Definition: A level of care provided by prehospital emergency medical services. Advanced life support consists of invasive life-saving procedures including the placement of advanced airway adjuncts, intravenous infusions, manual defibrillation, electrocardiogram interpretation, and much more.
Advanced life support certifications and licenses include emergency medical technician - intermediate (EMT-Intermediate) and paramedic.
Early history
Throughout the evolution of what we now call paramedicine, there has been an ongoing association with military conflict. One of the first indications of a formal process for managing injured people dates from the Imperial Legions of Rome, where aging Centurions, no longer able to fight, were tasked with organizing the removal of the wounded from the battlefield and providing some form of care. Such individuals, although not physicians, were probably among the world's earliest surgeons, suturing wounds, completing amputations, and not through training, but by default. This trend would continue throughout the Crusades, with the Knights Hospitallers of the Order of St. John of Jerusalem, known throughout the British Commonwealth today as St. John Ambulance, filling a similar function.
The first vehicle that was specifically designed as an ambulance was created during the Napoleonic War, and called the ambulance volante. Created by Napoleon's Chief Surgeon, Baron Dominique Jean Larrey, this new horse-drawn contrivance was intended to transport the wounded rapidly to surgeons, waiting at the rear. Such vehicles were seen by the military as a general resource, and care of the wounded was not given much priority; it was not uncommon for such vehicles to be tasked with carrying fresh ammunition to the battlefront, before they transported the wounded back. The basic design of such vehicles remained unchanged for nearly 100 years.
Medications administered
Paramedics in most jurisdictions administer a variety of emergency medications. The specific medications vary widely, based on physician medical director preference, local standard of care, and law, but may include:
Adenosine, which will slow the heart for a short period of time
Atropine, which will speed up a heartbeat that is too slow.
Sympathomimetics like dopamine for severe hypotension (low blood pressure) and cardiogenic shock.
D50W (Dextrose 50%) to treat hypoglycemia (low blood sugar)
Sedatives like Versed, Ativan, or Etomidate, and paralytics such as succinylcholine, rocuronium, or vecuronium to perform rapid sequence induction (RSI), a procedure to quickly induce anesthesia prior to intubation
Antipsychotics like Haldol or Geodon to sedate combative patients
Albuterol, atrovent, and methylprednisolone to treat respiratory conditions.
Medications to relieve pain or decrease nausea and vomiting.
Nitroglycerin, baby aspirin, and morphine sulfate for chest pain.
Antiarrhythmics like amiodarone to treat cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation not responding to defibrillation.
Narcotics like morphine sulfate, pethidine, fentanyl and in some jurisdictions, ketorolac to treat severe pain, i.e. burns or fractures.
