Introduction of advanced care to pre-hospital services in Québec

̀In the fall of 2004, several Québec emergency medical technicians obtained Ontario certification in advanced paramedic care and asked for authorization to apply their training here. It was in this context that the Minister of Health and Social Services asked AETMIS (Agence d’évaluation des technologies et des modes d’intervention en santé) in November 2004 to prepare a report on the role of advanced care, also known as advanced life support (ALS), in the organization of pre-hospital emergency services in Québec.

The present assessment is based primarily on a comprehensive review of the scientific literature on this topic. The analysis also took into account developments in pre-hospital care, advanced- care practices and training, internationally as well as in Canada and in Québec.

Examination of scientific data led to four major findings. First, there is not enough solid evidence to warrant the generalized introduction of advanced pre-hospital care throughout Québec. Second, some preliminary evidence shows that advanced care could be beneficial, especially in the case of respiratory distress or cardiac chest pain. Third, the limited amount of available evidence indicates that advanced care is neither beneficial nor detrimental in terms of mortality or morbidity in patients experiencing non-traumatic cardiopulmonary arrest, although the hypothesis that this type of care may be beneficial remains plausible. Finally, evidence reveals that advanced care is associated with adverse effects in certain circumstances, such as the endotracheal intubation of young children and the treatment of trauma.

In light of these findings, current developments and Québec’s particular context, AETMIS recommends that, for the time being, Québec limit the use of advanced care to duly evaluated pilot projects, with priority being given to the treatment of respiratory distress, chest pain and cardiopulmonary arrest. AETMIS also recommends implementing a series of measures designed to optimize both primary pre-hospital care and the chain of survival throughout Québec, chiefly by enhancing the training provided to emergency medical technicians.