Intermediate Life Support

Intermediate Life Support is a medical doctrine and provider level which contains a serie skills and protocols for emergency medical care outside medical facilities. ILS extends the Basic Life Support and (Basic) First Aid and partly contains skills and protocols from Advanced Life Support. The level of training is comparable with Emergency medical technician – intermediate (EMT-I) or Advance Emergency Medical Technicians. ILS is used by non-transporting first responders, mostly volunteers.

Since 1985 Intermediate Life Support is used in the USA but since 2016 it is trademarked in the Benelux and a new concept in first aid and emergency medical response after a six-year pilot within an event medical care organisation.^[1] It is used by non-transporting first medical responders. Arrive within 15 minutes are the criteria in the Netherlands for ambulance services. That's a big difference with the United States. In the USA is arriving within eight minutes the gold standard for a good EMS system.^[2] Some municipalities, especially in California, have even moved response time standards to 12 or 15 minutes for private EMS providers 90% of the time, but these are usually coordinated with ALS first response.^[3] Studies confirm that quick and effective response, especially within four minutes, can make a difference for traumapatiënts outcomes.^[4] Good quality of fast first response is the main goal of Intermediate Life Support.

ILS is an mid-level of medical care provided by trained first responders, who received more training then Basic First Responders and First-aid providers.

Scope of practice

Intermediate Life Support providers are called "Medical" or "Advanced Medical". Mostly the Medicals and Advanced Medicals work as a Medical team. They both had the same training, but the Advanced Medical is allowed to provide the advanced medical skills. Advanced Medicals work on a daily base as nurses, anesthesiologist-assistants, medical students, paramedics or physician assistants.

Providing a wide range of medical skills and treatment at scene allows the Medical Team to provide better medical care to their patiënts than regular first aid. Without the Advanced Medical at scene, the Medicals still can provide a wide range of medical care. Medicals can immobilize fractures of the extremities, stabilize the cervical spine and monitor vital signs as oxygination (SpO2), pulse, bloodpressure, glucose and consciousness. They are also trained to administer oxygen, oral glucose, ipratropium/salbutamol inhalation, fentanyl intranasal spray, valium klysma and paracetamol oral. The scope of practice of the Intermediate Life Support trained Medicals is comparable with the EMT's known in the USA. No needles are required in treatment.^[5]

When an Advanced Medical is on scene, it increases the abilities to provide a wider range of emergency medical care. Partly the Advanced life support protocols are integrated in the Intermediate Life Support. Cardiac arrests^[6] and anafylactic shock treatments can be provided in the same way as Advanced Life Support and Ambulance protocols^[7] subscribe. That means also that bag-mask ventilation and inserting an intermediate airway device (iGel or other supraglottic airway device) can be performed if the Advanced Medical has been properly trained.^[8] They also starting intravenous access and administer medication in case of cardiac arrest, anafylactic shock or hypoglycemia.

References

Sources

• American Heart Association Guidelines
• Ambulancezorg Nederland
• National Registry of Emergency Medical Technicians (NREMT)
• UptoDate Medical Database