# Light or No Lights?



## ZombieEMT (Jul 9, 2013)

I would like to get an idea how EMS runs in different areas and your opinions on Lights/Sirens. What does your department consider as an emergency run vs non-emergency or lights vs no lights?

A little background on this is I work with three different organizations that run three different ways.

A| Volunteer Department - We classify and emergency run as something with significant risk of lift, limb or eminent childbirth. Just because someone dials 9-1-1 does not mean that they will get a response with Lights/Sirens. Lights/Sirens is based on report and whether or not significant risk exists. In fact more than often, lights/sirens do not get used. If BLS, no lights/sirens ever in transport, if ALS up to ALS decision. Additionally some calls never get a light/siren response ie anything with stand-by/staging, mental health or lift assist.

B|Paid EMS Only - We classify an emergency run basically as anything that comes via 911 or direct line with chance of transport. All responses are lights/sirens and all transports are the same. This includes even the most minor of BLS calls and mental health calls.

C| Paid EMS and IFT - All 911 responses get Lights/Sirens. If the call is evaluated to be BLS only on arrival, transport is nonemergent with no lights/sirens. If ALS is on board, lights/sirens are used. No leway on either. 


I personally like the volunteer way best. It is the safest option for me and my partner. Also, lights/sirens have shown to only shave off minimal time from response and transport. It distracts other drivers and makes the transport worse for everyone. Many calls we take do not really need and ER let alone an ambulance. I also want to add, that people seem to forget that when utilizing lights/sirens you should still drive with due regard. You should not be going anyway faster or braking any less because you have lights and sirens. They simply help to clear traffic and intersections.


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## DesertMedic66 (Jul 9, 2013)

Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient. 

Not the best system.


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## Wheel (Jul 9, 2013)

DesertEMT66 said:


> Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.
> 
> Not the best system.



This is how ours is, except if we are responding to a facility with a nurse or a physician and a call that is not life threatening (very loose definition).


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## Medic Tim (Jul 9, 2013)

We hav priority dispatch so we go code 1 ( lights and siren) or code 2 ( no lights no siren).  I believe w go hot for Charlie calls and up.


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## DesertMedic66 (Jul 9, 2013)

Wheel said:


> This is how ours is, except if we are responding to a facility with a nurse or a physician and a call that is not life threatening (very loose definition).



If the facility calls 911 we respond lights and siren. If they call our dispatch line the facility staff can determine if they want us to respond to lights and sirens or no lights and sirens.


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## RocketMedic (Jul 9, 2013)

We work the same way as Desert66, not the best system.

Running hot is usually retarded.


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## Wheel (Jul 9, 2013)

Rocketmedic40 said:


> We work the same way as Desert66, not the best system.
> 
> Running hot is usually *retarded*.



You can't say retarded.















But yeah, you're right.


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## cprted (Jul 9, 2013)

Maybe people use 911 differently down south, but I can't imagine running Code 3 (lights and sirens) for someone complaining of a sore knee just because they called 911.  My system uses AMPDS (Advanced Medical Priority Dispatch System), which we already think spits out way too many Code 3 responses.  Through AMPDS calls get a response code which determines what resources are sent and in which manner.  A call can either be:
-BLS rountine
-BLS Code 3
-BLS and First Responders Code 3
-BLS, ALS and First Responders Code 3

http://en.wikipedia.org/wiki/Medical_Priority_Dispatch_System


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## the_negro_puppy (Jul 9, 2013)

AMPDS determines our response.

To go L&S to all 911 / 000 / 999 calls is ridiculous considering the nature of most of the calls.


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## Mariemt (Jul 9, 2013)

We use them depending on the call. Whether we have a medic on board or not. 

Unresponsive patient, patient not breathing, CPR in progress, um.... seizure in progress. Car accidents with injury. All get lights and sirens to the call. Not always will they get l and s transporting. 

We do not transport imminent delivery of a baby unless we know for sure we have time. Delivering with a moving ambulance and woman strapped down isn't going to happen, we will deliver on scene or pull over. 

Medics will work most codes on scene, if medic not on scene, we load and go and lights and sirens used. We are not performing CPR enroute as that is dangerous, we use and autopulse to transport


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## Tigger (Jul 9, 2013)

In the fire district where I work fulltime, if you call 911 with a medical complaint you get an ambulance, engine, and shift captain all coming to emergent per the fire chief. We have EMD, but even Alpha level calls get all of this. If the patient requests no lights and sirens the captain has the option of downgrading the response. Crew discretion on transports, we very rarely transport emergent as a result. Exceptions include CVA, MI, and some unresponsives. Shift captain or chief can also make us transport emergently if we have pending calls so we can get back in service faster. I think the whole thing is silly, but oh well.

At my part time place we choose response priority. Most calls we respond to non-emergent unless it sounds obviously bad (difficulty breathing, unconscious, etc). Same thing with transports, we don't usually return hot since anything worth transporting emergent needs to go the city and there is a windy pass to descend to get there that you can't drive faster than 40-45 to get down smoothly. I like this a lot better.


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## Superlite37 (Jul 9, 2013)

Depends on the call. SOB, MVC, Chest pain, major trauma and of course the unresponsive/arrest, would get Lights and Sirens. Also if the truck is on its way back from a call, and have a long ETA, we generally light it up.  Also depending on the call, dispatch will put a bird on standby, or auto lift one.  But I work in a county where the nearest hospital is 25 to 35 miles away, depending on what base your working out of, we have two. Our average transport time is close to 40 mins, and that's just to the nearest facility, which is not a trauma center, but does have a great cath lab.


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## NomadicMedic (Jul 9, 2013)

ALS responds to Charlie/Delta/Echo calls with lights and sirens. 

Most (98%) of transports are cold.


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## Anonymous (Jul 10, 2013)

Response to all calls with lights and sirens.

BLS transports no lights or sirens.

ALS transports lights and sirens. 

However for the most part I drove my ambulance how I wanted. I didn't run "hot" for all ALS calls just because that is how everyone else did it and there were times I felt the need to upgrade BLS transports based on the condition of my patient.


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## Christopher (Jul 10, 2013)

HaleEMT said:


> I would like to get an idea how EMS runs in different areas and your opinions on Lights/Sirens. What does your department consider as an emergency run vs non-emergency or lights vs no lights?
> 
> A little background on this is I work with three different organizations that run three different ways.
> 
> ...



B's system is broken, plain and simple. I don't even know if you can call that a real EMS system. They're just playing around as far as I can tell. Very unprofessional.

A and C seem fairly reasonable, except C's "if ALS is on board L&S"...

Our service did 129 lights and sirens to the receiving facility in the last year (7/2012-7/2013; 2219 calls for service, 1385 transports). 71 were by protocol (STEMI, Stroke, unstable-ROSC, Trauma), the rest were provider discretion. 

Basically only 5% were mandated L&S, and are fairly justifiably critical patients. Nota bene: this does not mean that any L&S usage is justifiable, but with a reasonable protocol in place you'll have a floor of less than 10%.

We routinely ask the question "why L&S?" during QA of calls where the provider chose to, because ambulance wrecks kills more people than you save by shaving off 1-2 minutes.


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## Nightmare (Jul 10, 2013)

*In my opinion*

I am in a similar situation as you, with a few minor differences. The volunteer agency I run with will only use L&S at the discretion of highest ranking member present within the department going to the call, so basically based on the dispatch information most common L&S responses are MVA's with a long travel time (our district is very large) and then with transports L&S are only used on cardiac, stroke and patients deemed unstable (diff breathers etc.) But the paid agency I work with uses L&S on EVERYTHING, even the people with tummy aches. My thought is that the only time L&S should be used is to clear intersections so you arent stuck waiting at red lights for extended periods of time. But gotta follow the rules of your agency in the end.


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## Bullets (Jul 10, 2013)

In all systems i work, use of L&S is at the crews discretion

Both are volunteer nights and paid days

We generally respond L&S for cardiac, seizure, unconscious/unresponsive, major trauma, and respiratory


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## DrParasite (Jul 11, 2013)

All calls with reports of illnesses and injuries get a L&S response.  People lie to dispatchers all the time, so I am not going to downgrade a response until a person with authority gets there.  been burned a few times with the "man down" being a cardiac arrest, a "person vomitting" being a cardiac arrest, a "fall victim" being a skull fx, etc.  Once personnel get there, they can downgrade or cancel responding units.  

Of course, as someone told me on either this forum or firehouse.com, the toe pain complaint might be referred pain from a diabetic who is actually having an abnormally presenting MI....

Transporting w/ L&S is at the crews discretion.  depends on where you are, how far the hospital is, city units w/ calls pending, time of day and traffic patterns, and most importantly, the patient's condition.  With the 2-5 minutes saved in a 20 minute transport really affect the patient's outcome?

We also transport more cardiac arrests than we should.... always with L&S.... not my call on that one....


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## Handsome Robb (Jul 11, 2013)

We use medical priority dispatching, the computer decides if we go code to the call or not by information given to the EMD. I know there are others around here that use the Clawson Cards as well.

Either EMT-I or P attends and RLS transport is on the medic's discretion.

It always makes me laugh when we transport someone from out of the area and they're floored that we aren't using the lights and sirens to transport them.


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## chaz90 (Jul 11, 2013)

Robb said:


> It always makes me laugh when we transport someone from out of the area and they're floored that we aren't using the lights and sirens to transport them.



Patients seem to ask me all the time why we aren't transporting emergently. Most of the time they're fairly satisfied with my answer that we only use those for patients that are imminently circling the drain and they're not at that point.


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## Tigger (Jul 11, 2013)

I like the people that whine about not getting transported emergent. I tell them that they should be happy to not be hearing them, as many of the patients that do get transported like that are awful close to hearing nothing ever again.


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## Chris07 (Jul 11, 2013)

> C| Paid EMS and IFT - All 911 responses get Lights/Sirens. If the call  is evaluated to be BLS only on arrival, transport is nonemergent with no  lights/sirens. If ALS is on board, lights/sirens are used. No leway on  either.


Exactly how we are here. 911 calls get a BLS Ambulance, BLS Engine, ALS Squad. If ALS jumps on board it's a code 3 transport...automatically.


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## NomadicMedic (Jul 11, 2013)

Chris07 said:


> Exactly how we are here. 911 calls get a BLS Ambulance, BLS Engine, ALS Squad. If ALS jumps on board it's a code 3 transport...automatically.



Sorry, but that is ridiculous. A BLS engine and ambulance along with an ALS squad is a waste of resources and an "automatic" hot transport is dangerous for everyone. Must be California.


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## Fox800 (Jul 11, 2013)

My last system did this
Alpha: EMS non-emergent, dispatched first responders in outlying areas only (also non-emergent).
Bravo: EMS code 3. Dispatched first responders only in outlying areas (also code 3).
Charlie/Delta/Echo: EMS code 3, first responders code 3 (everywhere in the county).


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## Chris07 (Jul 11, 2013)

DEmedic said:


> Must be California.



Nailed it. Total waste of resources...and I can't tell you how much BS I've taken L&S just because a medic jumped on board. Ex: headache x 45min with no other findings that should have been BLS but med control wanted it brought in ALS.
One of the many reasons why I want out.


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## Trashtruck (Jul 11, 2013)

I'd end up being a pt if I worked in California, which would be some sick, sick irony.

Where I work: L/S to everything.

You make the decision to use them or not on the way to the hospital.


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## DPM (Jul 11, 2013)

My system and the others near me that I have experience with all use EMD (Emergency Medical Dispatch.)

Calls are given an acuity level, either Alpha to Echo or 3-1, starting from BLS / BS up to the most emergent CPR in progress type calls.

When In doubt calls go out Priority 1(code 3) but can be downgraded Code 2 per EMD. 

Unfortunately, only Alpha and Level 3 calls are BLS.

Code 3 returns are the Medic's discretion. Most returns are Code 2. Life, limb or serious injury get Code 3 (usually anything that would require an alert, like trauma, Stroke, STEMI)


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## DarkStarr (Jul 15, 2013)

This thread makes me angry.  Seriously, turn the lights OFF!


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## chaz90 (Jul 15, 2013)

I find myself having a conversation with a different BLS crew almost once a week about why I want to go non-emergent. To some, this seems to mean "lights no sirens" to placate me yet still get to the hospital faster through traffic. I understand that they want to be back covering their district and not wait in beach traffic forever, but you can only deal with one call at a time. 

I was tossed up to the wheelwell of an ambulance last week when we had to brake really hard as we passed a vehicle on the right running lights after I had requested to transport cold. It's decidedly frustrating.


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## Christopher (Jul 15, 2013)

chaz90 said:


> I find myself having a conversation with a different BLS crew almost once a week about why I want to go non-emergent. To some, this seems to mean "lights no sirens" to placate me yet still get to the hospital faster through traffic. I understand that they want to be back covering their district and not wait in beach traffic forever, but you can only deal with one call at a time.
> 
> I was tossed up to the wheelwell of an ambulance last week when we had to brake really hard as we passed a vehicle on the right running lights after I had requested to transport cold. It's decidedly frustrating.



When I've had this problem in the past I've asked them to pull over to the side of the road and to get in the back and "help me for a second".

Once in the back, I explain to them that they can only help me if they slow down and drive with due regard, and if they do not slow down I will request another ambulance come and intercept us ("because I do not have the luxury of dying today"). If the other provider is interested in being helpful and driving with due regard I'll simply switch them out.

(I'll append this with the note that BLS crews request us to intercept rather than myself being on a fly car and riding along)


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## EMTnurse (Jul 15, 2013)

We are a hybrid paid/volunteer agency. We run lights and sirens to the scene of all calls, unless it's just a public service call that doesn't require any actual medical care. We then make the call when we transport to the hospital whether L&S are needed. Priority 1 always gets them. Priority 2 is case by case. Sometimes smooth and easy is preferable to balls out. Priority 3 and 4 no L&S. 

We also have a <15 min transport time from most of our run area, without using L&S, so that probably changes things. It's better, for us, to increase the chances of getting there safely vs. just a couple of minutes faster.


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## DrParasite (Jul 16, 2013)

chaz90 said:


> I understand that they want to be back covering their district and not wait in beach traffic forever, but you can only deal with one call at a time.


oddly enough, I find this attitude quite common, especially in two tiered systems.  The BLS has a responsibility to cover their first due, so they want to transport, drop off, and get pack in their primary as soon as they can.  The regional chase care ALS unit isn't in as much of a rush, because their response times are typically longer, and if they aren't available, oh well, the BLS should just transport rapidly to the closest appropriate ER.  Plus BLS almost always beats ALS to the scene, so a few extra minutes won't matter to the public perception, whereas the BLS gets crap because it took them FOREVER to respond.

Not saying you are wrong in your thinking, just pointing that out.


chaz90 said:


> I was tossed up to the wheelwell of an ambulance last week when we had to brake really hard as we passed a vehicle on the right running lights after I had requested to transport cold. It's decidedly frustrating.


probably wouldn't have happened if you were wearing your seatbelt, as is required by your agency's policy


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## chaz90 (Jul 16, 2013)

DrParasite said:


> probably wouldn't have happened if you were wearing your seatbelt, as is required by your agency's policy



Ah, but our SOPs state that we need to be seatbelted as often as possible depending upon patient care needs. I had unbelted to reach over and change the IV drip rate. I'm belted probably 80% of the time on the way to the hospital and 100% of the time on the way back.


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## CFal (Jul 16, 2013)

RI just passed a law excluding cops, FFs and EMTs from seatbelt laws


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## Trashtruck (Jul 16, 2013)

Brilliant!


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## TransportJockey (Jul 16, 2013)

CFal said:


> RI just passed a law excluding cops, FFs and EMTs from seatbelt laws



Ugh that's exactly the opposite direction of where it should be going


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## Handsome Robb (Jul 17, 2013)

CFal said:


> RI just passed a law excluding cops, FFs and EMTs from seatbelt laws



That's the dumbest thing I've ever heard. I'm no saint about my seatbelt in the back but I try to be. The cab is a totally different story, wheels don't roll without belts on.


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## Wheel (Jul 17, 2013)

Robb said:


> That's the dumbest thing I've ever heard. I'm no saint about my seatbelt in the back but I try to be. The cab is a totally different story, wheels don't roll without belts on.



Yeah, not sure what the point of this law would be. I understand that you can't always be buckled in. I know I'm not, but that doesn't mean you shouldn't be.


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## Handsome Robb (Jul 17, 2013)

Wheel said:


> Yeah, not sure what the point of this law would be. I understand that you can't always be buckled in. I know I'm not, but that doesn't mean you shouldn't be.



 Unless a firefighter or a cop is in the back of an ambulance or some tactical vehicle (think SWAT APC) there is no reason they should be exempt from seatbelt laws. I'm not totally sure how it works for FFs being belted while they're getting their SCBA on and what not in the truck mounted ones so I could see n exemption there for the little bit of time it takes to get envy thing squared away without the seatbelt in the way but that's about it.


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## wigwag (Jul 19, 2013)

We run L&S on nearly all responses, particularly since our dispatches are known to be wrong.  I've been called to a "teen not feeling well" only to roll up on him in full cardiac arrest!  Of course, I've also responded to "pregnant, full-term female hemorrhaging" only to determine, on-scene, epistaxis.  The only time we wouldn't go L&S to the scene is if the dispatcher, PD or first responder says, over the air or a recorded line, "precautionary" or "mental hygiene."  

From a legal perspective, they called 911 because (they believed) they were having an "emergency".  If I were called to the witness stand, I would have to answer why I took it upon myself to determine it wasn't an emergency.

From the scene to the hospital, it just depends on the condition of the Pt.  We don't employ hard rules.  The notion you wouldn't go L&S with BLS is crazy.  In NYC, as in many places, all trauma is BLS.  If I have a guy who fell 15-ft off a ladder and is unstable or potentially unstable, you won't find me stopping at red lights under the false notion that BLS is never emergent.


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## Tigger (Jul 19, 2013)

Robb said:


> Unless a firefighter or a cop is in the back of an ambulance or some tactical vehicle (think SWAT APC) there is no reason they should be exempt from seatbelt laws. I'm not totally sure how it works for FFs being belted while they're getting their SCBA on and what not in the truck mounted ones so I could see n exemption there for the little bit of time it takes to get envy thing squared away without the seatbelt in the way but that's about it.



Meh even with the in-seat SCBA there is still no excuse. I recall Denver Fire distributing a video showing how to get in the truck and put your seatbelt on so it wasn't tangled in anything and that one could dismount on scene and be good to go. 

The department whose station I run out of got rid of the option entirely due in part to poor seatbelt compliance from what I heard.



wigwag said:


> We run L&S on nearly all responses, particularly since our dispatches are known to be wrong.  I've been called to a "teen not feeling well" only to roll up on him in full cardiac arrest!  Of course, I've also responded to "pregnant, full-term female hemorrhaging" only to determine, on-scene, epistaxis.  The only time we wouldn't go L&S to the scene is if the dispatcher, PD or first responder says, over the air or a recorded line, "precautionary" or "mental hygiene."


There are few truly time sensitive emergencies where a couple minutes make any difference at all. The fact that you have occasionally showed up to a call and found a critical patient when you were not expecting one does not justify responding emergent all the time. I'd bet that the vast majority of the time that dispatch gets it right, or at least close in terms of priority. Some errors will be made, it's inevitable. A miniscule decrease in the error rate while putting my, my partner's, and the general public's lives in danger is not worth this change.



> From a legal perspective, they called 911 because (they believed) they were having an "emergency".  If I were called to the witness stand, I would have to answer why I took it upon myself to determine it wasn't an emergency.



I don't care if the patient _thinks_ they are having a true medical emergency, because odds are they are not. Needing an ambulance to go to the hospital and having a true, time sensitive medical emergency are not the same things. If, for the sake of argument, the patient has stubbed his toe and it hurts rull bad, the patient might think he is having an emergency. As medical professionals (or something like that), we know in fact that he is not having an emergency! At some point we have to call it like it is. In the days of EMD if it sounds like something that is not time sensitive, it probably isn't. 



> From the scene to the hospital, it just depends on the condition of the Pt.  We don't employ hard rules.  The notion you wouldn't go L&S with BLS is crazy.  In NYC, as in many places, all trauma is BLS.  If I have a guy who fell 15-ft off a ladder and is unstable or potentially unstable, you won't find me stopping at red lights under the false notion that BLS is never emergent.



Most BLS calls should be non-emergent. If you have a patient in back that would be better served by ALS then that's one thing, but systems that routinely do that are broken. If I fall off a 15 foot latter and am still conscious you can bet that I will be whining aggressively until someone comes to give me pain meds. This will be done before I am moved. That is what the standard of care is. Throwing me in back and driving emergent is about the opposite of what good care is.


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## lightsandsirens5 (Jul 19, 2013)

DesertEMT66 said:


> Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.
> 
> Not the best system.



Exactly the same here minus the fire response.

Every. Freaking. Call. Is dispatched P1. I hate it, despite what my username is....


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## EMDispatch (Jul 19, 2013)

Unfortunately we don't advise priority in my area... They tried a pilot test, and it failed miserably. So they mostly run hot to all calls, but we try to give them a good idea of the priority in our dispatches. Still, most just run hot. We also have automatic mutual aid in some areas, which also ignores priority. I'm never  a big fan of sending two different county ALS agencies plus volly units to a low priority sick person.


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## Tigger (Jul 19, 2013)

EMDispatch said:


> Unfortunately we don't advise priority in my area... They tried a pilot test, and it failed miserably. So they mostly run hot to all calls, but we try to give them a good idea of the priority in our dispatches. Still, most just run hot. We also have automatic mutual aid in some areas, which also ignores priority. I'm never  a big fan of sending two different county ALS agencies plus volly units to a low priority sick person.



Why did it fail?


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## EMDispatch (Jul 19, 2013)

Tigger said:


> Why did it fail?


 Apparently field units didn't follow the Alpha-Echo system. They just didn't want to deal with it, and they felt it wasn't benificial, or at least that's what we were told. I'd imagine we'd try to input it again, it's been at least 2 years since they've tried it


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## Tigger (Jul 19, 2013)

EMDispatch said:


> Apparently field units didn't follow the Alpha-Echo system. They just didn't want to deal with it, and they felt it wasn't benificial, or at least that's what we were told. I'd imagine we'd try to input it again, it's been at least 2 years since they've tried it



So they system didn't fail, the crew's just failed to implement it. 

That's too bad, sorry about that.


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## JMorin95 (Jul 21, 2013)

My service makes it 100% the crews choice on l and s response. Up to the person whether not we transport l and s. We tend to not use l and s unless the patient is unstable/critical.


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## highglyder (Aug 17, 2013)

Response priority is determined by the algorithm that our dispatchers follow.  Return priority is determined by us based on the patient's current and anticipated condition.


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## wigwag (Aug 17, 2013)

Tigger said:


> There are few truly time sensitive emergencies where a couple minutes make any difference at all. The fact that you have occasionally showed up to a call and found a critical patient when you were not expecting one does not justify responding emergent all the time. I'd bet that the vast majority of the time that dispatch gets it right, or at least close in terms of priority.



We are dispatched by PD and they do not give a priority.  So saying they get the "priority right" most of the time is simply not factual.  You are making the assumption that I'm given a priority and ignore it.



Tigger said:


> If, for the sake of argument, the patient has stubbed his toe and it hurts rull bad, the patient might think he is having an emergency. As medical professionals (or something like that), we know in fact that he is not having an emergency! At some point we have to call it like it is. In the days of EMD if it sounds like something that is not time sensitive, it probably isn't.



We are not EMD'd.  Again, you are making a lot of assumptions about my service and about me.  You have now made the assumption that we are being given a priority by an EMD.  The 911 call-taker is a patrol cop, working a rotation, who only asks one question if the Pt isn't the caller, and that's "is he breathing?"  If they say "yes, the person is breathing," then the cop tells us "the patient is conscious and alert."  !!  You heard me right.

This is why many dispatches have been wrong in terms of chief complaints.  There is no EMD and the dispatcher asks no questions as they aren't trained to ask them.  Our agency is not immune from being sued like the dispatcher (police) is.  I wish this wasn't the case, but it answers why we respond hot to most calls.

Now, proceed with telling us all why we are so wrong.


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## Tigger (Aug 17, 2013)

wigwag said:


> We are dispatched by PD and they do not give a priority.  So saying they get the "priority right" most of the time is simply not factual.  You are making the assumption that I'm given a priority and ignore it.



I did assume you had EMD, my bad. The place where I work also does not have EMD for 60% of our calls. They city we cover has it, the county we cover does not. 



> We are not EMD'd.  Again, you are making a lot of assumptions about my service and about me.  You have now made the assumption that we are being given a priority by an EMD.  The 911 call-taker is a patrol cop, working a rotation, who only asks one question if the Pt isn't the caller, and that's "is he breathing?"  If they say "yes, the person is breathing," then the cop tells us "the patient is conscious and alert."  !!  You heard me right.
> 
> This is why many dispatches have been wrong in terms of chief complaints.  There is no EMD and the dispatcher asks no questions as they aren't trained to ask them.  Our agency is not immune from being sued like the dispatcher (police) is.  I wish this wasn't the case, but it answers why we respond hot to most calls.
> 
> Now, proceed with telling us all why we are so wrong.



I'm not really making any assumptions about you there bud...

Where I work we get the same thing. Chief complaint and is the patient conscious/breathing. We still respond non-emergent to 80% of our calls. Sometimes the dispatcher messes up and forgets to provide important information and we show up non-emergent to a somewhat unstable patient. Oh well, even if we saved five minutes running hot, it is unlikely to have made any difference in outcomes. 

So yeah, not having EMD is not an excuse to run hot to every call. Period. You gain so little from doing it and risk quite a bit more.


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## BasicBek (Aug 17, 2013)

DesertEMT66 said:


> Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.
> 
> Not the best system.



Same here, however AMR is coming here to take over and apparently is changing out priority 2 patients to running cold. I disagree with this greatly, unless they plan to rectify how dispatch codes calls. Almost every critical patient I've had has come in as a 2.


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## PaulEMT (Aug 18, 2013)

We light 'em up code 3 lights/sirens every call.


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## ZombieEMT (Aug 18, 2013)

I love the feedback that this thread has created, as I feel this is an important issue in EMS. I am happy to see that many areas are pushing towards no lights/sirens on most transport. I believe it is safer for the providers, patients and other drivers. 

On a positive note, I have been told that New Jersey had put out new guidlines (not protocols) that state patients should not be transported lights/sirens unless ALS is indicated. They also state lights/sirens are not indicated for patient's in cardiac arrest due to the high risks of lights/sirens compared to probability of positive outcome from cardiac arrest. However, I feel that this is something many people are not onboard with.


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## TransportJockey (Aug 18, 2013)

PaulEMT said:


> We light 'em up code 3 lights/sirens every call.



What's the thought process, if there is one, behind an outdated and dangerous practice like that?


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## DesertMedic66 (Aug 18, 2013)

TransportJockey said:


> What's the thought process, if there is one, behind an outdated and dangerous practice like that?



Could be what the public wants. That's how it is for us right now, when 911 is called you get a lights/siren response from fire and ambulance. In order for us to keep our contract we have to keep the public happy :glare:


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## Scott33 (Aug 18, 2013)

PaulEMT said:


> We light 'em up code 3 lights/sirens every call.



1976 just called...


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## PaulEMT (Aug 18, 2013)

TransportJockey said:


> What's the thought process, if there is one, behind an outdated and dangerous practice like that?



I don't know waht you mean? If you call 911 then you get lights/sirens, code 3. Always. It's the protocol we follow.


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## TransportJockey (Aug 18, 2013)

PaulEMT said:


> I don't know waht you mean? If you call 911 then you get lights/sirens, code 3. Always. It's the protocol we follow.



Just what I said. It's an outdated and dangerous practice.


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## PaulEMT (Aug 18, 2013)

It's more dangerous to wait for red lights when the PT is bleeding out.


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## TransportJockey (Aug 18, 2013)

PaulEMT said:


> It's more dangerous to wait for red lights when the PT is bleeding out.



Lol thanks I needed that. Studies show you're gonna save very little time. I take it that you are probably in favor of transporting cardiac arrests too?


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## PaulEMT (Aug 18, 2013)

TransportJockey said:


> Lol thanks I needed that. Studies show you're gonna save very little time. I take it that you are probably in favor of transporting cardiac arrests too?



I'm an EMT. Are you? I am only here to help people.


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## Scott33 (Aug 18, 2013)

So would you transport a cardiac arrest?


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## BasicBek (Aug 18, 2013)

With the way roads and traffic are here, we save a very significant amount of time by going emergent to every call. A lot of the time the issue is the response distance because this is one of the busiest systems in the world and trucks are always on calls and when 5 go out at a time, that 6th one might have a truck responding from 10 + miles.

There certainly are a great deal of calls that shouldn't have required an emergent response, but like I said before some of my most critical patients have come out as priority 2 (non-life threatening) calls. So it seems in patients best interest to run hot.

Transporting to the hospital is almost always going to be a code 3 transport (code 3 here is what code 1 is basically everywhere else), its non-emergent. But code 1 applies quite often too. We are 100% ALS here.


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## BasicBek (Aug 18, 2013)

Scott33 said:


> So would you transport a cardiac arrest?



In what case? Protocols everywhere are different. There are certain things that require we transport a pt in cardiac arrest. If we got a pulse back at any point during the code for example.


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## Scott33 (Aug 18, 2013)

BasicBek said:


> In what case? Protocols everywhere are different. There are certain things that require we transport a pt in cardiac arrest. If we got a pulse back at any point during the code for example.



If you get a pulse back they are not in cardiac arrest.


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## BasicBek (Aug 18, 2013)

Scott33 said:


> If you get a pulse back they are not in cardiac arrest.



No duh. I said at any point, even if the pulse is lost again you still have to transport.


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## NomadicMedic (Aug 18, 2013)

This is an interesting thread. Let's not let this degrade into name calling and hyperbole.

As several posters have mentioned, the rationale behind running red lights and sirens to every call is flawed. Studies have shown that there is very little time saved between a hot and cold response, and patient outcome has not been affected. MEDIC in Charlotte has done extensive research on response and transport times and the information is readily available.

I understand that public perception may play a part in determining your response mode, but it is dangerous and outdated to respond to every call with lights and sirens.


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## BasicBek (Aug 18, 2013)

I can understand that over all it may not change patient outcome but there is still a great handful of calls that would've had a much worse outcome if we had gotten there by 24:59 vs 8:59. And if there is that fair of an amount of chance the patients fast response and care shouldn't have to suffer. I have had multiple instances, one where it was a priority 2 sick person, for high bp for example, no other symptoms, if we had responded cold priority 2 status (because chances are we would've been pulled from the call for a priority 1 elsewhere) then we would've been being called to a cardiac arrest instead because that very patient coded on us just minutes after she got in our truck and we got there in about 4 minutes. She got immediate CPR and full ALS and we got her back.


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## ZombieEMT (Aug 18, 2013)

PaulEMT said:


> It's more dangerous to wait for red lights when the PT is bleeding out.



PaulEMT - I do not think anyone is suggesting that there is never a response with lights/sirens, but more based on the priority in dispatch. If we get a report that a patient is bleeding out, lights/sirens might be warranted.


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## cprted (Aug 18, 2013)

I'm a little dumbfounded that there are services that run L&S to every call just because someone called 911.  Maybe things are different south of the 49th, but here, people have no qualms calling 911 because they broke their finger, they've been feeling nauseous for five days, have a tummy ache, etc ...


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## Medic Tim (Aug 18, 2013)

cprted said:


> I'm a little dumbfounded that there are services that run L&S to every call just because someone called 911.  Maybe things are different south of the 49th, but here, people have no qualms calling 911 because they broke their finger, they've been feeling nauseous for five days, have a tummy ache, etc ...



my first ems job was in the US. We responded lights and siren to everything then it was our choice to the hospital. Our dispatchers were the hospital switchboard operators who were put through a day of training by the hospital.(hospital run ambulance service) They are/were not EMDs. they would simply relay us the address and a chief complaint and keep track of our times. 

there are several area in the states that use forms of priority dispatch like most places in Canada use. The pt's we see are also about the same. There is a lot of abuse and bs calls on both sides of the border.


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## NomadicMedic (Aug 18, 2013)

Most services are now using some type of priority dispatch. This is eliminating red light and siren responses when they're not warranted. Clawson is quoted in an article saying that ambulance/rescue response related accidents decreased by 76% following the institution of priority dispatch codes. Now, I don't know how they managed to correlate that data, but I would think that an ambulance traveling with the flow of traffic, without excessive speed or their warning devices operating, would be less likely to be involved in a traffic collision than those with warning equipment operating and exceeding the speed limit. It just seems to make sense, doesn't it?

Studies have shown, the time savings and increase in positive patient outcome that everybody seems to talk about, simply isn't there.


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## ZombieEMT (Aug 18, 2013)

I do believe that part of the issue with driving lights and sirens has do with the drivers. Lights and sirens are not a free pass to drive like a crazy person or violate any traffic laws. Light and sirens are simply warning devices, that help to move traffic when responding. Speed limits are posted for safety, that does not change because you are an ambulance. I see many of my partners that feel that they should go faster due to using lights and sirens. 

Some people also forget the importance of actually stopping at a red light while using light/sirens. It is still very important to stop at the light and ensure that all traffic has STOPPED before preceeding through. I never assume someone is stopping, even if they appear to be slowing or have cars stopped in front of me.

I had a friend of mine in an ambulance accident who proceeded through an intersection going lights and sirens, assuming the car was going to stop because the one in front of him did. Unfortunately the car decided to go around the stopped car and smashed right into the ambulance. My friends partner will never walk again as a result.


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## EMDispatch (Aug 18, 2013)

DEmedic said:


> Clawson is quoted in an article saying that ambulance/rescue response related accidents decreased by 76% following the institution of priority dispatch codes.



http://www.emergencydispatch.org/articles/donoharm1.htm

It's pretty far down in the discussion on MPDS, but the statistic specifically comes from Salt Lake City.


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## NomadicMedic (Aug 18, 2013)

EMDispatch said:


> http://www.emergencydispatch.org/articles/donoharm1.htm
> 
> It's pretty far down in the discussion on MPDS, but the statistic specifically comes from Salt Lake City.



Thanks. For some reason I thought it was Miami.


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## TransportJockey (Aug 18, 2013)

Y'all forgot the biggest reasons for stupid policies like all calls receive a code three responses. This is fire and ems. Years of tradition unimpressed by progress


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## Bullets (Aug 18, 2013)

PaulEMT said:


> It's more dangerous to wait for red lights when the PT is bleeding out.





PaulEMT said:


> I'm an EMT. Are you? I am only here to help people.



Dont feed the troll guys

I think it was Houston, it was definitely a major Texas metro area, that did another study that showed RLS (EWD in NJ) save no clinically significant time. 

My agency just wrote a policy on RLS, we are only required to respond with RLS to the following:

a)	All ALS calls
b)	All working fires
c)	All MVC with known or suspected entrapment
d)	Emergency rescue and special operations (Technical Rescue, Water Rescue)

EMS provides all rescue services to the municipality. 

And to an earlier poster, yes, NJDOH-OEMS released an updated vehicle operations guide that strongly discouraged RLS for transport and suggested it may not be needed for response.

Unfortunately, Division of Fire Safety refuses to address this, resulting in Fire going hot to EVERYTHING, even is persons on scene downgrade


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## ZombieEMT (Aug 18, 2013)

Thanks Bullets - I actually did some research and was able to locate the guidlines.


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## EMDispatch (Aug 18, 2013)

A few more links on the subject of L&S studies, as well as the ambulance accidents.
Is Ambulance Transport Time With Lights and Siren Faster Than That Without?
Patient Outcome Using Medical Protocol to Limit "Lights and Siren" Transport
Dispelling Myths on Ambulance Accidents

Also an opinion piece by Dr. Clawson
Unecessary Light-and-Siren Use:  A Public Health Hazard


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## the_negro_puppy (Aug 18, 2013)

Its absolutely absurd to call L&S to all 911 calls. Even here we used AMPDS and most calls are over-triaged.


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## DrParasite (Aug 18, 2013)

TransportJockey said:


> What's the thought process, if there is one, behind an outdated and dangerous practice like that?


As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....

Are you judged on your response times?  I know our elected officials want a rapid response when 911 is called.  even if it just saves a 30 seconds to a minute, that helps.  if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace.  Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?

The other thing is as I have said before, garbage in, garbage out.  Just because the caller says the call is minor, doesn't mean the patient's isn't sick and dying.  Until a medically trained person arrives and assesses the patient, they could be dying, just the idiot caller says the person's toe hurts.

Yes, most calls don't even need an ambulance, a taxi ride to their PMD would probably suit 80% of the calls just as easily, but until you get a trained medical professional to that scene, you won't know for sure.


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## rmabrey (Aug 18, 2013)

Im on the fence. On one hand you get lights and sirens and the fire department for chronic back pain cause someone said the patient isnt alert. 

Then you have days where a 26-A-2 (blood pressure abnormality) but the complaint is ALOC and vomitting that turns out to be having an MI.


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## DrParasite (Aug 18, 2013)

rmabrey said:


> Im on the fence. On one hand you get lights and sirens and the fire department for chronic back pain cause someone said the patient isnt alert.
> 
> Then you have days where a 26-A-2 (blood pressure abnormality) but the complaint is ALOC and vomitting that turns out to be having an MI.


not only that, but you get the FD arriviing quickly, the family is reassured (the like the FD and their quick response, even if they don't do much except apply oxygen), and often all the FD can do is hold the patient's hand as they request an ETA, and then request EMS to expidate as they are taking a nice easy ride with traffic.

Perception is a big thing, and who is then viewed as the heroes, and who failed the patient?  remember, who will the family remember when budget time comes around, those who helped or those who arrived too late?


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## Tigger (Aug 19, 2013)

DrParasite said:


> As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....
> 
> Are you judged on your response times?  I know our elected officials want a rapid response when 911 is called.  even if it just saves a 30 seconds to a minute, that helps.  if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace.  Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?
> 
> ...



If response times had any bearing on patient outcomes that would be one thing, but they don't. If the elected officials think that's all that matters, perhaps someone should try and educate them? Maybe add in the extra danger that 100% emergent responses put the general public in?

Not to mention that the first example is ludicrous, I doubt there is any agency in the country that would run non-emergent to an auto vs. ped regardless of the manner that they are dispatched.


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## TransportJockey (Aug 19, 2013)

DrParasite said:


> As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....
> 
> Are you judged on your response times?  I know our elected officials want a rapid response when 911 is called.  even if it just saves a 30 seconds to a minute, that helps.  if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace.  Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?
> 
> ...



No we aren't judged on response times. Mainly because in my county we can have 2 minute responses, but we can also have 45+ minute responses because the vollies don't bother to respond to calls.


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## Bullets (Aug 20, 2013)

DrParasite said:


> As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....
> 
> Are you judged on your response times?  I know our elected officials want a rapid response when 911 is called.  even if it just saves a 30 seconds to a minute, that helps.  if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace.  Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?
> 
> The other thing is as I have said before, garbage in, garbage out.  Just because the caller says the call is minor, doesn't mean the patient's isn't sick and dying.  Until a medically trained person arrives and assesses the patient, they could be dying, just the idiot caller says the person's toe hurts.



If you want to get really technical, if your dispatchers are trained EMD, then your response time to having medically trained persons with the patient is effectively zero

My system is judged on patient outcomes


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## DesertMedic66 (Aug 20, 2013)

My system is judged on times. We (my company) signed a contract saying 90% of the 911 calls we will be on scene in under a certain amount of time (the county picks the time frame). If at any time we go below the 90% mark for 3 months in a row we loose our contract (possibly jobs) and another ambulance company will be brought in to take over our area. 

Some of our responses to our outlying areas are +45 minutes. In order to keep the 90% we have to run code to all 911 calls (unless an on scene crew determines we can drive non emergent, which never really happens). 

A lot of EMTs/Medics/Supervisors at my company know how dangerous driving code is, but we have to follow what's in the contract (what the public wants) or else we all risk loosing our jobs.


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## DrParasite (Aug 20, 2013)

Tigger said:


> If response times had any bearing on patient outcomes that would be one thing, but they don't. If the elected officials think that's all that matters, perhaps someone should try and educate them? Maybe add in the extra danger that 100% emergent responses put the general public in?


I wish that would work, but that is above my pay grade.  I'd make another comment, but it would sound incredibly racially insensitive.  

Not only that, but when the uneducated public wants something done, and wants quicker response times because the ambulance is taking too long, then the mayor will do whatever he can to keep the voters on his side, regardless of if their complaint is based in reality or not





Bullets said:


> If you want to get really technical, if your dispatchers are trained EMD, then your response time to having medically trained persons with the patient is effectively zero
> 
> My system is judged on patient outcomes


They all are, but they mayor and most of the citizens disagree with your opinion on response times.  And your first medical professional is the EMD, but they are still getting information from an uninformed citizen.


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## unleashedfury (Aug 22, 2013)

we use the Priority Dispatch code. Alpha - Echo

Its honestly up to the crew chief on the call to justify the L&S enroute. I work mainly nightshift so when the streets are dead, were just a pretty light show. I would say that 70% of our responses are non emergent. and there is the few that are hot no matter what. Pediatrics, Allergic Reactions, Respiratory anything that could be justified as a load and go patient based on dispatch information. 

Is the system flawed why yes, I had a patient the other night who was dispatched as Bravo sick person who we went to cold, to find out she was a unconscious stroke patient. However running hot would have saved us a minute at 3am? 

98% of our transports however are cold. 

Cardiac arrests transports are another I argue. Yes I am there to help people. However if after a significant amount of effort and resources have been utilized with no noted change. No defibrillation, asystole in all leads the prognosis is poor. Theres always gonna be that one who we did CPR for a half hour and we had ROSC. but those cases are far and few inbetween, yet the quality of life is poor afterwards.


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## Rialaigh (Aug 22, 2013)

Tigger said:


> *If response times had any bearing on patient outcomes that would be one thing, but they don't.* If the elected officials think that's all that matters, perhaps someone should try and educate them? Maybe add in the extra danger that 100% emergent responses put the general public in?
> 
> Not to mention that the first example is ludicrous, I doubt there is any agency in the country that would run non-emergent to an auto vs. ped regardless of the manner that they are dispatched.




This begs the questio

 Is the purpose of an EMS service to

1. Improve medical outcomes
 or 
2. To serve the public by having the highest patient satisfaction scores possible

 Because those are two distinctly different goals. 

If it is to improve medical outcomes then L+S is total crap 99% of the time.

However the current system is set up to serve the public. Do blankets have any effect on improved medical care, no they do not. However a blanket when it is cold is one of the biggest things an EMS crew can do to improve patient satisfaction. Do lights and sirens have any positive effect on any outcomes at all, no they do not. 

However L&S serves a very important role in public satisfaction. And because of this I think they are absolutely necessary on many calls from a management/money/patient satisfaction standpoint.


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## BasicBek (Aug 22, 2013)

Rialaigh said:


> This begs the questio
> 
> Is the purpose of an EMS service to
> 
> ...



Very well put. I agree 100%.


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## DesertMedic66 (Aug 22, 2013)

BasicBek said:


> Very well put. I agree 100%.



That nicely sums up my thoughts as well. When normal citizens hear the sirens they are thinking we are going to save a life. When a citizen hears the siren after calling 911 for their loved one it is a huge relief, at least that's how it was when I had to call 911 many years ago for my mom after she had a PE.


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## chaz90 (Aug 22, 2013)

Rialaigh said:


> This begs the questio
> 
> Is the purpose of an EMS service to
> 
> ...



On some level I agree with your assessment that much of our role is to increase patient satisfaction. There's a huge difference in giving a patient a blanket vs. running hot though. The potential of harm is vastly increased by Code 3 responses and transports whereas passing out blankets has only positive consequences. We've done this to ourselves. Years of running hot to and from everything has caused a public perception of "if we're not running lights and sirens, we must not care." If we've caused this ourselves with years of practice, we can certainly reduce it too. Let's keep emergent responses and transports where they really belong. They should be the exception rather than the rule, and they should be used to help move through clogged traffic, but not to vastly exceed the speed limit and drive like maniacs.


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## brian328 (Aug 22, 2013)

Fire (ALS) runs code every time. The BLS ambo  that does the actual transport does not (depending on the call). When fire/als is on scene they can upgrade the ambo or if the bls ambo has an extended response time they can be upgraded. Transport is code 2 or 3 depending on patients condition, traffic, etc. I think the system works well.


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## BasicBek (Aug 23, 2013)

DesertEMT66 said:


> That nicely sums up my thoughts as well. When normal citizens hear the sirens they are thinking we are going to save a life. When a citizen hears the siren after calling 911 for their loved one it is a huge relief, at least that's how it was when I had to call 911 many years ago for my mom after she had a PE.



Exactly, I imagine it is a huge relief. We read it on their faces every day when they see us walk through the door, and usually thanking us for a quick response.


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## Jim37F (Aug 23, 2013)

BasicBek said:


> Exactly, I imagine it is a huge relief. We read it on their faces every day when they see us walk through the door, and usually thanking us for a quick response.



That, IMO, is a big factor, albeit an intangible one. We may not be able to measure it scientifically, but it's a factor that should not be discounted. Yes we are clinicians responsible for treating and caring for our patients, but in the end, whether you're an emt/medic for a private for profit company, govt agency, hospital or volunteer, we're all ultimately public service agents. 

That's not to say we should run code to every call. The danger involved cannot be anymore discounted than the publics desire that when they have an emergency, emergency workers will respond emergent. 

Of course the majority of those calls won't warrant the danger of an emergent transport, and a proper dispatching set up can reduce the number of code 3 dispatches for non emergent situations. 

BUT a common theme I keep running into everywhere, is that dispatch information is notoriously unreliable. 

Yes running code is dangerous. But I also think the public we serve views it as a danger inherent by the very nature of our jobs, just like the dangers of being shot when you're a LEO or having a burning structure collapse on you as a firefighter. 

Of course that's not to say don't take measures to reduce the danger, such as not running code every call, or not driving like a madman when you do, don't be speeding and swerving like your playing GTA, and actually STOPPING and CLEARING Intersections. (I wonder how many accidents involving ambulances could be avoided just by doing that)


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## unleashedfury (Aug 23, 2013)

chaz90 said:


> On some level I agree with your assessment that much of our role is to increase patient satisfaction. There's a huge difference in giving a patient a blanket vs. running hot though. The potential of harm is vastly increased by Code 3 responses and transports whereas passing out blankets has only positive consequences. We've done this to ourselves. Years of running hot to and from everything has caused a public perception of "if we're not running lights and sirens, we must not care." If we've caused this ourselves with years of practice, we can certainly reduce it too. Let's keep emergent responses and transports where they really belong. They should be the exception rather than the rule, and they should be used to help move through clogged traffic, but not to vastly exceed the speed limit and drive like maniacs.



This is where we need to educate the public to change the perception of Emergency services. Like you said years and years of a specific practice has developed the perception of care vs don't care.


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## Tigger (Aug 23, 2013)

Jim37F said:


> That, IMO, is a big factor, albeit an intangible one. We may not be able to measure it scientifically, but it's a factor that should not be discounted. Yes we are clinicians responsible for treating and caring for our patients, but in the end, whether you're an emt/medic for a private for profit company, govt agency, hospital or volunteer, we're all ultimately public service agents.
> 
> That's not to say we should run code to every call. The danger involved cannot be anymore discounted than the publics desire that when they have an emergency, emergency workers will respond emergent.
> 
> ...



So because the public expects us to put ourselves into danger, we should?


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## Jim37F (Aug 23, 2013)

Tigger said:


> So because the public expects us to put ourselves into danger, we should?



No more so than our fellow first responders


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## Jim37F (Aug 23, 2013)

Stop and clear intersections, don't be swerving, only oppose when absolutely necessary, lights and sirens do not mean you have to speed, and more. Assume every other driver is a complete idiot and there will be a car going through that red light at the same time you are if you don't stop and clear first. 

I believe proper drivers training, reinforced regularly, and actually enforcing ECOC rules and punishing ambulance drivers that don't abide by them can and will have a significant impact on reducing the danger. On top of knowing when and when not to use this particular tool. 

And if you still wish you didn't have to run L&S, maybe it's time to transfer to an IFT only company or health care facility


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## Tigger (Aug 23, 2013)

Jim37F said:


> No more so than our fellow first responders



Public expectation of assumed risk has been managed by other agencies as as well. Firefighters now know better than to run into every burning building and the police don't get into high speed chases with every driver who attempts to elude. I haven't heard much of a public outcry over those things. If we stopped justifying silly, outdated policies with "it's what the public wants us to do," we would all be doing ourselves a favor. If we want to be considered part of healthcare this absolutely must happen. Even if the argument remains that EMS should remain just an "emergency service," putting ourselves at risk so we can reassure a misguided public who in all likelihood does not care how we deliver service still makes no sense. Many in government/healthcare/emergency services are guilty of pulling the "it's what the public wants card" without actually checking to see, you know, what the public actually wants. 



Jim37F said:


> Stop and clear intersections, don't be swerving, only oppose when absolutely necessary, lights and sirens do not mean you have to speed, and more. Assume every other driver is a complete idiot and there will be a car going through that red light at the same time you are if you don't stop and clear first.
> 
> I believe proper drivers training, reinforced regularly, and actually enforcing ECOC rules and punishing ambulance drivers that don't abide by them can and will have a significant impact on reducing the danger. On top of knowing when and when not to use this particular tool.
> 
> *And if you still wish you didn't have to run L&S, maybe it's time to transfer to an IFT only company or health care facility*



Or you could just go work for a more progressive agency that, for lack of a better phrase, gets it.


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## JPINFV (Aug 23, 2013)

Tigger said:


> So because the public expects us to put ourselves into danger, we should?



Sure... however only when the potential benefit outweighs the risks.


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## JPINFV (Aug 23, 2013)

Jim37F said:


> And if you still wish you didn't have to run L&S, maybe it's time to transfer to an IFT only company or health care facility



I wish I didn't have to do rectal exams... I'm still in medicine.


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## Tigger (Aug 23, 2013)

JPINFV said:


> Sure... however only when the potential benefit outweighs the risks.



Which is where the debate comes in...


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## JPINFV (Aug 23, 2013)

Tigger said:


> Which is where the debate comes in...




Well, yes. However there's a difference between "We take no risks... period" and "we take risks when appropriate." I think the public expects the latter, not the former.


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## Bullets (Aug 23, 2013)

Jim37F said:


> No more so than our fellow first responders



Do your cops run L&S to every call?

Then why should we?


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## Wheel (Aug 23, 2013)

Jim37F said:


> No more so than our fellow first responders



Where I'm from fire and LE don't run emergent to everything. I've beat LE to domestic situations only to stage and wait on them to get there non emergent because we had a policy to run hot to everything. If other agencies can justify not running emergent we should too, because it is a safety issue.


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## Rialaigh (Aug 23, 2013)

Tigger said:


> So because the public expects us to put ourselves into danger, we should?



Quite frankly, yes. If running hot was so much of a danger issue for EMS than agencies that run hot would have to pay their medics and EMT's more than agencies that don't, The best I can tell agencies that never run hot (IFT) have to pay their EMS more than most 911 agencies despite the fact that the job carries much much less risk. Clearly amount of risk is not an issue for the majority of EMS employees (judging by salaries of EMS systems that carry the highest risk). 

Firefighters running into every building and Police chasing every car is apples and oranges.

I am fairly sure firefighters run into basically every building with a person in it that is even remotely viable and many that are not. Police (I would venture) would also run code and chase a car if there was a kidnapped person in it. Thus we run code to every call that is even remotely deemed to be life threatening regardless of the statistics. 



EMS is a business, and we will ALWAYS (generally) do what benefits patient perception over what benefits patient outcome.


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## JPINFV (Aug 23, 2013)

Rialaigh said:


> Quite frankly, yes. If running hot was so much of a danger issue for EMS than agencies that run hot would have to pay their medics and EMT's more than agencies that don't, The best I can tell agencies that never run hot (IFT) have to pay their EMS more than most 911 agencies despite the fact that the job carries much much less risk. Clearly amount of risk is not an issue for the majority of EMS employees (judging by salaries of EMS systems that carry the highest risk).



The agencies that run lights and sirens often have less demand for EMTs and more supply of applicants than those that don't. Supply v demand is more important than level of risk. 

EMS is a business, and we will ALWAYS (generally) do what benefits patient perception over what benefits patient outcome.[/QUOTE]


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## Mariemt (Aug 24, 2013)

The state of Iowa now has us filling out lights and sirens forms every time we use them.

The state believes running hot is a danger to other drivers,  not just us. 

We fill it out with name, dispatch complaint. Our impression of patient and why they were used. Plus a copy of the run report.  When the state comes in and decides to look around, we better have it.

You see it isn't just about us driving safe. Iam considered our best driver. A hot response with traffic is my specialty. I was driving before I was certified.  I have SEEN people panic when we got behind them at lights. No worries,  I can get around.  But they panic and pull out in the intersection,  into traffic at a red light. 
I have seen people try to give me the right away by pulling into left oncoming traffic.
I have seen one person slam on her brakes and just sit there. . I was half worried she died of fear 

It isn't just about us driving safe. Citizens do the craziest things


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## Rialaigh (Aug 25, 2013)

JPINFV said:


> The agencies that run lights and sirens often have less demand for EMTs and more supply of applicants than those that don't. Supply v demand is more important than level of risk.



Point being that the supply of applicants is higher, meaning somewhere in there risking some amount of the reward of working emergencies is completely acceptable to the majority of EMS personnel, if it was acceptable they wouldn't apply for these jobs, they would take the higher paying lower risk jobs.


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## DesertMedic66 (Aug 25, 2013)

I guess we have it a little bit wrong in my area. 911 ambulance company has higher pay than the IFTs in my area.


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## Rialaigh (Aug 25, 2013)

DesertEMT66 said:


> I guess we have it a little bit wrong in my area. 911 ambulance company has higher pay than the IFTs in my area.



I think this is the exception rather than the norm, but idk, I know in my area they must pay people much better for IFT than 911 generally


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## Bullets (Aug 25, 2013)

DesertEMT66 said:


> I guess we have it a little bit wrong in my area. 911 ambulance company has higher pay than the IFTs in my area.



Pretty much how it is here, i dont know of any 911 agencies that pays less then the IFTs. Most municipals pay their EMTs $15-$21. The hyvrid agencies run by volunteers are a little less, around $14. IFTs come in around $12. 

Exception is CCT, obviously


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## rob the mexican medic (Aug 25, 2013)

HaleEMT said:


> I would like to get an idea how EMS runs in different areas and your opinions on Lights/Sirens. What does your department consider as an emergency run vs non-emergency or lights vs no lights?
> 
> A little background on this is I work with three different organizations that run three different ways.
> 
> ...




code 1 no lights and sirens - even if it came in 911

code 2 and code 3 lights and sirens


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## chaz90 (Aug 26, 2013)

rob the mexican medic said:


> code 1 no lights and sirens - even if it came in 911
> 
> code 2 and code 3 lights and sirens



If you're already running hot, what does going from Code 2 to Code 3 do? Make you drive with the lights on brighter or with louder siren volume? In all seriousness, that is great that you respond to some 911 calls Code 1.


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## JPINFV (Aug 26, 2013)

chaz90 said:


> If you're already running hot, what does going from Code 2 to Code 3 do? Make you drive with the lights on brighter or with louder siren volume? In all seriousness, that is great that you respond to some 911 calls Code 1.


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## chaz90 (Aug 26, 2013)

I almost said something about turning it up to 11, but I realized that would be silly of me. That would obviously be called Code 11, and they haven't even progressed through Codes 4-10 yet!


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## Achilles (Aug 26, 2013)

Alright since it hasn't been asked, I need to know.
If an EMT uses his siren and no one is around to hear it, does it make a noise?


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## NomadicMedic (Aug 26, 2013)

Achilles said:


> Alright since it hasn't been asked, I need to know.
> If an EMT uses his siren and no one is around to hear it, does it make a noise?



Of course, because the EMT heard it and made a YouTube "cool. I'm responding code 3" video.


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## STXmedic (Aug 26, 2013)

DEmedic said:


> Of course, because the EMT heard it and made a YouTube "cool. I'm responding code 3" video.



:rofl:


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## rob the mexican medic (Aug 26, 2013)

chaz90 said:


> If you're already running hot, what does going from Code 2 to Code 3 do? Make you drive with the lights on brighter or with louder siren volume? In all seriousness, that is great that you respond to some 911 calls Code 1.





it means we can drive 10 mph faster. and more importantly it means we can't get re routed when were on a code 3.


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## Medic Tim (Aug 26, 2013)

rob the mexican medic said:


> it means we can drive 10 mph faster. and more importantly it means we can't get re routed when were on a code 3.



so code 2 is Lights and siren but you follow the speed limit or speed limit +10 and can get diverted to a higher priority call?


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## rob the mexican medic (Aug 26, 2013)

Medic Tim said:


> so code 2 is Lights and siren but you follow the speed limit or speed limit +10 and can get diverted to a higher priority call?



correct . code 2 is lights and sirens but following the speed limit. You can get diverted to another call.

code 3 is lights and sirens and 10 mph over speed limit. You cannot get diverted from a code 3 except in some extreme circumstances.


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## emt11 (Aug 30, 2013)

rob the mexican medic said:


> correct . code 2 is lights and sirens but following the speed limit. You can get diverted to another call.
> 
> code 3 is lights and sirens and 10 mph over speed limit. You cannot get diverted from a code 3 except in some extreme circumstances.



I find this interesting.

My system does not use the code 1,2,3 system. 

We use...wait for it... emergency or ambulance only :glare:. The emergency calls are L&S and ambulance only is typically no L&S, sometimes we do go L&S depending on the call notes and the address. 

Also, the medic has to tech every call even if someone literally called 911 with no complaint and wanted an ambulance to take them to the hospital. Not the best system with that. Since we are a busy system our medics have gotten very tired of having to tech every call and it gets tiring only being able to drive for 12 hours. Granted most of our medics are nice and let us start IV's, place 4 or 12 leads, give meds, etc.


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## ZombieEMT (Aug 31, 2013)

So making a patient a Code 3 vs Code 2 means that you can drive recklessly and break state law?

Unfortunately the one agency I work for, we have an expedite term which is when we speed up, dangerours! Also, this same company treats a reduced speed assignment as just slower.

My other agency, expedite does not exist. If going lights and sirens it is assumed you are already going max speed (which is the speed limit). We dont go fast and drive like a maniac if the patient is reported to be in any worse of a condition.


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## DesertMedic66 (Aug 31, 2013)

HaleEMT said:


> So making a patient a Code 3 vs Code 2 means that you can drive recklessly and break state law?
> 
> Unfortunately the one agency I work for, we have an expedite term which is when we speed up, dangerours! Also, this same company treats a reduced speed assignment as just slower.
> 
> My other agency, expedite does not exist. If going lights and sirens it is assumed you are already going max speed (which is the speed limit). We dont go fast and drive like a maniac if the patient is reported to be in any worse of a condition.



He may not be breaking state law. It all depends where your at. In CA I believe there is no state law on how fast we can go in code 3 operations (L/S) but company policy is no more than 10mph above the posted limit not to exceed 75mph.


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## STXmedic (Aug 31, 2013)

HaleEMT said:


> So making a patient a Code 3 vs Code 2 means that you can drive recklessly and break state law?


Can you quote where he said this? I can't seem to find it... :unsure:


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## hobozach (Aug 31, 2013)

HaleEMT said:


> A| Volunteer Department - We classify and emergency run as something with significant risk of lift, limb or eminent childbirth. Just because someone dials 9-1-1 does not mean that they will get a response with Lights/Sirens. Lights/Sirens is based on report and whether or not significant risk exists. In fact more than often, lights/sirens do not get used.* If BLS, no lights/sirens ever in transport*, if ALS up to ALS decision. Additionally some calls never get a light/siren response ie anything with stand-by/staging, mental health or lift assist.



If you have a BLS crew you go to the hospital cold on codes, traumas, strokes, ect.? Damn, unless I misunderstand that statement, it looks like your policy needs reviewing.


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## Medic Tim (Aug 31, 2013)

hobozach said:


> If you have a BLS crew you go to the hospital cold on codes, traumas, strokes, ect.? Damn, unless I misunderstand that statement, it looks like your policy needs reviewing.



I would hope everyone ( who actually transport codes) runs no lights and siren for them.(codes)


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## exodus (Aug 31, 2013)

Medic Tim said:


> I would hope everyone ( who actually transport codes) runs no lights and siren for them.(codes)



Everyone out here transports working arrests code 3.


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## chaz90 (Aug 31, 2013)

exodus said:


> Everyone out here transports working arrests code 3.



Easy. Don't transport working arrests. Full disclosure, I say that nonchalantly, but have a heck of a time actually implementing it where I am.


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## DesertMedic66 (Aug 31, 2013)

chaz90 said:


> Easy. Don't transport working arrests. Full disclosure, I say that nonchalantly, but have a heck of a time actually implementing it where I am.



Most medics out here are good about not transporting arrests. However by protocol the only arrest we don't have to transport are asystole or PEA <10 after 2 rounds of meds and no shocks


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## Akulahawk (Aug 31, 2013)

DesertEMT66 said:


> He may not be breaking state law. It all depends where your at. In CA I believe there is no state law on how fast we can go in code 3 operations (L/S) but company policy is no more than 10mph above the posted limit not to exceed 75mph.


Even when going Code 3, you must always drive with due regard for the safety of others. When you're going Code 3, you're the most hazardous/dangerous thing out on the road. Failure to drive with due regard is a very bad thing...


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## DesertMedic66 (Aug 31, 2013)

Akulahawk said:


> Even when going Code 3, you must always drive with due regard for the safety of others. When you're going Code 3, you're the most hazardous/dangerous thing out on the road. Failure to drive with due regard is a very bad thing...



Yeah I know. I was just pointing out that driving over the speed limit doesn't mean you are breaking a law while driving code.


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## Akulahawk (Sep 1, 2013)

DesertEMT66 said:


> Yeah I know. I was just pointing out that driving over the speed limit doesn't mean you are breaking a law while driving code.


Just to be certain, there have been a few times when I've had to take an E350 PSD up to where the rpm limiter prevented further acceleration. I wasn't breaking any laws... including "due regard" as it was safe (for others) for me to go that fast at the time. There were many times I've essentially gone with traffic flow because that was safest to do.


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## Achilles (Sep 1, 2013)

I'm sure it's been asked, but does anyone turn their lights off for freeway driving? Unless the accident is there.


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## Tigger (Sep 1, 2013)

Achilles said:


> I'm sure it's been asked, but does anyone turn their lights off for freeway driving? Unless the accident is there.



When I worked in Boston I generally did if traffic was moving at faster than I could drive safely. No point in doing 75 in the left lane with the lights on when you're getting passed on the right by people doing 85+.


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## Jim37F (Sep 1, 2013)

Achilles said:


> I'm sure it's been asked, but does anyone turn their lights off for freeway driving? Unless the accident is there.



In California, we're required to shut down lights and sirens on the freeway (unless you're responding to an incident on the freeway)


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## JPINFV (Sep 1, 2013)

Laminar flow vs turbulent flow. Even the wannabe plumbers should get that one.  



Jim37F said:


> In California, we're required to shut down lights and sirens on the freeway (unless you're responding to an incident on the freeway)




No... it's just highly highly advised.


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## Jim37F (Sep 1, 2013)

Akulahawk said:


> DesertEMT66 said:
> 
> 
> > He may not be breaking state law. It all depends where your at. In CA I believe there is no state law on how fast we can go in code 3 operations (L/S) but company policy is no more than 10mph above the posted limit not to exceed 75mph.
> ...



I completely agree with your sentiment Akulahawk, driving with due regard is vital, but it does have to be noted that in plenty of areas, driving 10mph over the posted limit means you're the slowest driver on the road lol

(Serious note, that's usually on the freeways where we aren't allowed to drive code anyway)


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## Jim37F (Sep 1, 2013)

JPINFV said:


> No... it's just highly highly advised.



Ah. I was always told in ride alongs and orientations and what not it was a statewide no-no to drive L&S on the freeway and seen enough other rigs t shut down while on the onramp and hit the lights on the off ramp I always just accepted it at face value it was a law somewhere


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## Akulahawk (Sep 1, 2013)

Jim37F said:


> Ah. I was always told in ride alongs and orientations and what not it was a statewide no-no to drive L&S on the freeway and seen enough other rigs t shut down while on the onramp and hit the lights on the off ramp I always just accepted it at face value it was a law somewhere


I have yet to see a law, regulation, or local rule by a governmental agency that requires me to shut down from code 3 travel when getting on or off a freeway. That being said, it would not be unheard of for a company to institute that rule and enforce it on their drivers.


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## JPINFV (Sep 1, 2013)

Akulahawk said:


> I have yet to see a law, regulation, or local rule by a governmental agency that requires me to shut down from code 3 travel when getting on or off a freeway. That being said, it would not be unheard of for a company to institute that rule and enforce it on their drivers.




Basically this. IIRC, there's a little blub in the DMV book discouraging it, but that's it.


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## DesertMedic66 (Sep 1, 2013)

Achilles said:


> I'm sure it's been asked, but does anyone turn their lights off for freeway driving? Unless the accident is there.



No point in using L&S on the freeways here. Traffic is already going 70mph (more like 80 in my area). So it would be pointless. Now if there is heavy traffic going slower than 15mph we can light up per company policy and cruise the shoulder of the freeways.


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## Jim37F (Sep 1, 2013)

Akulahawk said:


> I have yet to see a law, regulation, or local rule by a governmental agency that requires me to shut down from code 3 travel when getting on or off a freeway. That being said, it would not be unheard of for a company to institute that rule and enforce it on their drivers.



Hmm...come to think of it neither have I. Like I said I was always told don't do it, and seen enough other providers shut down on the freeway that I had just assumed it was a state thing. Looks like I'll have to investigate further. At the very least it is a no no at our company


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## hobozach (Sep 1, 2013)

Medic Tim said:


> I would hope everyone ( who actually transport codes) runs no lights and siren for them.(codes)



If there is no medic in the back we go hot to the hospital after 3 rounds of CPR on-scene.


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## xrsm002 (Sep 1, 2013)

Rialaigh said:


> Quite frankly, yes. If running hot was so much of a danger issue for EMS than agencies that run hot would have to pay their medics and EMT's more than agencies that don't, The best I can tell agencies that never run hot (IFT) have to pay their EMS more than most 911 agencies despite the fact that the job carries much much less risk. Clearly amount of risk is not an issue for the majority of EMS employees (judging by salaries of EMS systems that carry the highest risk).
> 
> Firefighters running into every building and Police chasing every car is apples and oranges.
> 
> ...



I worked for an IFT and running hot was fairly common. We had lots of calls we ran hot. My last day I ran an active MI transfer from the air ambulance to the ER hot.


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## xrsm002 (Sep 1, 2013)

rob the mexican medic said:


> correct . code 2 is lights and sirens but following the speed limit. You can get diverted to another call.
> 
> code 3 is lights and sirens and 10 mph over speed limit. You cannot get diverted from a code 3 except in some extreme circumstances.



From what I understand in different states or even departments in the same state code 1,2 & 3 can all mean something totally different. Code 1 no lights or sirens, code 2 lights no siren code 3 is both. I know in Texas if your running lights your required to have your siren on, I asked a friend of mine who is also a judge about that.


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## emt11 (Sep 2, 2013)

xrsm002 said:


> From what I understand in different states or even departments in the same state code 1,2 & 3 can all mean something totally different. Code 1 no lights or sirens, code 2 lights no siren code 3 is both. I know in Texas if your running lights your required to have your siren on, I asked a friend of mine who is also a judge about that.



From some friends that work at Grady in downtown Atlanta. Their system is Code 1 is lights and sirens, Code 2 is lights and sirens but can be re routed to a higher priority call and code 3 is no lights or sirens.


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## DesertMedic66 (Sep 2, 2013)

And for my company Code 1 means we know we have the call but we can take our time and get there when we want (code 1 is never used). Code 2 means no lights and no sirens but we have to head directly to the call, we can get diverted. Code 3 is Lights and Sirens. We can not get diverted to another call.


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## BasicBek (Sep 3, 2013)

Jim37F said:


> Stop and clear intersections, don't be swerving, only oppose when absolutely necessary, lights and sirens do not mean you have to speed, and more. Assume every other driver is a complete idiot and there will be a car going through that red light at the same time you are if you don't stop and clear first.
> 
> I believe proper drivers training, reinforced regularly, and actually enforcing ECOC rules and punishing ambulance drivers that don't abide by them can and will have a significant impact on reducing the danger. On top of knowing when and when not to use this particular tool.
> 
> And if you still wish you didn't have to run L&S, maybe it's time to transfer to an IFT only company or health care facility



I agree. Working at an ALS service that goes emergent (L&S) to every call, with little to no accidents, and being one of the busiest systems in the world, tells me our medics are driving correctly. If it's an issue in your service then people need to either be trained or move to an IFT service. Or maybe the public needs to be more educated. Everyone here knows who we are, we are in the public every second of every day because we post and do not have stations, everywhere we go we are talked to, waved at, and thanked on occasion. We run hundreds of calls in this city every day, everyone knows and people are pretty abiding to our needs to get to a call.


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## rmabrey (Sep 5, 2013)

hobozach said:


> If there is no medic in the back we go hot to the hospital after 3 rounds of CPR on-scene.



Why? They're dead. Bouncing down the the road while ATTEMPTING CPR only is only going to keep them there.


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## morbusstrangularis (Sep 7, 2013)

Interesting thread. I've worked for private companies only, one providing 911 services with the fire department (a horrible arrangement, don't get me started on that) and another that ran IFT and had contracts with nursing facilities. They would call us instead of 911, because just about anytime you call 911 here, you get a rig, an engine, and at least one LEO. They all usually come in hot, are loud, and would disrupt the (often senile and easily agitated) residents. 

For the 911 service, we ran hot to everything except SWAT standbys. Kind of pointless, in my opinion, as fire there thought they were gods, and although we were ALS, fire had medical and scene control - it was rare they wouldn't have at least one fire ride back in on everything. They probably would be better staffed with a single EMT driving the rig, that way the EMT couldn't point out that it might be a good idea to get a 12 lead and a line before giving nitro, but I digress... Emergent returns were at the discretion of the attending provider, no protocols for required C3 returns. 

For the private service, dispatch (without the aid of computers or cards) would decide response priority. More often than not, we came in non-emergent. Since we had contracts all over the greater metro area, sometimes we would run hot simply because we were greater than 10 miles away and the nursing facilities around here are not known for their good medical judgment. The owners of the company would also play fast and loose with these rules, sometimes just to impress a facility or client, we would be told to step it up to get to a hospital discharge; or the one time a BLS crew didn't call in for a refusal - they were told to run hot back to the scene to get the doc a piece of information they had forgotten. As far as emergent returns, company policy dictated that they were at the attending provider's discretion, however after determining exactly once that an emergent return was warranted (craziest thing, patient exhibited contralateral decorticate/decerabrate posturing and a severely altered LOC, my partner and I were like quad the :censored::censored::censored::censored due to the fact that it was rush hour and shortened our transport time from about 30 to 12 minutes, the company, for their own reasons, used it to discipline me. Essentially what I'm getting at is while they had a decent system for response priorities (depending on who was dispatching), they only played lip service to what was written in their handbook.


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## spnjsquad (Apr 10, 2014)

No matter what our BLS rig goes lights and sirens to scene unless told not to by dispatch. Sometimes we do use lights and sirens for BLS only transport, the only times that we don't are mental transports and anything stupid (like someone showing no obvious signs of severe distress).


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## Medic Tim (Apr 10, 2014)

spnjsquad said:


> No matter what our BLS rig goes lights and sirens to scene unless told not to by dispatch. Sometimes we do use lights and sirens for BLS only transport, the only times that we don't are mental transports and anything stupid (like someone showing no obvious signs of severe distress).




I hope you realize that the " anything stupid " calls are what keep us employed. A very poor attitude and outlook..... Especially for a student .


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## Handsome Robb (Apr 10, 2014)

Especially when you list psych transports as your example.


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## broken stretcher (Apr 10, 2014)

Our dispatchers us MPDS... medical priority dispatch system.  calls get classified as priority 1, 2, 3. Theres also priority 2 "condition white" which is a priority 3 call with the option of going hot (2) or cold (3)


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## spnjsquad (Apr 10, 2014)

Medic Tim said:


> I hope you realize that the " anything stupid " calls are what keep us employed. A very poor attitude and outlook..... Especially for a student .


Hey easy there. You should know what I mean by a "stupid" call. I shouldn't have used that word to describe it, but you should know what I mean. We have all been there with a paitent who has no legitimate reason for calling 911, and we have been there with paitents who lie about their suspected condition just to get a bed and meal for the night. Why don't you look at the "Most Rediculous Call" post?


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## spnjsquad (Apr 10, 2014)

Robb said:


> Especially when you list psych transports as your example.


Also, I never listed psych transports as stupid. I said that we do not use lights or sirens on them. Look at my above reply, then try to understand what I was trying to say.


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## Tigger (Apr 10, 2014)

spnjsquad said:


> No matter what our BLS rig goes lights and sirens to scene unless told not to by dispatch. Sometimes we do use lights and sirens for BLS only transport, the only times that we don't are mental transports and anything stupid (like someone showing no obvious signs of severe distress).



Why does your agency transport emergent to the hospital on most calls? The very vast majority of EMT patient encounters do not involve "severe distress" and even the ones that do can often be transported non-emergent without detriment to the patient.


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## AtlasFlyer (Apr 10, 2014)

We generally respond to all but the lowest priority calls with lights & sirens. We generally transport to hospital with no lights & sirens, the highest priority PTs are transported with lights & sirens. On my 12-hour night shifts (7pm-7am) we do 5-8 runs on average per shift and we'll transport with lights & sirens maybe once a week. Usually less. There's little traffic in the night, our transport times are minimal, and there's no value in going full lights/sirens for someone who doesn't _really_ need it.  Even when responding, after about 9/9:30 I'll usually have the sirens off when going through residential neighborhoods, using them only when approaching and going through intersections or when specifically needed. Why wake everyone up... I also don't drive at breakneck speeds. It's not worth the risk to myself, my partner and my truck to drive like a madman. 

I gotta admit I love the air horn though... and I will blast it when necessary. (Not often, but it's there when I need it.)


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## Medic Tim (Apr 10, 2014)

spnjsquad said:


> Hey easy there. You should know what I mean by a "stupid" call. I shouldn't have used that word to describe it, but you should know what I mean. We have all been there with a paitent who has no legitimate reason for calling 911, and we have been there with paitents who lie about their suspected condition just to get a bed and meal for the night. Why don't you look at the "Most Rediculous Call" post?




Wasn't trying to jump down your throat. Just irks me when people refer to calls as bs or stupid. We may not see or view it as an "emergency" but to them it can be very real. There are those that do fake and lie but there is usually an underlying cause.


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## spnjsquad (Apr 10, 2014)

Yeah I understand


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## EMTodd (Apr 11, 2014)

Lights and sirens for 911 calls and critical patients.


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## ZombieEMT (Apr 24, 2014)

EMTodd said:


> Lights and sirens for 911 calls and critical patients.


 
Do you believe this is appropriate for all 911 calls? Do all responses/transports get a lights/sirens response?


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## DesertMedic66 (Apr 24, 2014)

ZombieEMT said:


> Do you believe this is appropriate for all 911 calls? Do all responses/transports get a lights/sirens response?



Nope and nope. Anything I can do about it? Nope (unless I want to get fired). Company and county protocol are all 911 calls receive a lights and siren response from the fire department and ambulance company.


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