# How to drive lights and sirens...



## Handsome Robb (Aug 15, 2011)

Driving 'code' has been beaten to death. My question is what are your protocols/guidelines for transporting a patient with lights and sirens? Where I am doing my rides/ALS internship it is up to the medic in charge whether we return to the ED code 3. However, driving with a patient and attendant in the back is completely different than responding to a call. 

When returning with a patient and running code, we are allowed to exceed the speed limit when it is deemed safe (which is subjective, I know) but when we get to urban surface streets we are instructed to drive smoothly up to the speed of traffic. The lights and sirens help us clear intersections and thats about it. There's no point to drive like a madman, it compromises patient care. Just wondering how it is done where you work/intern/volunteer? It seems to be an ongoing topic so I figured I'd start a topic on it.


Let the flaming begin.


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## nwhitney (Aug 15, 2011)

Here the ambulances are required to stop at all stop signs and red lights.


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## Lady_EMT (Aug 15, 2011)

In our area, we respond to all calls hot (except for pshychiatrics and calls where we're going to need to stand-by). We are allowed to slightly exceed the speed limit, but as you said, no need to drive like a mad-man.

We need to stop at stop signs and red lights, and after looking to make sure everyone has stopped, we proceed through the intersection


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## sir.shocksalot (Aug 15, 2011)

With emergent returns it's always about the same speed as traffic, the blinkies and whoowhoos are just for intersections. So really with an emergent return it takes about the same amount of time as going routine, maybe we save a minute or two depending on traffic and distance.

I don't think many agencies keep hard and fast rules for emergent returns, often they are the same as the rules for emergent response, regardless of how different a driver must approach each setting. When I was an EMT and drove emergent to the hospital, I always drove in a manner that wouldn't get me yelled at. Now that I am in the back I have to say that I don't really ever request emergent transport. When I do I really could care less about the smoothness of the ride, my patient needs a doctor, and the less time they spend with me the better.


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## ffemt8978 (Aug 15, 2011)

We're told to drive like we have a scalding hot cup of coffee with no lid between our legs.  We routinely run code on the highways where we can be as much as 45 miles between intersections, but the vast majority of the time we shut down the code response upon reaching city limits.


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## Shishkabob (Aug 15, 2011)

Legal wise, there is NO law controlling what an emergency vehicle can do under lights and sirens in the state of Texas, so long as we show "due regard".  We can do 150mph blowing through every stop light in the wrong way in traffic, and none of it is illegal, so long as it's done so safely.  If an accident happens while we are running code, it's presumed our fault.

Company policy is a "10mph over speed limit" idea, and stop and clear every intersection.



It is up to Paramedic on the truck whether or not we transport L&S to the hospital. 

 Although the benefits of driving code are few, I tend to do it if it's a time sensitive thing, ie an MI activation, stroke activation, someone I have to take airway control of (Like if I RSI), or someone unstable to the point that I am playing catch-up... yes, even though it generally only saves a 10-15 minutes.  I'm not a fan of doing it, but I will when I recognize a single Paramedic in the back is not enough for the patient.


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## PotatoMedic (Aug 15, 2011)

Anything not that is not a tender we are allowed to go 10 over the posted if L&S.  We don't use an opticom system because our drivers were being stupid and just gunning it through the lights.  We slow and/or stop at intersection and visually "clear" it before we proceed.  We also only use the siren as we approach and go through intersections and when we are approaching other people.  Our department does not do much in transport of Pts.  We usually send via Pvt AMB.


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## traumaluv2011 (Aug 15, 2011)

I have not yet been on a priority transport with my squad yet. We will run most calls with lights and stop at intersections while using the sirens and make sure traffic is clear before proceeding. I imagine trauma calls might be different seeing as our closest trauma center is about 30 minutes away.


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## MrBrown (Aug 15, 2011)

It is entirely at the discretion of the Ambulance Officer driving the vehicle as to how they operate (e.g. speed, lights or siren) taking into consideration the patients status (critical, serious, moderate or minor) and road traffic environment.

We use red lights but rarely use the siren other than at intersections


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## dstevens58 (Aug 15, 2011)

Lights & siren to the scene.  Left to the discretion of the EMT in charge of patient care as to how we respond to the hospital.  Most of the time, no lights & siren.........a little more urgent - no lights/siren until we hit traffic; urgent need (code, etc) - lights/siren all-the-way.


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## DesertMedic66 (Aug 15, 2011)

Driving code 3 doesn't change if we are responding to a call or transporting with a patient. We are only allowed to go 10mph above the posted speed limit not to exceed 75mph. Stop at all red lights and stop signs. 

Now what does change is how we drive. When we are responding to a call it's pretty much hold on because it's a rough ride. Hit speed bumps at speed slow down slightly for dips. Hard on the brake. Floor the gas pedal. (now someone is going to chime in with how dangerous this is. But it's pretty much standard practice and is also done by the supervisors). 

When we have a patient in the back everything is made as smooth as possible for the patient and the medic/EMT in the back.


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## usalsfyre (Aug 15, 2011)

The only things I tend to return emergent are system activations, meaning traumas, strokes and STEMIs, and then only because the chart will be QA'd and I'll get a ration of caca if I don't.

I hate running code. I hate running code to the call, I hate running code to the hospital...I just generally dislike it all around. I haven't seen that it makes any difference in my area.


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## 18G (Aug 15, 2011)

The basic principle here is to drive with due regard. We have to stop at all stop lights and stop signs, yield to school buses, etc.

My approach when driving L&S is to drive exactly the same as if I was driving non-emergency. Stop where I need to stop and do not go any faster then when driving non-emergency. 

It is near impossible to provide any care when being tossed around in a flying ambulance.


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## Tigger (Aug 15, 2011)

nwhitney said:


> Here the ambulances are required to stop at all stop signs and red lights.



I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign. Supposedly driving is the most dangerous aspect of the EMS field, and blowing through red lights is only contributing to that.

To the original question, the decision for an emergency transport is made only by the transporting crew. A lot of employees at my company will transport with lights and sirens in the absence of ALS. Often the patient is at little risk of further deterioration, yet we still transport at a "slow 2" to avoid having to wait at every single traffic light in the city. Right, wrong, or indifferent, that's how it is here. As I've mentioned in other threads, if a patient is in pain they don't need to spend anymore time in my BLS ambulance than absolutely necessary, so I am happy if my driver can safely shave five minutes off the transport.


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## Shishkabob (Aug 15, 2011)

Tigger said:


> I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign.



Not required in Texas.  Infact, I can't think of a single state where it IS legally required.


The very nature of emergency vehicles laws is to exempt them from all traffic laws.


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## DesertMedic66 (Aug 15, 2011)

Tigger said:


> I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign. Supposedly driving is the most dangerous aspect of the EMS field, and blowing through red lights is only contributing to that.




The law in California states that we can go thru red lights at 15mph without stopping. 

But company policy is to stop.


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## JJR512 (Aug 15, 2011)

I have heard several different takes on Maryland's law, but according to my own research, as well as the prevailing view among the most credible people I know, there is no part of the law that specifies a maximum speed, or speed over speed limit, for emergency vehicles. At the state level. However, some jurisdictions or private companies may choose to create their own rule for how much to exceed the speed limit.

I believe that state law also does not require a full stop at all stop signs or red lights. Just as with speed, if a local jurisdiction or private company wishes to have more strict rules in place, they can do so.

I, personally, do not believe it is necessary to stop at every single stop sign or red light. Especially in non-urban areas, there are many intersections where you can see quite a distance down both sides of the cross road while approaching the intersection. If I can see a cross road is clear in either direction for at least a mile while I'm still a quarter-mile from the intersection, and it remains clear on my approach, why should I stop?

The laws that limit speeds and specify full stops exist as an attempt to provide legislation as a replacement for common sense. "Drive safely and prudently" should be all that is needed. It's sad that so many idiots out there have made it necessary for laws to be created to replace the common sense that is missing from so many people.


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## JPINFV (Aug 15, 2011)

Tigger said:


> I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign. Supposedly driving is the most dangerous aspect of the EMS field, and blowing through red lights is only contributing to that.


Why do we need laws to govern what should be governed by professional judgement?


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## JJR512 (Aug 15, 2011)

JPINFV said:


> Why do we need laws to govern what should be governed by professional judgement?


 
Exactly, and it's good to find another area on which we so closely agree when we traditionally have not agreed on much in the past (see the last paragraph of my previous reply).


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## JPINFV (Aug 15, 2011)

firefite said:


> The law in California states that we can go thru red lights at 15mph without stopping.
> 
> But company policy is to stop.



I think that's just a very strong objection (as in, "There's absolutely zero hope that anything faster than this will, in any manner, approach "due regard") than a hard rule. CVC 21055 spells out the exemptions, which includes the chapter (chapter 2) on "signs, signals, and markings." CVC 21056 holds the requirement to drive with due regard.


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## WuLabsWuTecH (Aug 15, 2011)

On my city department, I feel that exceeding the speed limit is damn near impossible with all the traffic lights everywhere.  We clear every intersection so by the time we get up to 45 it's time to slow down again!

Out in a rural area, where we cover 190 square miles, it's different, but even at night we don't exceed 65 on the rural routes where there are lots of deer.  ON the interstate we may get up to about 80 in good conditions.

On Returning the patient emergently: Will the time saved make a difference?  Remembering that responding hot and transporting hot are not the same, it's slower to transport hot b/c of your partners in the back.  There are runs where it's obvious, and some runs where it is not.  For example: we had a 60 yom with stroke symptoms, failed the Cincinnati.  He woke up at 5:30 this morning, and was ok until he went down in the shower at 6 per his wife.  He got worse and you arrive at 8:30.  Stroke center is 20 minutes away.  We lit up; why?  Well, the tPA was only going to be good for another 30 minutes, and we wanted to make damn sure that we had enough time to get him and in that they could have enough time to get him situated and get the tPA started.  Would 10 minutes be enough? Probably, but if I can shave another 5 off, especially in that morning rush hour traffic, we're going to do it in that case.


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## Tigger (Aug 15, 2011)

Linuss said:


> Not required in Texas.  Infact, I can't think of a single state where it IS legally required.
> 
> 
> The very nature of emergency vehicles laws is to exempt them from all traffic laws.



I guess I was mistaken, I thought that law was much more prevalent, though it does seem to be a common agency policy. It is in fact the law in Massachusetts, for what it's worth.

"and may drive such vehicle through an intersection of ways contrary to any traffic signs or signals regulating traffic at such intersection if he first brings such vehicle to a full stop and then proceeds with caution and due regard for the safety of persons and property, unless otherwise directed by a police officer regulating traffic at such intersection." From chapter 89, section 7b MGL.

As you might imagine, such a law is not quite followed to the letter, but it was written for a reason I imagine. If nothing else, hopefully those that are driving think twice before blowing an intersection. I don't think a complete stop is necessary every time either, but it is probably the best policy in a congested urban environment.

Laws are not created in vacuum are they? At some point professional judgement fell by the wayside and the legislature felt the need (right or wrong) to step in.


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## usalsfyre (Aug 15, 2011)

Tigger said:


> As you might imagine, such a law is not quite followed to the letter, but it was written for a reason I imagine. If nothing else, hopefully those that are driving think twice before blowing an intersection. I don't think a complete stop is necessary every time either, but it is probably the best policy in a congested urban environment.


The problem with a law worded such as this is it's a trial lawyer's dream. Much better to simply have "due regard" worded in.


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## ArcticKat (Aug 15, 2011)

We respond lights and sirens to all Charlie, Delta, and Echo MPDS response determinants.  We can exceed the posted speed limit by 25% and drive through red lights or stop signs.  We do several interfacility transports which involve 2 or more hours on open highway.  If our patient can benefit from the 20 minutes we can save by using lights and exceeding the speed limit, (typically cath lab or Pre CT scan CVA) we will do so but shut them down once we reach city limits.

As always, the driver is ultimately responsible for the operation of the vehicle.  If he goes through a red light with siren and emergency lighting activated and gets hit by an oncoming car...the driver of the ambulance is at fault.


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## the_negro_puppy (Aug 16, 2011)

We do many lights and siren calls to peoples houses, but rarely any to hospital as most are not transport critical.

Driving L&S siren is not too much different to driving normally. You arent trying to break any speed records and obviously slow down and make sure red lights and intersections are clear. Why drive like a maniac, risking your life for a most likely BS call?

Going L&S to hospital is like driving normally except going through intersections and stop signs. If you try to drive hard with a paramedic trying to work on a sick patient in the back, they will let you know real quick


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## 94H (Aug 16, 2011)

Here in PA Ambulances cannot exceed the speed limit and must stop at all red lights and stop signs to clear the intersections.


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## 18G (Aug 16, 2011)

Im sorry but if your not stopping or at least slowing to almost a complete stop before proceeding it's careless driving. How much time are you saving by not clearing the intersection? 

It's no secret that the majority of accidents involving emergency vehicles happen at intersections. And how many of these operators presumed or "thought" the intersection was clear????? If they would have stopped they would have gained the extra two seconds that would have allowed them to catch a glimpse of the vehicle entering the intersection with the right-of-way thus preventing the MVC (I intentionally do not call it an accident because it is not an accident).

Law or no law, a jury can decide whatever they choose. If your found negligent because you didn't ensure the intersection was clear... sorry about your luck.


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## 18G (Aug 16, 2011)

This is a new emergency vehicle response law in Virginia just passed called "Ashley's Law"

http://www.vachiefs.org/index.php/news/item/governor_mcdonnell_signs_ashleys_law


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## JPINFV (Aug 16, 2011)

18G said:


> This is a new emergency vehicle response law in Virginia just passed called "Ashley's Law"
> 
> http://www.vachiefs.org/index.php/news/item/governor_mcdonnell_signs_ashleys_law




"*Emergency vehicles proceeding past red lights.*  Provides that emergency vehicles proceeding past any steady or flashing red signals, traffic lights, stop signs, or other devices  indicating moving traffic shall stop, must flash emergency lights and either (i)  sound a siren, exhaust whistle, or air horn designed to give automatically intermittent signals or (ii) yield right-of-way or, if  required for safety, bring the vehicle to a complete stop before proceeding with  due regard to the safety of persons and property."

http://lis.virginia.gov/cgi-bin/legp604.exe?ses=111&typ=bil&val=SB762

So, um, in order for an emergency vehicle to be given the right of way at an intersection, it must have its emergency visual and auditory warning systems engaged OR it must give the right of way. Additionally, emergency vehicles must come to a complete stop at intersections when required for safety?

Sorry, but I hardly find that to be landmark legislation. A simple "drive with due regard" would have already covered everything that law mandates.


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## Smash (Aug 16, 2011)

usalsfyre said:


> I hate running code. I hate running code to the call, I hate running code to the hospital...I just generally dislike it all around. I haven't seen that it makes any difference in my area.



Amen to that!  There is nothing I hate more than the sound of sirens.  Actually, the sounds of the MRx monitor beeping incessantly because a fly landed on the unit, or a breeze blew past, or because it is Tuesday or whatever the f**k seems to activate the alarms on the piece of crap, that annoys me more.

But sirens I hate too.


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## Smash (Aug 16, 2011)

WuLabsWuTecH said:


> Stroke center is 20 minutes away.  We lit up; why?  Well, the tPA was only going to be good for another 30 minutes, and we wanted to make damn sure that we had enough time to get him and in that they could have enough time to get him situated and get the tPA started.



That's based on the pretty big assumption that tPA is going to be good at all! :lol:


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## Shishkabob (Aug 16, 2011)

I won't lie, I like the sound of the siren, if for nothing more than the romantic notion of "The cavalry is coming!"


However, I hate running code to stupid calls... especially to the same damn how for a "fever" when the person has had said fever for 5 months (no fever exist according to my thermometer) and it's come to the point that a big regional hospital has said "We don't want you coming here anymore" to the patient and their family.


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## MrBrown (Aug 16, 2011)

Smash said:


> the sounds of the MRx monitor beeping incessantly because a fly landed on the unit, or a breeze blew past, or because it is Tuesday or whatever the f**k seems to activate the alarms on the piece of crap



Sounds like you need to go to a country branch mate and sit all day sipping a cuppa


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## Smash (Aug 17, 2011)

MrBrown said:


> Sounds like you need to go to a country branch mate and sit all day sipping a cuppa



No, I just need a Corpuls monitor!  I can't stand being quiet, but I can't stand the steaming pile of poo that some muppet decided we should have as monitors.


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## Handsome Robb (Aug 17, 2011)

you don't like the Philips? Aside from the alarms what don't you like about it? We use it and despite the alarms I like it. My biggest pet peeve is the stupid CPR 'puck' that our protocols require us to use.


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## Smash (Aug 17, 2011)

NVRob said:


> you don't like the Philips? Aside from the alarms what don't you like about it? We use it and despite the alarms I like it. My biggest pet peeve is the stupid CPR 'puck' that our protocols require us to use.



It's heavy, it alarms because the sun is shining, it's not user friendly, the filtering is rubbish, 12 leads are impossible to read (admittedly that's because our service is too cheap to buy a proper printer so they print out on standard strips).

It has reached new heights of mediocrity.

Now this is a monitor:  









Sexy beast!


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