This report was translated from an official French publication of the Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS). Both the original report titled Introduction des soins medicaux avances dans les services prehospitaliers d'urgence au Quebec and the English report are available in PDF format on the Agency's Web site.
Scientific review Dr. Veronique Dery, MD, MSc, Chief Executive Officer and Scientific Director Jean-Marie R. Lance, MSc, Senior Scientific Advisor
Translation Jocelyne Lauziere, MA, Certified Translator
Editorial supervision Suzie Toutant
Proofreading Frederique Stephan
Page layout Frederique Stephan
Bibliography research Micheline Paquin
Co-ordination Lise-Ann Davignon
Communications and dissemination Richard Lavoie, MA
For further information about this publication or any other AETMIS activity, please contact: Agence d'evaluation des technologies et des modes d'intervention en sante 2021 Union Avenue, Suite 1050 Montreal (Quebec) H3A 2S9 Telephone: (514) 873-2563 Fax: (514) 873-1369 E-mail: aetmis@aetmis.gouv.qc.ca www.aetmis.gouv.qc.ca
How to cite this document: Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS). Introduction of advanced life support in pre-hospital emergency medical services in Quebec. Report prepared by Reiner Banken, Brigitte Côte, François de Champlain and Andre Lavoie (AETMIS 05-01). Montreal: AETMIS, 2005.
Legal deposit Bibliotheque nationale du Quebec, 2005 Library and Archives Canada, 2005 ISBN 2-550-44471-X (Print) (French edition ISBN 2-550-44197-4) ISBN 2-550-44472-8 (PDF) (French edition ISBN 2-550-44484-1)
© Gouvernement du Quebec, 2005.
This report may be reproduced in whole or in part provided that the source is cited.
MISSION
The mission of the Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS) is to contribute to improving the Quebec health-care system and to participate in the implementation of the Quebec government's scientific policy. To accomplish this, the Agency advises and supports the Minister of Health and Social Services as well as the decision-makers in the health care system, in matters concerning the assessment of health services and technologies. The Agency makes recommendations based on scientific reports assessing the introduction, diffusion and use of health technologies, including technical aids for disabled persons, as well as the modes of providing and organizing services. The assessments take into account many factors, such as efficacy, safety and efficiency, as well as ethical, social, organizational and economic implications.
EXECUTIVE
Dr. Luc Deschênes Cancer Surgeon, President and Chief Executive Officer of AETMIS, Montreal, and Chairman, Conseil medical du Quebec, Quebec
Dr. Veronique Dery Public Health Physician, Chief Executive Officer and Scientific Director
Dr. Alicia Framarin Physician, Deputy Scientific Director
Jean-Marie R. Lance Economist, Senior Scientific Advisor
BOARD OF DIRECTORS
Dr. Jeffrey Barkun Associate Professor, Department of Surgery, Faculty of Medicine, McGill University, and Surgeon, Royal Victoria Hospital (MUHC), Montreal
Dr. Marie-Dominique Beaulieu Family Physician, Holder of the Dr. Sadok Besrour Chair in Family Medicine, CHUM, and Researcher, Unite de recherche evaluative, Hôspital Notre-Dame (CHUM), Montreal
Dr. Suzanne Claveau Specialist in microbiology and infectious diseases, Hôtel-Dieu de Quebec (CHUQ), Quebec
Roger Jacob Biomedical Engineer, Coordinator, Capital Assets and Medical Equipment, Agence de developpement de reseaux locaux de services de sante et de services sociaux de Montreal, Montreal
Denise Leclerc Pharmacist, Board Member of the Institut universitaire de geriatrie de Montreal, Montreal
Louise Montreuil Assistant Executive Director, Direction generale de la coordination ministerielle des relations avec le reseau, ministere de la Sante et des Services sociaux, Quebec
Dr. Jean-Marie Moutquin Obstetrician/Gynecologist, Research Director, and Executive Director, Departement d'obstetrique-gynecologie, CHUS, Sherbrooke
Dr. Reginald Nadeau Cardiologist, Hôpital du Sacre-Cœur, Montreal, Board Member of the Conseil du medicament du Quebec
Guy Rocher Sociologist, Professor, Departement de sociologie, and Researcher, Centre de recherche en droit public, Universite de Montreal, Montreal
Lee Soderström Economist, Professor, Department of Economics, McGill University, Montreal
FOREWARD
In the fall of 2004, several Quebec 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'evaluation des technologies et des modes d'intervention en sante) 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 Quebec.
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 Quebec.
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 Quebec. 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 Quebec's particular context, AETMIS recommends that, for the time being, Quebec 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 Quebec, chiefly by enhancing the training provided to emergency medical technicians. In submitting this report, AETMIS hopes to inform the ongoing debate on the introduction of advanced care to Quebec's pre-hospital services.
Dr. Luc Deschênes President and Chief Executive Officer
ACKNOWLEDGEMENTS
This report was prepared at the request of the Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS) by Reiner Banken, MD, MSc (Community Health), Consultant Researcher, AETMIS, Brigitte Côte, MD, MSc (Public Health), Consultant Researcher, AETMIS, François de Champlain, MD, FRCPC, F.AC.E.P Emergency Medicine Specialist, and Andre Lavoie, PhD (Epidemiology), Epidemiologist.
AETMIS would like to thank the external reviewers of this report for their valuable feedback:
Marica Ferri, MD Co-ordinator, Unità di Progetto: EBM e Modelli Assistenziali, Agenzi di Sanità Pubblica della Regione Lazio, Rome, Italy
Assunta De Luca, MD Head of Emergency Unit, Unità di Progetto: EBM e Modelli Assistenziali, Agenzi di Sanità Pubblica della Regione Lazio, Rome, Italy
Alphonse Montminy, MD President, Comite des soins d'urgence cardiaque, Fondation des maladies du cœur du Quebec, Montreal, Quebec
Joseph J. Osterwalder, MD Head of Emergency Department, Kantonsspital St. Gallen, Switzerland
Pierre Poirier Executive Director, Paramedic Association of Canada, and Chairman, National Occupational Competency Profiles for Paramedic Practitioners Review Committee, Ottawa, Ontario
Wayne Smith, MD Medical Director, Services prehospitaliers d'urgence, Agence de developpement de reseaux locaux de services de sante et de services sociaux de l'Estrie, Sherbrooke, Quebec
The following individuals greatly contributed to this report by providing information, support and key advice:
Marcel Boucher, MD Director, Services professionnels et de l'assurance de la qualite, Corporation d'urgences-sante, Montreal, Quebec
Robert Burgess, ACP, AEMCA Senior Manager, Division of Prehospital Care, Sunnybrook-Osler Centre for Prehospital Care, Toronto, Ontario
Mario Deschênes, MD Assistant Syndic, College des medecins du Quebec, Montreal, Quebec
Claude Desrosiers Co-ordinator, Module de l'assurance de la qualite et de la formation clinique, Corporation d'urgences-sante, Montreal, Quebec
Daniel Lefrançois, MD Medical Director, Direction adjointe des services prehospitaliers d'urgence, ministere de la Sante et des Services sociaux, Quebec City, Quebec
Suzanne Michalk, MD President, Comite sur les soins prehospitaliers d'urgence, College des medecins du Quebec, Montreal, Quebec
Gisele Ouimet Research Consultant, Module de l'assurance de la qualite et de la formation clinique, Corporation d'urgences-sante, Montreal, Quebec
Eli Segal, MD Research Co-ordinator, Module de recherche, Corporation d'urgences-sante, Montreal, Quebec
Ian Stiell, MD Senior Scientist, Clinical Epidemiology Clinic, Loeb Health Research Institute, and principal investigator, OPALS study, Ottawa, Ontario
Brian Schwartz, MD Medical Director, Division of Prehospital Care, Sunnybrook-Osler Centre for Prehospital Care, Toronto, Ontario, and President, Canadian Relations Ad Hoc Committee, National Association of EMS Physicians (USA)
DISCLOSURE OF CONFLICTS OF INTEREST Dr. François de Champlain is also a physician with the Corporation d'urgences-sante. Andre Lavoie was in charge of research and quality assurance for the Corporation d'urgences-sante from 1992 to 1999. He worked as a consultant for JSS Medical Research, especially in the context of a binding contract between this firm and the Corporation d'urgences-sante. Dr. de Champlain and Andre Lavoie informed AETMIS of this situation well before this work began.