edition of the New England Journal of Medicine, shows that when patients with heart failure, chronic obstructive pulmonary disorder, asthma, pneumonia and other serious breathing problems are treated by paramedics with advanced life-support training, the death rate falls to 12.4 per cent from 14.3 per cent.

While that may seem like a marginal improvement, Dr. Stiell said, it is significant because so many people suffer from respiratory distress.

It is estimated that more than two million Canadians and Americans are transported by ambulance each year after having breathing problems.

It is the second-most-common reason for adults to be transported by ambulance (minor trauma is No. 1).

The study compared outcomes for patients in 15 Ontario cities before and after the introduction of Advanced Life Support (ALS) paramedics.

"Before, they could give patients oxygen and drive fast to the hospital. Now, paramedics can give them IV drugs and airway support," Dr. Stiell said. "It makes a difference."

In addition to the lower death rate, the study found, patients with respiratory distress who were treated in the field had better vital signs when they arrived at the emergency room, suffered less brain damage and spent less time in hospital.

"What impresses me is that the quality of life of patients is impacted in a positive manner," said Anthony Di Monte, chief of the Ottawa Paramedic Service.

"When you know you're making a difference, it's very rewarding."

Chief Di Monte said advanced life-support training was introduced in Ontario in 1998, and is now standard in most big cities (with the exception of those in Quebec), but the research still provides an important guide.

"How we approach our business - for lack of a better word - is evidence-based," he said.

"We want our paramedics doing what is best for the patient."

The study involved 8,138 patients suffering respiratory distress, about half of whom were treated by paramedics with ALS training.

That meant they were able to carry out procedures like endotracheal intubation (a tube is inserted through the mouth down into the trachea - the large airway from the mouth to the lungs) and administer drugs such as nitroglycerin and salbutamol.

Earlier research by the same group showed that having paramedics with ALS training did not reduce the mortality rate among people suffering cardiac arrest.

Rather, it was quick action by bystanders who knew CPR that made the difference.

Future research will look at the role of paramedics in dealing with trauma.

There is considerable debate on the question of whether paramedics should "stay and play" (treat injuries in the field) or "load and go" (get patients to hospital as quickly as possible).

Dr. Stiell said that his team hopes to provide scientific evidence to answer these questions, but that research so far shows the best approach varies depending on the diagnosis of the patient.

"Just because it's cool and the guys who play paramedics on TV do it is not a reason to do it," Dr. Stiell said. "We need the evidence that interventions will improve mortality and morbidity."