Useing BLS before ALS is the correct approach for care providers to use when providing care to the injured or ill. If you are student taking a practical skills evaluation, you can bet that the proctor will be looking closely at your ability to keep advanced intervention in their proper place. If you are a seasoned professional, the same rules apply. Often care providers who are at an advanced level are quick to think at an advanced level when basic interventions are all that is really needed. An example is the intubation of a cardiac arrest patient who has no airway complication whatsoever. With regards to cardiac arrest, the priorities are early CPR and defibrillation.

That is what is most likely to produce a positive outcome, not intubation. Each time intubation is attempted, valuable coronary and cerebral perfusion pressure is lost if chest compression are stopped. Unless there is some kind of an airway complication BLS airway management is sufficient in the management of the cardiac arrest patient. The basics, (as basic as they are) correctly applied often can make the most significant difference in the overall outcome and greatly improve the possibility of a hospital to discharge that is “successful”, with minimal neurological damage.

The BLS course is designed to instruct new providers on the correct application of basic life support and also “remind” the advanced providers that the basics are still relevant and appropriate in many cases. The best care providers use the tools appropriate for the presenting condition as needed and not because they are licensed to do so. I am all for advanced interventions, but I am not for advanced providers who have poor BLS skills or simply start their care with advanced interventions. The old adage “keep it simple stupid” does so often apply to patient care. Supplemental oxygen is among the most basic drugs and also one of the most effective. Remember that the chest pain patient gets a lot of it via non-rebreather (along with ASA) not a cannula. If you are thinking about nitro and morphine before you are giving oxygen you better at least be having someone reaching for the O2. That is BLS before ALS.

One last thing that I think is most basic… If you don’t remember something, look it up. Grab your protocol book, cheat sheet, or ASK someone who knows. Ensuring that you have accurate information and that your interventions are correct is BASIC not advanced. Advanced providers are only human and we all forget something from time to time. Don’t be afraid to look it up.