Training paramedics to better improve the breathing of people rushed to the hospital in respiratory distress saves lives, a Canadian study shows.
"It's estimated that of all the ambulance transports in North America, about 20 percent have shortness of breath caused by lots of different conditions," explained Dr. Ian G. Stiell, chair of the department of emergency medicine at the University of Ottawa. "In the United States, perhaps two million people a year are taken to the hospital for trouble breathing."
Helping those people breathe by giving a drug, implanting a tube or another method reduced the death rate by 30 percent in the two-phase trial of more than 8,100 patients, which was reported in the May 25 New England Journal of Medicine.
In the first phase of the trial, paramedics riding ambulances were not trained in advanced respiratory life support and did not give advanced assistance to those with breathing difficulties. In the second phase, paramedics trained in advanced life support helped more than half the patients by such methods as implanting a breathing tube (1.4 percent of patients) or giving intravenous drugs (15 percent of patients).
"The rate of death among all patients decreased significantly, from 14.3 percent to 12.4 percent," the report said. That works out to a 30 percent increase in survival among those in the advanced care group versus those in the basic care cohort.
"When you consider how common such breathing difficulties are, giving this help could affect literally tens of thousands of lives each year," Stiell said.
It's not clear how widely emergency respiratory measures are used in ambulances, he said. While their advantages are known in general, "this is the first study that shows this kind of help makes a difference," Stiell said.
In the United States, ambulance attendants in most large cities are believed to provide emergency respiratory help "to a certain degree, but in smaller communities, probably not," he said. "We would like to suggest that they be adopted on a large scale in smaller communities in North America."
It is relatively easy to help by applying a breathing mask or giving drugs such as nitroglycerine or albuterol, Stiell said. "For really sick patients, you can put in a breathing tube," he said. "You can start an intravenous to draw fluid from the lungs and also put nitroglycerine under the tongue. For asthma, there are inhaled medications."
The treatment phase of the trial was marked by a substantial increase in the use of drugs such as nitroglycerine, the report noted.
The trial is the latest in a series in which the Canadian researchers have investigated life support measures for out-of-hospital emergency problems, such as cardiac arrest.
The new report is "a real boost to supporters of emergency medical treatment" of respiratory distress, said Dr. Howard Blumstein, associate professor of emergency medicine at Wake Forest University and secretary-treasurer of the American Academy of Emergency Medicine.
"The reason it is important is that, until now, there has been no real evidence that the treatments they provide are actually beneficial to patients," Blumstein said. "There has been a real dearth of research to show benefit."
About half the emergency patients in the Wake Forest area who have respiratory distress get treatment for it, he estimated.
"In our community, in Winston-Salem and all the communities I am familiar with, paramedics working under established protocols had authority already to provide these things without asking permission," Blumstein said.
