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Advanced life support, level 2 (als 2)

HCPCS code

Name of the Procedure:

  • Common Names: Advanced Life Support, Level 2
  • Medical Term: ALS 2 (A0433)


Advanced Life Support, Level 2 (ALS 2) is a critical procedure performed by paramedics and emergency medical personnel during life-threatening emergencies. This intervention involves advanced medical techniques to stabilize critically ill or injured patients before and during transportation to a healthcare facility.


ALS 2 addresses severe medical conditions such as cardiac arrest, respiratory failure, or severe trauma. The goal is to stabilize the patient, maintain vital functions, and improve the chances of survival and recovery.


  • Cardiac arrest
  • Severe trauma
  • Respiratory failure
  • Life-threatening medical emergencies requiring advanced interventions
  • Patients experiencing severe allergic reactions or poisoning


  • No specific preparation is required from the patient due to the emergency nature of the procedure.
  • Emergency medical personnel may quickly gather patient information and history if possible.

Procedure Description

  1. Assessment: Rapid assessment of the patient's condition, including airway, breathing, and circulation.
  2. Airway Management: Use of advanced airway devices such as endotracheal tubes or supraglottic airway devices.
  3. Breathing Support: Administration of oxygen, ventilation with bag-valve masks, or mechanical ventilators.
  4. Circulation Support: Establishing intravenous (IV) or intraosseous (IO) access for fluids and medications.
  5. Medication Administration: Use of advanced medications such as epinephrine, atropine, or anti-arrhythmics.
  6. Defibrillation: Use of manual defibrillators for cardiac arrest management.
  7. Monitoring: Continuous monitoring of vital signs, including ECG, blood pressure, and oxygen saturation.


  • Advanced airway devices
  • Bag-valve masks
  • Mechanical ventilators
  • IV/IO kits
  • Medications
  • Defibrillators
  • Monitoring equipment

Anesthesia or Sedation: Not typically applicable due to the emergency nature.


The procedure duration varies but usually lasts for the duration of the emergency response and transport, which could be 20 minutes to over an hour, depending on the situation and distance to the hospital.


Performed in the field (e.g., at the scene of an accident or medical emergency) and during transport in an ambulance.


  • Paramedics
  • Emergency Medical Technicians (EMTs)
  • In some cases, emergency physicians may be involved via telemedicine or direct response.

Risks and Complications

  • Potential airway injury from advanced airway techniques
  • Medication side effects or allergic reactions
  • Circulatory complications from IV/IO access
  • Risk of infection


  • Stabilization of life-threatening conditions
  • Potentially life-saving interventions
  • Improved chances of survival and recovery when performed promptly


  • Immediate follow-up and definitive care in a hospital setting
  • Recovery depends on the underlying condition and timely response
  • Further treatment or surgeries may be required


  • Basic Life Support (BLS) which involves less invasive measures
  • Hospital Emergency Department care without pre-hospital ALS (not typically feasible in life-threatening situations)

Pros and Cons of Alternatives:

  • BLS: Suitable for less severe cases but may not provide the necessary support for critically ill patients.
  • Hospital Care Only: Delays care and decreases survival rates for life-threatening conditions.

Patient Experience

  • As the patient is likely in a critical condition, awareness of the procedure may be minimal.
  • Patients might experience discomfort or pain due to the nature of their condition and interventions.
  • Comfort measures focus on quickly alleviating life-threatening conditions and stabilization.

Pain Management and Comfort Measures:

  • Pain management may be limited due to the focus on stabilization; however, pain relief medications may be administered if feasible.

Medical Policies and Guidelines for Advanced life support, level 2 (als 2)

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