“…By expensive, it is meant threefold: in economic, social and professional terms. By controversial, we mean that many of the general practices of pre-hospital ACLS and BTLS, although appealing and empirically useful, have not necessarily been proven effective by prospective studies and, at this time, the most rigorous data are lacking (5,6,(23)(24)(25)(26)(27)(28)(29)(30)(31). Thus, in the United States and in North America in general, there are 30 to 50 protocols for any paramedic to choose from in any given situation-many of which probably do not require attention in the span of an ambulance's arrival and delivery of the patient to an ED, especially in an urban setting with short transport times.…”