Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing).
Key aspects of ALS level care include:
Tracheal intubation
Rapid sequence induction
Cardiac rhythm monitoring by ECG
Cardioversion and defibrillation using a manual or automated external defibrillator
Transcutaneous pacing
Ultrasonography
Intravenous cannulation (IV)
Intraosseous (IO) access and intraosseous infusion
Surgical cricothyrotomy
Needle cricothyrotomy
Needle or finger thoracostomy of tension pneumothorax
Pericardiocentesis
Advanced medication administration through parenteral and enteral routes (IV, IO, PO, PR, ET, SL, topical, and transdermal)
Advanced cardiac life support (ACLS)
Pediatric Advanced Life Support (PALS) or Pediatric Education for Pre-Hospital Providers (PEPP)
Pre-Hospital Trauma Life Support (PHTLS), Basic Trauma Life Support (BTLS) or International Trauma Life Support (ITLS)
In cases of cardiac arrest, ALS builds on the foundations of basic life support (BLS) interventions such as bag-mask ventilation with high-flow oxygen, chest compressions, and use of an AED.
The core algorithm of ALS that is invoked when cardiac arrest has been confirmed, Advanced Cardiac Life Support (ACLS), relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation and/or medication may be administered. Oxygen is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effectiveness of the interventions on the heart rhythm, as well as the presence of cardiac output, is assessed.
Medications that may be administered include adrenaline (epinephrine), amiodarone, atropine, bicarbonate, calcium, potassium and magnesium, among others. Saline or colloids may be administered to increase the circulating volume.
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A medical director is a physician who provides guidance and leadership on the use of medicine in a healthcare organization. These include the emergency medical services, hospital departments, blood banks, clinical teaching services and others. A medical director devises the protocols and guidelines for the clinical staff and evaluates them while they are in use. The role of a medical director in the emergency medical services (EMS) varies by which type of system is in use.
Advanced airway management is the subset of airway management that involves advanced training, skill, and invasiveness. It encompasses various techniques performed to create an open or patent airway – a clear path between a patient's lungs and the outside world. This is accomplished by clearing or preventing obstructions of airways. Obstructions can be caused by many things, including the patient's own tongue or other anatomical components of the airway, foreign bodies, excessive amounts of blood and body fluids, or aspiration of food particles.
Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians). It can be provided by trained medical personnel, such as emergency medical technicians, and by qualified bystanders. The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to coordinate the efforts of resuscitation worldwide.
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