Particularly in light of the recent EMSA crash, I have been re-thinking lights and sirens driving considerably. I would like to share some of my thoughts/rants, and get your responses. We've had pieces of this discussion before in different places, but i'm discussing a new approach.
I will start by saying I am not a particular fan of driving with L&S… I work mainly PB (ALS) and my company has fairly few (or little) policies regarding driving. We do not have Road Safety, and it seems management does not care much what we do as long as nobody complains and there are no collisions.
I am aware of the considerable risks that come with L&S, the high rates of collision and significant damage and the minimal cost savings. With that said, I generally drive to all emergencies with L&S, and modulate my speed/rush based on dispatch complaint (drivers make the priority decision here, not dispatch). Once we get the patient into the truck, I leave my partner (medic) to decide how they want to get to the hospital, but find myself disagreeing more often recently. More on that in a minute.
One of our managers (an experienced instructor in his own right) strongly believes, and shares broadly his belief that unless a team of RNs and MDs swarm around our patient when we arrive at the ED, or the patient receives some critical diagnostic or treatment within 3-5 minutes of arriving, we shouldn’t have been using L&S on the way in. Especially when working ALS, that makes a lot of sense.
I recognize some EDs have particularly lazy staff, and this tenant stems from the quality (and accuracy) of our radio/triage report, but it resonates deeply with my thinking. We can do whatever we think is prudent on the way to scene, provide whatever assessment or treatment we need, then realistically look at how fast we need to get to the hospital.
This is where I disagree with my medic partners—they like lights in, and I am reluctant. I absolutely trust them to make decisions that are in the best interest of the patient, realize that I do not always understand their motives, and always honor their requests (within reason), but just do not think it’s worth the risk for what I see as low priority patients. When I push their thinking after the call, I frequently get shallow excuses with no mention of patient acuity. When we are done with our paperwork 10 minutes later and say goodbye to the patient, they haven’t been seen yet by a tech or RN, let alone an MD.
I don’t want to debate who’s in charge on a PB truck… that’s a different issue… but differing opinions on patient priorities, and whether we are really doing the right thing rushing patients, and developing more formal decision matrices for L&S use patient loaded.
There are some services to my knowledge (Boston EMS comes to mind) that have policies that call for ALL patients to be transported L&S, even if they are going to the waiting room, ostensibly to maximize unit availability (boingo/TOTWTYTR can you confirm/deny?) Does anyone have data on whether the cost of adding trucks is more than increased crashes, or does that boil down to driver training? Do we have a panacea for emergency vehicle driver training? What do services with the lowest collision rates do? Is it a function of EVO or other drivers? Conditions? Type/size of vehicles?
I will start by saying I am not a particular fan of driving with L&S… I work mainly PB (ALS) and my company has fairly few (or little) policies regarding driving. We do not have Road Safety, and it seems management does not care much what we do as long as nobody complains and there are no collisions.
I am aware of the considerable risks that come with L&S, the high rates of collision and significant damage and the minimal cost savings. With that said, I generally drive to all emergencies with L&S, and modulate my speed/rush based on dispatch complaint (drivers make the priority decision here, not dispatch). Once we get the patient into the truck, I leave my partner (medic) to decide how they want to get to the hospital, but find myself disagreeing more often recently. More on that in a minute.
One of our managers (an experienced instructor in his own right) strongly believes, and shares broadly his belief that unless a team of RNs and MDs swarm around our patient when we arrive at the ED, or the patient receives some critical diagnostic or treatment within 3-5 minutes of arriving, we shouldn’t have been using L&S on the way in. Especially when working ALS, that makes a lot of sense.
I recognize some EDs have particularly lazy staff, and this tenant stems from the quality (and accuracy) of our radio/triage report, but it resonates deeply with my thinking. We can do whatever we think is prudent on the way to scene, provide whatever assessment or treatment we need, then realistically look at how fast we need to get to the hospital.
This is where I disagree with my medic partners—they like lights in, and I am reluctant. I absolutely trust them to make decisions that are in the best interest of the patient, realize that I do not always understand their motives, and always honor their requests (within reason), but just do not think it’s worth the risk for what I see as low priority patients. When I push their thinking after the call, I frequently get shallow excuses with no mention of patient acuity. When we are done with our paperwork 10 minutes later and say goodbye to the patient, they haven’t been seen yet by a tech or RN, let alone an MD.
I don’t want to debate who’s in charge on a PB truck… that’s a different issue… but differing opinions on patient priorities, and whether we are really doing the right thing rushing patients, and developing more formal decision matrices for L&S use patient loaded.
There are some services to my knowledge (Boston EMS comes to mind) that have policies that call for ALL patients to be transported L&S, even if they are going to the waiting room, ostensibly to maximize unit availability (boingo/TOTWTYTR can you confirm/deny?) Does anyone have data on whether the cost of adding trucks is more than increased crashes, or does that boil down to driver training? Do we have a panacea for emergency vehicle driver training? What do services with the lowest collision rates do? Is it a function of EVO or other drivers? Conditions? Type/size of vehicles?