Jayaraman Sudha, Sethi Dinesh
Department of Surgery, University of California San Francisco, S-321, 513 Parnassus Ave, San Francisco, CA, USA, 94143.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD003109. doi: 10.1002/14651858.CD003109.pub2.
There is an increasing global burden of injury especially in low- and middle-income countries (LMICs). To address this, models of trauma care initially developed in high income countries are being adopted in LMIC settings. In particular, ambulance crews with advanced life support (ALS) training are being promoted in LMICs as a strategy for improving outcomes for victims of trauma. However, there is controversy as to the effectiveness of this health service intervention and the evidence has yet to be rigorously appraised.
To quantify the impact of ALS-trained ambulance crews versus crews without ALS training on reducing mortality and morbidity in trauma patients.
Searches were not restricted by date, language or publication status. We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid SP), EMBASE (Ovid SP), CINAHL (EBSCO) and PubMed in all years up to July 2009. We also searched the reference lists of relevant studies and reviews in order to identify unpublished material.
Randomised controlled trials, quasi-randomised controlled trials and non-randomised studies, including before-and-after studies and interrupted time series studies, comparing the impact of ALS-trained ambulance crews versus crews without ALS training on the reduction of mortality and morbidity in trauma patients.
One review author applied eligibility criteria to trial reports for inclusion and extracted data.
We found one controlled before-and-after trial, one uncontrolled before-and-after study, and one randomised controlled trial that met the inclusion criteria. None demonstrated evidence to support ALS training for pre-hospital personnel. In the uncontrolled before-and-after study, 'a priori' sub-group analysis showed an increase in mortality among patients who had a Glasgow Coma Scale score of less than nine and received care from ALS trained ambulance crews. Additionally, when the pre-hospital trauma score was taken into account in logistic regression analysis, mortality in the patients receiving care from ALS trained crews increased significantly.
AUTHORS' CONCLUSIONS: At this time, the evidence indicates that there is no benefit of advanced life support training for ambulance crews.
全球伤害负担日益加重，尤其是在低收入和中等收入国家（LMICs）。为应对这一情况，最初在高收入国家开发的创伤护理模式正在被LMICs采用。特别是，在LMICs中，接受过高级生命支持（ALS）培训的救护人员作为改善创伤受害者预后的一项策略正在得到推广。然而，对于这项卫生服务干预措施的有效性存在争议，且相关证据尚未得到严格评估。
量化接受ALS培训的救护人员与未接受ALS培训的救护人员相比，对降低创伤患者死亡率和发病率的影响。
检索不受日期、语言或出版状态限制。我们检索了Cochrane伤害组专业注册库、CENTRAL（Cochrane图书馆2009年第3期）、MEDLINE（Ovid SP）、EMBASE（Ovid SP）、CINAHL（EBSCO）以及截至2009年7月的所有年份的PubMed。我们还检索了相关研究和综述的参考文献列表，以识别未发表的资料。
随机对照试验、半随机对照试验和非随机研究，包括前后对照研究和中断时间序列研究，比较接受ALS培训的救护人员与未接受ALS培训的救护人员对降低创伤患者死亡率和发病率的影响。
一位综述作者将纳入标准应用于试验报告以进行纳入，并提取数据。
我们发现一项前后对照试验、一项非对照前后研究和一项随机对照试验符合纳入标准。没有一项研究显示有证据支持对院前人员进行ALS培训。在非对照前后研究中，“先验”亚组分析显示，格拉斯哥昏迷量表评分低于9分且接受过ALS培训的救护人员护理的患者死亡率有所增加。此外，在逻辑回归分析中考虑院前创伤评分时，接受ALS培训的救护人员护理的患者死亡率显著增加。
目前，证据表明对救护人员进行高级生命支持培训没有益处。
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