Brian Field


In the mid 1990's, due to health services fiscal restraints, the Ontario Ministry of Health, policy makers required quality scientific evidence to support decisions to initiate or continue funding for expensive health programs. There was not convincing evidence for the effectiveness of ALS programs for critically ill and injured patients for the policy makers to move into the field of Pre-hospital Advanced Life support. This was in spite of considerable political pressure and pressure on the paramedic profession.

To resolve the impasse, an expert panel was formed to recommend a process for satisfying the government's need for scientific evidence and to address the political and professional pressures of the day. This expert panel included representatives from the research community, the government, paramedic unions, ambulance service operators and the medical community.

The result of this process was the development of the largest pre-hospital study of its kind world wide with an operational budget of 15 million dollars over 8 years.

This study has provided valuable evidence to Ontario communities and elsewhere, about the relative effectiveness of pre-hospital programs on the survival and morbidity of cardiac arrest, major trauma and respiratory distress patients. The study objectives included:

To assess the incremental benefits in cardiac arrest patient survival and morbidity that results from the sequential introduction of rapid defibrillation programs.

To assess the incremental benefit in survival, morbidity and processes of care that result from the introduction of pre-hospital ALS programs to multiple Ontario communities for patients with cardiac arrest (primary objective), major trauma and respiratory distress.

To conduct an economic evaluation of ALS programs for the same patient groups by estimating the incremental cost per life saved and per quality-adjusted life year.

This discussion will address two broad areas of the OPALS Project:

1) An overview of the origin of the OPALS project and the political and operational challenges that had to be overcome, and

2) The study results to date.