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When it comes to ambulance care, basic may be better

Patients who have a heart attack, stroke, respiratory failure or other emergency trauma have a better chance of survival if they were transported by basic life support ambulance rather than one equipped for advanced care, according to new research released this week.

"It's seems counterintuitive because we see the words 'advanced' and 'basic,' but those are just words and we really have to look at how these are actually working," Prachi Sanghavi, a visiting research fellow in health care policy at Harvard Medical School and assistant professor in the Department of Public Health Sciences in the Biological Sciences Division of the University of Chicago, told CBS News.

For the study, published in the Annals of Internal Medicine, Sanghavi and her team analyzed outcomes for nearly 400,000 emergency cases from a random sample of Medicare patients from urban and suburban counties between 2006 and 2011.

The researchers looked at survival rates for patients who received advanced life support transport in counties that use more advanced care ambulances and patients who received basic life support transport in counties that use less advanced care ambulances.

"To summarize, we found is that if you have trauma, stroke, heart attack or respiratory failure your probability for survival is going to be better with basic life support than with advanced life support," Sanghavi said.

Advanced life support ambulances account for 65 percent of emergency care for Medicare patients in the United States, the study authors say. They are staffed by paramedics and are equipped to perform more invasive procedures than basic life support ambulances, which are staffed by emergency medical technicians.

A patient with respiratory distress, for example, might receive endotracheal intubation to keep their airway open from an advanced advanced care ambulance crew, while the same patient may be treated with a bag-mask respirator in a basic life support ambulance.

"The advanced life support ambulance is more of what is called the 'stay and play' approach, while the basic life support is known ad the 'scoop and run' method," Sanghavi said.

This delay in transport to the hospital by advanced care ambulances could explain the lower survival rates for this group, Sanghavi said.

Specifically, the researchers found that:

  • Patients with a heart attack were 5.9 percent more likely to survive for 90 days after their ambulance transport if they were brought to the hospital in a basic life support ambulance as opposed to advanced life support.
  • Those who had a stroke had a 4.3 percent greater chance of surviving for 90 days if they were transported in a basic life support ambulance.
  • Patients who experienced critical major trauma transported by a basic life support ambulance had a 12.5 percent greater chance of surviving for 90 days than patients with the same conditions who transported by advanced care ambulance.

The researchers also suggested that using more basic support ambulances would save money, as they are less expensive than the advanced care. "This study demonstrates that in medicine costlier isn't always better; simply transporting the patient to the hospital as soon as possible appears to have a high payoff," study co-author Joseph Newhouse, the John D. MacArthur Professor of Health Policy and Management at Harvard University, said in a statement.

But some experts caution that despite the authors' attempts to avoid selection bias in their analysis, advanced care ambulances tend to carry sicker patients which would explain their worse outcomes.

"I don't think the two groups were all that comparable," Dr. Robert E. O'Connor, professor and chair of the department of Emergency Medicine at the University of Virginia School of Medicine and spokesperson for the American College of Emergency Physicians, told CBS News. "It's an interesting study that raises questions about what's the best type of transport for patients but it's not conclusive and the paper should by no means be used to make any decisions regarding changes to reimbursements or what type of care patients should receive."

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