# Responding and Transporting Code 3



## CPRinProgress (Mar 5, 2013)

I have recently heard people talk about not wanting ambulances to drive lights and sirens to a scene and to the hospitals.  I don't see why anyone would not want to get to places as fast as possible.  Stroke as an example are time sensitive and if your having a stroke do you really want the ambulance stopping at lights and getting stuck in traffic.  That is just the nature of the job. Police catch bad guys, fire men put out fire, and EMS performs CPR in the back of an ambulance while blasting sirens and breaking traffic laws.  Plus its fun, first time I responded to a call I was in heaven.


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## DesertMedic66 (Mar 5, 2013)

Driving lights and sirens is extremely dangerous. We normally don't transport people with CPR in progress. The fun aspect goes away when you realize it's dangerous. 

It's also shown to not have much of an impact as far as time goes. Some studies say only a couple of seconds to a minute or 2.


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## Tigger (Mar 5, 2013)

CPRinProgress said:


> I have recently heard people talk about not wanting ambulances to drive lights and sirens to a scene and to the hospitals.  I don't see why anyone would not want to get to places as fast as possible.  Stroke as an example are time sensitive and if your having a stroke do you really want the ambulance stopping at lights and getting stuck in traffic.  That is just the nature of the job. Police catch bad guys, fire men put out fire, and EMS performs CPR in the back of an ambulance while blasting sirens and breaking traffic laws.  Plus its fun, first time I responded to a call I was in heaven.



How is it fun?


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## CPRinProgress (Mar 5, 2013)

Tigger said:


> How is it fun?



Well even if the person is in need of help you don't get an adrenaline rush from the sirens and responding to help people I find it fun.


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## RocketMedic (Mar 5, 2013)

You should change your attitude now, it will help you go farther and will prevent some serious mistakes.
I transport emergency when there is no good way to avoid it. My job is potentially dependant on my adherence to policies, and since those policies state that some patients must go emergency due to condition, they are transported emergency. That being said, my partner has learned well that mh emergent is a casual, slow, deliberate beast.


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## BeachMedic (Mar 5, 2013)

CPRinProgress said:


> Well even if the person is in need of help you don't get an adrenaline rush from the sirens and responding to help people I find it fun.



After you get some time on the job the siren gets really, really, annoying. Driving code 3 gets old too. Plus, it's dangerous. You should probably read up on the statistics of ambulance fatalities.

Driving a van 15 miles per hour over the speed limit isn't as exciting as jumping out of a plane, riding a wave, rappelling down a wall, or bombing downhill on a bike.


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## Rialaigh (Mar 5, 2013)

CPRinProgress said:


> Well even if the person is in need of help you don't get an adrenaline rush from the sirens and responding to help people I find it fun.



Responding code 3 is dangerous. The benefit from time saved is almost nothing. 

While (as someone with an economics background) you could argue that "fun" is a benefit to you it is not a benefit that can be provided at no cost. Other people should not have to "pay" for the expense of your fun. 


That said, dispatch and response times are a major measuring piece for quality control in many EMS systems. Until we change the underlying problem we won't see policy change.


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## CPRinProgress (Mar 5, 2013)

BeachMedic said:


> After you get some time on the job the siren gets really, really, annoying. Driving code 3 gets old too. Plus, it's dangerous. You should probably read up on the statistics of ambulance fatalities.
> 
> Driving a van 15 miles per hour over the speed limit isn't as exciting as jumping out of a plane, riding a wave, rappelling down a wall, or bombing downhill on a bike.



There are, according to an article I read says that there are about 52 fatalities involved with an emergency vehicles.  This number I believe is not very big when you look at all accidents that that take place. How many accidents would ambulances be involved in if they just drove normally.


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## VFlutter (Mar 5, 2013)

CPRinProgress said:


> Stroke as an example are time sensitive and if your having a stroke do you really want the ambulance stopping at lights and getting stuck in traffic.



Please explain how saving 6 mins off a transport time by running L/S is going to make a meaningful impact on your stroke patient's outcome. 

Have you ever seen a "code stroke" in a hospital? It is really not that exciting. No one is running around and sprinting to the med room for tpa. Even though it is an emergent situation it is actually a relatively slow process measured in hours not minutes.


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## ffemt8978 (Mar 5, 2013)

Depending upon distances, the time saved may or may not be insignificant.

We can save 15 minutes by transporting Code 2 or 3 on the rural highways and dropping to no code once we get to city limits.


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## CPRinProgress (Mar 5, 2013)

Chase said:


> Please explain how saving 6 mins off a transport time by running L/S is going to make a meaningful impact on your stroke patient's outcome.
> 
> Have you ever seen a "code stroke" in a hospital? It is really not that exciting. No one is running around and sprinting to the med room for tpa. Even though it is an emergent situation it is actually a relatively slow process measured in hours not minutes.



Yes I have but just because the hospital staff don't rush for these things doesn't mean the minutes don't count and impact the pt


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## BeachMedic (Mar 5, 2013)

ffemt8978 said:


> Depending upon distances, the time saved may or may not be insignificant.
> 
> We can save 15 minutes by transporting Code 2 or 3 on the rural highways and dropping to no code once we get to city limits.



If i'm on a rural highway and it's not busy chances are I will not light up. That's just me though.

I don't light up on the freeway either if i'm already going 75 mph and there are no cars in front of me. That's just me though. That is not my companies policy and not the way a lot of my co-workers drive.

Sometimes policy can be ....questionable...:unsure:


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## CPRinProgress (Mar 5, 2013)

BeachMedic said:


> If i'm on a rural highway and it's not busy chances are I will not light up. That's just me though.
> 
> I don't light up on the freeway either if i'm already going 75 mph and there are no cars in front of me. That's just me though. That is not my companies policy and not the way a lot of my co-workers drive.
> 
> Sometimes policy can be ....questionable...:unsure:



But if you're on a highway in dead stop traffic you will want to get going depending on the condition of the pt


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## BeachMedic (Mar 5, 2013)

CPRinProgress said:


> But if you're on a highway in dead stop traffic you will want to get going depending on the condition of the pt



I know that already.:wacko:


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## Milla3P (Mar 5, 2013)

What part of a stroke is fun? Ask a survivor. Or a stroke victim family member. 

Responding/transporting with L/S puts the driver/providers at increased risk of death, dismemberment or other injury. Getting hit by a flying portable O2 tank sounds awesome...

After racing at breakneck speeds through unpredictable traffic to transport a moderately sick person take the time to look around your local ED. Does the ED staff drop everything and start running and yelling like on TV? Count the minutes from the time of your initial intake report to the next time the ED staff enters the room. 

"Hurry up and wait!"

This Drive as fast as you can and put everyone on the road at risk of injury or death mentality puts everyone in our field back decades.


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## VFlutter (Mar 5, 2013)

CPRinProgress said:


> Yes I have but just because the hospital staff don't rush for these things doesn't mean the minutes don't count and impact the pt



I guess we will have to agree to disagree because I can already tell I won't be able to convince you otherwise. As you gain experience you will learn, or maybe not, that those minutes saved do not really count nor do they produce any positive impact for your patients except for a few specific situations. And strokes are usually are not one of them.  

It is all about risk vs reward.... "Fun" has nothing to do with it


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## Milla3P (Mar 5, 2013)

Side note: The original post makes me want to turn in all my training, experience and licensure as flip burgers for a living.


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## NYMedic828 (Mar 5, 2013)

CPRinProgress said:


> Yes I have but just because the hospital staff don't rush for these things doesn't mean the minutes don't count and impact the pt



Allow me to offer the opposite end of that spectrum.

"Haste makes waste."

We are professionals (hopefully) and professionals don't get excited/high strung over certain events in which they are expected to have seen before and know how to do their job for. We don't rush to get the job done at excessive speeds because we know that slowing down and taking an extra moment to ensure the proper steps are followed is more valuable than doing a poor job at a faster rate.


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## CPRinProgress (Mar 5, 2013)

Chase said:


> I guess we will have to agree to disagree because I can already tell I won't be able to convince you otherwise. As you gain experience you will learn, or maybe not, that those minutes saved do not really count nor do they produce any positive impact for your patients except for a few specific situations. And strokes are usually are not one of them.
> 
> It is all about risk vs reward.... "Fun" has nothing to do with it



Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.


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## NYMedic828 (Mar 5, 2013)

CPRinProgress said:


> Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.



Why is it unnecessary? 

Haf an hour, maybe. But most lights/sirens trips save 1-3 minutes depending on where you are.


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## CPRinProgress (Mar 5, 2013)

NYMedic828 said:


> Allow me to offer the opposite end of that spectrum.
> 
> "Haste makes waste."
> 
> We are professionals (hopefully) and professionals don't get excited/high strung over certain events in which they are expected to have seen before and know how to do their job for. We don't rush to get the job done at excessive speeds because we know that slowing down and taking an extra moment to ensure the proper steps are followed is more valuable than doing a poor job at a faster rate.



Or is it that people get desensitized to emergencies and therefore do not care as much.  Just wondering.


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## CPRinProgress (Mar 5, 2013)

NYMedic828 said:


> Why is it unnecessary?
> 
> Haf an hour, maybe. But most lights/sirens trips save 1-3 minutes depending on where you are.



Well you are stopped at a light no matter how long it is you begin to feel helpless that you could be getting this person to definitive care but you have to stop for a light


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## STXmedic (Mar 5, 2013)

CPRinProgress said:


> Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.



I'd argue and say the swaying and hard braking seen with emergent transports would cause an increase in anxiety in the patient and family. 

And personally, I love the red lights. Perfect time to get up and reach for something if need be. IVs? BPs? It's nice having a stagnant environment at times. If you're comfortable in knowing you can provide the care for your patient that they need, you won't feel rushed or "Get to the hospital ASAP!" at all.


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## Milla3P (Mar 5, 2013)

CPRinProgress said:


> Or is it that people get desensitized to emergencies and therefore do not care as much.  Just wondering.



This is preposterous. "Desensitized" to emergencies? Now you are just insulting people's professional disposition. 

Go ahead and click "Search" and look for a thread I believe is called "When will we stop transporting code"

You should probably read that.


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## medicsb (Mar 5, 2013)

OP, do you happen to live under a bridge?  I seriously can't tell.


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## NYMedic828 (Mar 5, 2013)

CPRinProgress said:


> Well you are stopped at a light no matter how long it is you begin to feel helpless that you could be getting this person to definitive care but you have to stop for a light



Nope I don't feel helpless.

Thankfully for me it is not up to the patient or family how I decide to drive. If I felt it warranted, I may proceed through the light in slow and controlled manor.





CPRinProgress said:


> Or is it that people get desensitized to emergencies and therefore do not care as much.  Just wondering.



No... Not really sure what else to answer that with but a no.

You have a what if to everything by this point in the thread.


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## STXmedic (Mar 5, 2013)

CPRinProgress said:


> Or is it that people get desensitized to emergencies and therefore do not care as much.  Just wondering.



Being calm and collected is not a sign of being desensitized. It's being confident (and typically experienced). I recognize when patients are in need of care quickly. That does not mean I have to lose my mind and become reckless.


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## usalsfyre (Mar 5, 2013)

CPRinProgress said:


> Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family


Just imagine the psychological effect of being dead.... 



CPRinProgress said:


> and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.


I've transferred ICU patients that are far, far more critically ill than the majority of patients transported code 3. I can count on one hand with fingers left over the number of times I've felt the need to transport these patients code. 

I think you said it all when you said "exciting", "fun" and "adrenaline rush". Some of us have come to realize how deadly serious that part of the job is though, and would prefer to go home to our families at the end of a shift rather than get an adrenaline rush.


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## Milla3P (Mar 5, 2013)

This "helpless" feeling comes from inexperience and insecurity. 

If you can't spend an extra 3 minutes with a sick person you should look for a new profession.


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## usalsfyre (Mar 5, 2013)

PoeticInjustice said:


> And personally, I love the red lights. Perfect time to get up and reach for something if need be. IVs? BPs? It's nice having a stagnant environment at times. If you're comfortable in knowing you can provide the care for your patient that they need, you won't feel rushed or "Get to the hospital ASAP!" at all.


Of course, when you're a BLS unit from a volunteer rescue squad and the medics refused to transport with you, you don't really have much else. I do feel for the guy in that aspect though (been there, done that, unfortunately have the t-shirt).


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## CPRinProgress (Mar 5, 2013)

Milla3P said:


> This "helpless" feeling comes from inexperience and insecurity.
> 
> If you can't spend an extra 3 minutes with a sick person you should look for a new profession.



Its not about the time but not doing anything when something can be done.  The bottom line is that it come down to a risk reward situation where people have to decide to take the risk.


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## Milla3P (Mar 5, 2013)

CPRinProgress said:


> Its not about the time but not doing anything when something can be done.  The bottom line is that it come down to a risk reward situation where people have to decide to take the risk.



Risk: Getting in a T-Bone accident causing a career/life ending injury, with other injured people as well. Not to mention being in the news (which I try to avoid at all costs) and possible disciplinary action for destroying an ambulance. 

Reward: Getting to the hospital 90 seconds sooner, doing it all over again. 

Sounds like a fair trade.


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## usalsfyre (Mar 5, 2013)

CPRinProgress said:


> Its not about the time but not doing anything when something can be done.  The bottom line is that it come down to a risk reward situation where people have to decide to take the risk.


We've established the risk, please explain the reward.


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## NomadicMedic (Mar 5, 2013)

I guess the question is: is driving with lights and sirens worth the risk to the patient and provider in the back? 

9 times out of 10 the answer is no. 

You're new and excited about the job. That's good. 

Don't get excited about the job for the wrong reasons. 

Lights and sirens don't save patients. Ever. 

The actions of the providers do that. Help them do their job by driving with due regard and not getting blinded by the "woo woo rush".


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## VFlutter (Mar 5, 2013)

CPRinProgress said:


> Or is it that people get desensitized to emergencies and therefore do not care as much.  Just wondering.



No not at all. Being desensitized to emergencies does not mean that a person does not care. When one of my patients codes my demeanor does not change at all. There is no yelling, no panic, no running around. Everything is calm and organized. I have actually had family members get frustrated that we are so calm because it does not "feel" like an emergency or what they expected. They expect people yelling out orders, running down the halls, etc. We all truly care about the patient. 

If you think that person yelling, panicking, and sprinting down the hallway with the crash cart bumping into walls and dropping supplies cares more than me by then all means request them when your family member codes. I wish you the best of luck.


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## Trashtruck (Mar 5, 2013)

CPRinProgress said:


> Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.



You are clearly new. In time, you'll become sick of the wail of sirens and find driving with them very, very annoying(and pretty much useless). 
As far as it being fun, if I were to bet, you will not find running lights and sirens 'fun' after doing it a few times.
As a medic sitting in the back with a pt(s), I often get asked why we aren't going through red lights, swerving through traffic, speeding, and all the other cool stuff that ambulances do on TV. I tell them, flatly, this isn't an emergency and that they are not used in non-emergent situations. 
I'm not going to 'play' with the ambulance like I'm in Grand Theft Auto so that the pt can feel psychologically comforted. 
Going through red lights, disobeying traffic laws, creating anxiety in other drivers, throwing people around in the back, and CREATING a hazardous situation is unnecessary.
When I drive lights and sirens, I drive no differently than when they are not on. Same speed. I still stop at all lights. I don't go off the road. I don't oppose traffic for more than a block. It's controlled. Just more flashy and loud.


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## ffemt8978 (Mar 5, 2013)

BeachMedic said:


> If i'm on a rural highway and it's not busy chances are I will not light up. That's just me though.
> 
> I don't light up on the freeway either if i'm already going 75 mph and there are no cars in front of me. That's just me though. That is not my companies policy and not the way a lot of my co-workers drive.
> 
> Sometimes policy can be ....questionable...:unsure:


Not so much policy as it is a requirement for the legal exemption from the speed limit.


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## Tigger (Mar 5, 2013)

I've given some broader thoughts, here's something n=1.

When I was taken to the hospital after hitting a tree skiing, the crew drove non-emergent in the rural areas and then emergent through the one town on the way to the hospital. 

The emergent part was a lot more painful. I know they were trying to get me to the hospital faster, but the harder stops, starts, and cornering actually made things more painful. The driver was by no means driving recklessly, but it was still more painful.

Not to mention that when you're riding backwards you cannot see the traffic so you cannot anticipate the use of the airhorn. Scared the crap outta me a few times and made my back lock up even worse.

It's a similar thing to "treating" pain with 02. Many think that the patient is being "reassured" that you are treating their problem, but many do the exact opposite. They thought their breathing was fine and now they're scared because you just clamped a mask on their face. The public perception of an ambulance racing to the hospital with a critical patient in back is very real. If you're hauling to the hospital, your not-so sick patient probably thinks they are in trouble.

Our patients do not know better, but we do.


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## Veneficus (Mar 5, 2013)

CPRinProgress said:


> Or is it that people get desensitized to emergencies and therefore do not care as much.  Just wondering.



I have actually been written up for "not sounding paniced enough" with a critical patient when I phoned med control during my EMS career.

Am I desensitized to emergencies? Absolutely.

But I go about my business with a calm and methodical precision. With trained accuracy my speed and efficency have been built.

I do not run around in a panic thinking my urgency is going to have any positive impact on the situation. 

I know that if I panic, everyone else in the room does. If I am calm, they are calm. 

Whether it is a newborn or a 100 year old, my process is the same. My results are self-evident.

It is hard to find patients critical enough to even be stimulating. People call me when they do. 

Whether or not I care is a judgement I will leave to others.


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## ffemt8978 (Mar 5, 2013)

Veneficus said:


> I have actually been written up for "not sounding paniced enough" with a critical patient when I phoned med control during my EMS career.
> 
> Am I desensitized to emergencies? Absolutely.
> 
> ...


This...it pays to remember whose emergency it really is.


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## chaz90 (Mar 5, 2013)

CPRinProgress said:


> Its not about the time but not doing anything when something can be done.  The bottom line is that it come down to a risk reward situation where people have to decide to take the risk.




You admit you haven't been doing this long. In this case, take the advice of those who have been doing this longer than you. We're not trying to tear you down, but instead attempting to teach you how to be a better provider. "Taking the risk" in this case is risking additional harm to your patient with no possible benefit. The vast majority of hot returns save a trivial amount of time that has been statistically proven to be non-beneficial in mortality benefits to patients. Even the "Golden Hour" is an obsolete concept that no longer holds water. As a disclaimer, the studies I cite here are just the first one I found on a quick Google search, and I am certain there are better ones out there. 

Fact 1: Driving emergently *does* increase the risk of being involved in an accident. 

http://www.purdue.edu/discoverypark/nextrans/assets/pdfs/completedprojects/Final Report 015.pdf

Fact 2: Lights and sirens responses and returns save a trivial amount of time in the vast majority of transport environments. 

http://www.ncbi.nlm.nih.gov/pubmed/10634288

An honest risk reward assessment that you suggested should lead us to transport significantly fewer to no patients using lights and sirens. One common statistical analysis used in medicine is number needed to treat vs. number needed to harm. In the case of emergent transport, the number needed to treat and potentially benefit one patient with a time sensitive emergency that can be affected by our 90 second transport reduction is much higher than the number needed to harm. This means I am statistically more likely to cause further harm to my patient by being involved in an ambulance collision than to help them by getting them to the hospital more quickly. 

As far as the specific situation of transporting patients while performing CPR, please see the thread regarding moving CPR vs. no CPR for further information. No need to beat a dead horse on that subject here.


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## chaz90 (Mar 5, 2013)

I apologize for the length of the previous rant. This subject happened to hit home after a course I had to attend tonight. I'm just really not a fan of the worship at the almighty altar of emergent transport that so many people I meet seem to adhere to...


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## Bullets (Mar 6, 2013)

Code 3 driving saves 60-90 seconds, nothing is that time sensitive. Nothing is worth killing yourself or others over. The days of traveling code 3 while doing CPR are numbered and shouldn't even occur. 

What changed my mind about a lot of things was a conversation I had with my uncle, a USMC Drill Sergent.  When they are teaching new Marines how to operate under fire they teach one concept "Slow Is Smooth, Smooth Is Fast "


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## Handsome Robb (Mar 6, 2013)

PoeticInjustice said:


> I'd argue and say the swaying and hard braking seen with emergent transports would cause an increase in anxiety in the patient and family.
> 
> And personally, I love the red lights. Perfect time to get up and reach for something if need be. IVs? BPs? It's nice having a stagnant environment at times. If you're comfortable in knowing you can provide the care for your patient that they need, you won't feel rushed or "Get to the hospital ASAP!" at all.



Agreed

Took my old partner a minute to get used to me asking him to pull over so I could start an IV. "Hey if you've got a good spot can I get a stop for an IV? If not, no worries."

No reason to blow a line when you can take the time to pull over and stop everything from moving.


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## katgrl2003 (Mar 6, 2013)

This past month, I lost 2 very close friends in an ambulance crash. They DIED.  I really don't think you understand the risk of driving emergent. I am not willing to risk anyone else in a crash for needless speed. My job is to go home at the end of the night, if I happen to save someone, that's extra. I and my coworkers are not going to die for your 'fun'.


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## Clare (Mar 6, 2013)

Driving with lights and siren is a huge risk; we recently changed our entire dispatch system to only go on a 1 to those calls that are immediately life threatening i.e. cardiac or respiratory arrest, patients who are still fitting, major bleeding, severe shortness of breath, cardiac chest pain, stroke with altered level of consciousness etc.

The time you save is not worth the risk unless the patient is status 1 i.e. immediately life threatening problem.


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## Bullets (Mar 6, 2013)

Robb said:


> Agreed
> 
> Took my old partner a minute to get used to me asking him to pull over so I could start an IV. "Hey if you've got a good spot can I get a stop for an IV? If not, no worries."
> 
> No reason to blow a line when you can take the time to pull over and stop everything from moving.



This aggravates me.  IV access isn't predicted on the responding type of an ambulance. What does the M in MICU stand for. Get in the truck and let's go or stay on scene and start your interventions, but don't tell me you can't start the line half way to the ER because the roads are bumpy


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## usalsfyre (Mar 6, 2013)

Bullets said:


> This aggravates me.  IV access isn't predicted on the responding type of an ambulance. What does the M in MICU stand for. Get in the truck and let's go or stay on scene and start your interventions, but don't tell me you can't start the line half way to the ER because the roads are bumpy



You speak of what you do not know. 

What difference does 15-30 seconds make?


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## RocketMedic (Mar 6, 2013)

Bullets said:


> This aggravates me.  IV access isn't predicted on the responding type of an ambulance. What does the M in MICU stand for. Get in the truck and let's go or stay on scene and start your interventions, but don't tell me you can't start the line half way to the ER because the roads are bumpy



Why not? What's the harm in pulling over to get a patent line vs a blown moving line? Same concept as the 20 that works beats the 16 that doesn't.


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## Achilles (Mar 6, 2013)

CPRinProgress said:


> Well I will not argue due to my lack of experience and training but think that the minutes saved have a psychological effect on the pt and family and think about the EMTs and medics in the back with the pt, you have a critical pt and you are sitting at a red light. I feel this is unnecessary.



Actually, the lights and sirens cause more anxiety in the pt.


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## Achilles (Mar 6, 2013)

Rocketmedic40 said:


> Why not? What's the harm in pulling over to get a patent line vs a blown moving line? Same concept as the 20 that works beats the 16 that doesn't.



Not just a line, AED, and hopefully it never happens in the truck but delivery as well.


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## 74restore (Mar 6, 2013)

Like the other's have said, lights and sirens can be dangerous. Does every vehicle always move for you and listen for lights and sirens? No. 

Sometime people have their radio or a/c turned up, and don't hear the sirens or see the lights coming until it's too late. 

Here: unless you want this to be you and your "critical patient", maybe code 3 is not the way to go in many situations. Just a glimpse of the back of the rig during a crash. Notice the flying sharps container too

http://www.youtube.com/watch?v=myZZtmpvB7g

I'm also not saying we should NEVER drive emergent, because in can be helpful in some cases.


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## Bullets (Mar 6, 2013)

usalsfyre said:


> You speak of what you do not know.
> 
> What difference does 15-30 seconds make?





Rocketmedic40 said:


> Why not? What's the harm in pulling over to get a patent line vs a blown moving line? Same concept as the 20 that works beats the 16 that doesn't.



I'm not saying don't start the line and take the time to get a good access. If we have a 2:1 or 4:1 provider to patient ratio then the patient gets better attention being with EMS.  Let's do the treatments on scene while the patient has multiple providers working on him. 

If the condition is so severe that we cant stay then we need to get you to an advanced care facility and IV access won't be beneficial.  

Add to that our local hospitals consider field starts "dirty" and like to pull them once the patient is in their care, it isn't beneficial to pull over for a stick


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## cruiseforever (Mar 6, 2013)

Does your service use Opticoms?  If they do what is your experience?


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## DesertMedic66 (Mar 6, 2013)

cruiseforever said:


> Does your service use Opticoms?  If they do what is your experience?



My service does use them. Generally it makes the ride more smooth and quicker due to every traffic light being green.


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## chaz90 (Mar 6, 2013)

Both services I've worked with use Opticom. They've been pretty hit or miss as far as I can see. The problem seems to be many of the intersections don't have sensors or just aren't calibrated correctly.


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## Mariemt (Mar 7, 2013)

Small town, we have ema. Emergency management guys who will block traffic for us to go through intersections as needed... we rarely run lights and sirens.


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## SSwain (Mar 7, 2013)

Having been in the back and in the driver's seat running L/S...I understand both mindsets.
Our rigs ride like lumbertrucks. Every turn and braking is magnifies due to being elevated in the box. 
In the box, a simple sweeping 35 MPH curve will easily set you off balance when driven at 35 MPH. In the driver's seat it isn't as noticeable.
The adrenaline "rush" from responding L/S can get the driver subconsciously driving faster and faster w/o realizing it. I find myself listening to the engine rpm more to guage my speed w/o having to look away from the road and other traffic.
Plus, after a 15 minute L/S run, by the time I got the the ED, my hearing was noticeably impaired. A night run will also play with your eyes with the strobe reflections off anything nearby.


Just my humble observations.


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## Veneficus (Mar 7, 2013)

SSwain said:


> Having been in the back and in the driver's seat running L/S...I understand both mindsets.
> Our rigs ride like lumbertrucks. Every turn and braking is magnifies due to being elevated in the box.
> In the box, a simple sweeping 35 MPH curve will easily set you off balance when driven at 35 MPH. In the driver's seat it isn't as noticeable.
> The adrenaline "rush" from responding L/S can get the driver subconsciously driving faster and faster w/o realizing it. I find myself listening to the engine rpm more to guage my speed w/o having to look away from the road and other traffic.
> ...



Just to point out, the fire service has done extensive research on the various configurations and intensity of warning lights, both in the day and at night. 

Any agency managers ordering trucks should probably be well versed with that body of literature.


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## slewy (Mar 7, 2013)

firefite said:


> Driving lights and sirens is extremely dangerous. We normally don't transport people with CPR in progress. The fun aspect goes away when you realize it's dangerous.
> 
> It's also shown to not have much of an impact as far as time goes. Some studies say only a couple of seconds to a minute or 2.




Are you serious? 1 or 2 MINUTES is huge.


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## chaz90 (Mar 7, 2013)

This isn't necessarily directed at any one person, but some of these posts really make me wonder if anyone is reading the rest of the thread before commenting.


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## Rialaigh (Mar 7, 2013)

slewy said:


> Are you serious? 1 or 2 MINUTES is huge.



I would do some research on this but if I had to venture a guess, 10 minutes isn't huge in 99.99% of transports. Certainly does not make a difference in most codes if you haven't gotten a pulse back yet.


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## kindofafireguy (Mar 7, 2013)

slewy said:


> Are you serious? 1 or 2 MINUTES is huge.



. . . I hope this was sarcasm. Hard to tell online.


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## Emtbob (Mar 7, 2013)

As I seem to have a different response area than most people responding to this thread, I feel I should reply.  

In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be.   Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.   

The standard around here seems to be an excessive amount of emergent transports though.   The mentality of care throughout the region is mostly scoop and go (even for ALS), and our protocols reflect that.   I don't even have a complete (or partially complete, lacking a fast acting steroid) algorithm for anaphylaxis, as apparently medics have trouble getting an IV started with a full assessment and maybe one medication given.

On the other hand, chiefs here can post some truly amazing numbers for our responses.   Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset.   The objective data there makes people very happy, at least in reports.   Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.


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## slewy (Mar 7, 2013)

100% agree


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## VFlutter (Mar 8, 2013)

Emtbob said:


> On the other hand, chiefs here can post some truly amazing numbers for our responses.   Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset.   The objective data there makes people very happy, at least in reports.   Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.



But how much of that is EMS transport time? And how much time was actually saved running code 3?

Quoting those times does not really mean much without a breakdown. A dispatch to balloon time of 35 minutes is exceptional but that does not tell me much about the EMS system since transport is the least complicated step in the process. It would however make me assume that the hospital and cath lab are very good at what they do.


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## Akulahawk (Mar 8, 2013)

Chase said:


> But how much of that is EMS transport time? And how much time was actually saved running code 3?
> 
> Quoting those times does not really mean much without a breakdown. A dispatch to balloon time of 35 minutes is exceptional but that does not tell me much about the EMS system since transport is the least complicated step in the process. It would however make me assume that the hospital and cath lab are very good at what they do.


In the downtown area of Sacramento, those times would not be uncommon at all. Why? That area has about a 5-6 minute response time, they tend to be on scene less than 10 minutes, and transport times to the hospital can be _maybe_ 10 minutes. As long as the cath lab is ready to go and the ED staff is confident (relatively speaking) in what they're getting, it's not impossible to have dispatch to needle/balloon times of < 40 minutes. 

In the more rural areas, in order to have such fast times, you'd have to have a helo.


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## medichopeful (Mar 8, 2013)

slewy said:


> Are you serious? 1 or 2 MINUTES is huge.



With the exception of certain situations, if 1-2 minutes is really that vital for the patient, they very well may not survive anyways.


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## Bullets (Mar 8, 2013)

Emtbob said:


> As I seem to have a different response area than most people responding to this thread, I feel I should reply.
> 
> In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be.   Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.
> 
> ...



Most of the people here work in urban/suburban areas

Overuse of L/S in the cities is more due to understaffing then need. Because there are not enough units to handle the calls, the units that are on are pressured to turn around quickly so they use the L/S to reduce their times. Seems to be common amongst the big city FD EMS agencies, philly, baltimore, NY and DC


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## Handsome Robb (Mar 8, 2013)

Bullets said:


> I'm not saying don't start the line and take the time to get a good access. If we have a 2:1 or 4:1 provider to patient ratio then the patient gets better attention being with EMS.  Let's do the treatments on scene while the patient has multiple providers working on him.
> 
> If the condition is so severe that we cant stay then we need to get you to an advanced care facility and IV access won't be beneficial.
> 
> Add to that our local hospitals consider field starts "dirty" and like to pull them once the patient is in their care, it isn't beneficial to pull over for a stick



I'm not sure what you're getting at. I sit on scene a lot. I've got no problem sitting on scene and getting stuff done. If I've got a real short transport absolutely I'll make sure everything is done that I want done before we turn a wheel, but if I've got some time to do stuff there's no reason to not get moving towards the ER. If I get everything done on scene what am I going to do for those 20-30 minutes on the ride in from one of our outlying valleys? I This is just something we'll have to agree to disagree. 




cruiseforever said:


> Does your service use Opticoms?  If they do what is your experience?



Meh, they work but you have to give them time to work, the light still has to cycle through being yellow, turning red then turning yours green. Plus when they change like that you still need to clear those intersections since it's usually an unexpected change and it can definitely mess with traffic. I've seen plenty of cars run through lights that have been changed by an opticom. 

Another problem is there are a couple different models and brands and they don't play nice. Also the traffic signals have to be equipped to read opticoms. 

FWIW they aren't including them on our new units from what I've heard.  



slewy said:


> Are you serious? 1 or 2 MINUTES is huge.



Give me two examples where this is true. Not trying to be an *** but there really isn't all that many cases where minutes make the difference. It's really frustrating transporting a stroke in code 3, clean the unit do another run and come back 40 minutes later to find them still sitting in the ER 



Emtbob said:


> As I seem to have a different response area than most people responding to this thread, I feel I should reply.
> 
> In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be.   Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.
> 
> ...



Heavy traffic situations are definitely one of those that you can save a substantial amount of time. There's a place for lights and sirens transport, it's just not as often as people like to think.


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## Rialaigh (Mar 8, 2013)

Robb said:


> *Heavy traffic situations are definitely one of those that you can save a substantial amount of time. There's a place for lights and sirens transport, it's just not as often as people like to think.*



I think this is crucial. As much as we may want to admit it or not I think the use of lights and sirens does not have much to do with how much of an "emergency" it is. Traffic situations are ones where use can be warranted. Heck, in some big cities with horrible traffic problems I could see using lights and sirens to navigate the streets at 5 miles an hour to get that "back pain" to the ER, simply so I am not spending an hour with the back pain. In those situations I think we can agree lights and sirens would only minimally (if at all) increase the risk of an accident, and I am talking about dead stand still traffic...


It's simply about cost benefit. I am more likely to run lights and sirens on a back pain if it will save me an hour over a 10 mile transport than on a code that would save me 2 minutes on a 10 mile transport. One greatly increases risk, the other does not. One saves lots of time which places your unit back in service (for high volume areas) the other does nothing to improve outcome or save time for yourself.


I am not advocating the use of lights and sirens for back pain but my point is....maybe we should evaluate the use of lights and sirens not on the basis of how much of an emergency this situation is. But cost/benefit....


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## Chris07 (Mar 8, 2013)

Robb said:


> There's a place for lights and sirens transport, it's just not as often as people like to think.



...unless you work in a system that's so *** backwards that all ALS runs, unless the medic specifically requests otherwise (which is extremely rare), is a L&S transport. I don't know how many people I've transported L&S for things that clearly don't need it, yet we have to because of the system's policy which dictates that if a medic is on board you have to transport L&S (Note: this is for 911). Also, all 911 calls get a L&S response.

The brilliant logic behind it all?
L&S Response: If the person called 911, they are having an emergency and who are we to determine what scale of emergency it really is? Run L&S in case it's serious. (I guess they've never heard of EMD).
L&S Transport with ALS: Get the medics back in service faster. (They are fire medics so they literally ride for the transport, transfer care to a nurse, and leave). 

Hmmm....can't beat that logic! <_<


I can say that the only real benefit to going L&S is during heavy traffic and when transporting someone who is unstable. An unstable pt is more likely to get immediate physician attention upon walking in the doors.


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## Mariemt (Mar 8, 2013)

We will use lights and sirens more often to get to a scene, than from scene to hospital. That being said, even that is rare..
We have a few patients in town that when we hear that address, we roll and we roll fast. Other than that. Unresponsive patients, choking children,choking anybody, drownings, cpr in progress  etc  will get me to flip my switch without hesitation.


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## Action942Jackson (Mar 8, 2013)

All our responses to the scene are L&S regardless of complaint.  As a rural provider do I take distance and traffic into consideration when I have a P2 (ALS) patient? Yes.  As we have 3 ambulances to cover 204 sq miles. It's a guaranteed 2 hours at the least for a 9-1-1 call from dispatch to available.  Do I run L&S for the stubbed toe or back pain. No.  Do I run it for that asthmatic that you can turn around with albuterol / methylpredisone? Yes.  

To urban providers L&S may not make a difference.  But in rural EMS where your next 9-1-1 call could be 50 miles outside of town and 70 miles to the ED. it truly does.


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## BeachMedic (Mar 8, 2013)

Action942Jackson said:


> All our responses to the scene are L&S regardless of complaint.  As a rural provider do I take distance and traffic into consideration when I have a P2 (ALS) patient? Yes.  As we have 3 ambulances to cover 204 sq miles. It's a guaranteed 2 hours at the least for a 9-1-1 call from dispatch to available.  Do I run L&S for the stubbed toe or back pain. No.  Do I run it for that asthmatic that you can turn around with albuterol / methylpredisone? Yes.
> 
> To urban providers L&S may not make a difference.  But in rural EMS where your next 9-1-1 call could be 50 miles outside of town and 70 miles to the ED. it truly does.



How busy are the rural roads?


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## Action942Jackson (Mar 8, 2013)

BeachMedic said:


> How busy are the rural roads?



Well considering that majority of rural roads are narrow two lane roads with ditches on either side.  With traffic oncoming and going with your flow.  Majority of our roads besides three 4 lane highways are back country roads where blind corners and large drop offs on the roads pose a decent threat to your response time.  As we are the most rural suburb of a large city, there's only one road coming from our county to the city (2 countys over) A wreck happens on that road.  Good luck your going no where.  Unless you double back 15 miles north to the interstate and add 29 more miles to your transport time.  

It's not like we have a 6 or 8 laner to open the throttle and hit cruise control.


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## Tigger (Mar 8, 2013)

Action942Jackson said:


> Well considering that majority of rural roads are narrow two lane roads with ditches on either side.  With traffic oncoming and going with your flow.  Majority of our roads besides three 4 lane highways are back country roads where blind corners and large drop offs on the roads pose a decent threat to your response time.  As we are the most rural suburb of a large city, there's only one road coming from our county to the city (2 countys over) A wreck happens on that road.  Good luck your going no where.  Unless you double back 15 miles north to the interstate and add 29 more miles to your transport time.
> 
> It's not like we have a 6 or 8 laner to open the throttle and hit cruise control.



So how does driving emergent help with any of this?


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## Mariemt (Mar 9, 2013)

Tigger said:


> So how does driving emergent help with any of this?



If I need to get to a scene on a two lane road and a factory has let out 300 employees .. its going to be hard to get there and around with the turning traffic, people slowing etc. If I have a certain patient where time is critical,  if I flip my lights, they will pull to the side, significantly reducing my response time.
We have 4 factories that all let out at the same time. Trying to get through that area and down that county road could be a problem during that half hour or so. A lot of people turning off and on ... 
90% of my calls dispatched do not require them, but I do see the point of the poster above, yes you can and will use them in more rural settings. It can be a challenge on two lane roads, not always but it does happen.

I was a driver before even attending EMT classes,  it is amazing how some people can react. You always have to watch yourself to make surd you don't get that tunnel vision,  plus the people you share the roads with.
we have two police officers on our squad. I had to go through emergency driving with them, plus a training officer. Was an eye opener.


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## Mariemt (Mar 9, 2013)

Sorry, I meant to quote Beach Medic


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## Veneficus (Mar 9, 2013)

Mariemt said:


> If I have a certain patient where time is critical,.



Just out of curiosity, how many of these patients have you had?


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## Clare (Mar 9, 2013)

Veneficus said:


> Just out of curiosity, how many of these patients have you had?



What is a "time critical" patient here has recently been reviewed and now makes much more sense.

Jobs will be dispatched lights and siren only if they are coded as "purple" or "red" - purple is cardiac or respiratory arrest and "red' is immediate threat to life; things like stroke, new cardiac chest pain > 35, seizure and still fitting, large burns, severe difficulty breathing, altered level of consciousness etc.  

Patients will be transported urgently (lights and siren) only if they have a problem that is immediately life threatening or time critical for example post-cardiac arrest, cardiogenic shock, GCS < 10, major trauma with multi system abnormality etc.

I have encountered very few (somewhere between 5 and 10) patients I would consider to be "time critical".


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## Veneficus (Mar 9, 2013)

Clare said:


> What is a "time critical" patient here has recently been reviewed and now makes much more sense.
> 
> Jobs will be dispatched lights and siren only if they are coded as "purple" or "red" - purple is cardiac or respiratory arrest and "red' is immediate threat to life; things like stroke, new cardiac chest pain > 35, seizure and still fitting, large burns, severe difficulty breathing, altered level of consciousness etc.
> 
> ...



I created a new thread and poll. Please select from there.


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## RocketMedic (Mar 9, 2013)

My answer to this is a hearty "I transport emergently when my agency's policies tell me I have no choice." As a relatively new employee still on 'probation', 100% of my charts are reviewed, and they do come down to things like 'return status'. Completely ignoring that my schedule essentially guarantees low-traffic, clear roads, BTW.

At the end of the day, I rarely have a truly valid medical reason for transporting emergently, but the potential personal financial consequences of being unemployed cause me to transport emergently. "When in doubt, think of how it will look on your paperwork and react accordingly." (a quote I hold in very high regard). I have very little desire to be fired due to 'overconfidence' or whatever excuse may be used, so I simply toe the line and don't provide ammunition. That being said, my partner's 'emergent' driving is quite sedate by request. We literally drive 'textbook' emergently. 

Keep in mind, I work in 1996 with fancy toys. Up until recently, 'use of CPAP' was an automatic emergent return.


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## Clare (Mar 9, 2013)

Rocketmedic40 said:


> Keep in mind, I work in 1996 with fancy toys. Up until recently, 'use of CPAP' was an automatic emergent return.



Um, we do not have CPAP and we only got PEEP in 2009 so um, what year might I be stuck in?


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## RocketMedic (Mar 9, 2013)

???
How is that? Our CPAP (BiPap-capable and generally used as such, Impact 731s) isn't exactly brand-new...

I thought y'all over in Kiwi Land had awesome everything?


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## Veneficus (Mar 9, 2013)

Rocketmedic40 said:


> ???
> How is that? Our CPAP (BiPap-capable and generally used as such, Impact 731s) isn't exactly brand-new...
> 
> I thought y'all over in Kiwi Land had awesome everything?



In a fair number of places CPAP is considered a non emergent therapy and not commonly used outside of pulmonary medicine.

Anesthesiologists tend to resist even learning about it because they claim it will lead to the admission of patients who could go to pulmonary and tie up limited ICU resources.

(sometimes we jokingly call these "intensive ventalatory units" because a patient needing intubation is the absolute criteria)


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## Clare (Mar 9, 2013)

I asked Clinical Standards Unit; they said we do not have it because (1) there is no solid evidence it reduces mortality in the pre-hospital environment and (2) we cannot afford it as our new ambulances only carry one tank of bulk oxygen and one portable oxygen.


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## katgrl2003 (Mar 9, 2013)

Clare said:


> I asked Clinical Standards Unit; they said we do not have it because (1) there is no solid evidence it reduces mortality in the pre-hospital environment and (2) we cannot afford it as our new ambulances only carry one tank of bulk oxygen and one portable oxygen.



Wow. We have a portable on the cot, one in the airway bag, and 3 spares in a side compartment.

We started with CPAP I think about 2 years ago. Ours screws into the portable tanks, and we have seen a significant drop in intubations since we started using it.


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## VFlutter (Mar 9, 2013)

Clare said:


> I asked Clinical Standards Unit; they said we do not have it because (1) there is no solid evidence it reduces mortality in the pre-hospital environment and (2) we cannot afford it as our new ambulances only carry one tank of bulk oxygen and one portable oxygen.



I will admit it does not directly reduce mortality in the pre hospital environment but it does however reduce intubations, ICU admissions, length of hospital stay, complications, and cost to the patient. No CPAP may make sense for EMS but is horrible for continuum of care.  

So if you had a patient on Bipap at the hospital that needed to be transferred to another facility would you just throw them on a NRB and hope you don't have to intubate them en route?


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## RocketMedic (Mar 9, 2013)

Clare said:


> I asked Clinical Standards Unit; they said we do not have it because (1) there is no solid evidence it reduces mortality in the pre-hospital environment and (2) we cannot afford it as our new ambulances only carry one tank of bulk oxygen and one portable oxygen.



That seems like a horrible punt answer. Some you can use on simple room air in a pinch.


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## RocketMedic (Mar 9, 2013)

Veneficus said:


> In a fair number of places CPAP is considered a non emergent therapy and not commonly used outside of pulmonary medicine.
> 
> Anesthesiologists tend to resist even learning about it because they claim it will lead to the admission of patients who could go to pulmonary and tie up limited ICU resources.
> 
> (sometimes we jokingly call these "intensive ventalatory units" because a patient needing intubation is the absolute criteria)



That seems like poor medicine.


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## katgrl2003 (Mar 9, 2013)

Chase said:


> So if you had a patient on Bipap at the hospital that needed to be transferred to another facility would you just throw them on a NRB and hope you don't have to intubate them en route?



I've actually had to do that before. Out of town transfer, dingbat dispatcher told the hospital we had CPAP...nope! We get there and the guy is a DNR. We were told the guy was visiting family, and had a syncopal episode. The hospital ends up putting him on a NRB, because no other service had CPAP at the time either. Halfway to his house, about 45 minutes - 1 hour into the trip, the wife riding with us told me that he had actually had a cardiac arrest and was going home to die, and that the hospital had told her they didn't expect him to survive the trip (found out later it was true). Got him home, on his home CPAP, and found out he died a few days later.


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## VFlutter (Mar 9, 2013)

katgrl2003 said:


> I've actually had to do that before. Out of town transfer, dingbat dispatcher told the hospital we had CPAP...nope! We get there and the guy is a DNR. We were told the guy was visiting family, and had a syncopal episode. The hospital ends up putting him on a NRB, because no other service had CPAP at the time either. Halfway to his house, about 45 minutes - 1 hour into the trip, the wife riding with us told me that he had actually had a cardiac arrest and was going home to die, and that the hospital had told her they didn't expect him to survive the trip (found out later it was true). Got him home, on his home CPAP, and found out he died a few days later.



It is fairly common for our terminal CHF patients to be on CPAP for comfort measures, more so for the family then the patient. It is tough for them to watch their loved one fighting to breath even after maxing out palliative doses of morphine and benzos. It is usually the last treatment to go almost like a terminal wean from a vent.


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## Clare (Mar 9, 2013)

katgrl2003 said:


> I've actually had to do that before. Out of town transfer, dingbat dispatcher told the hospital we had CPAP...nope! We get there and the guy is a DNR. We were told the guy was visiting family, and had a syncopal episode. The hospital ends up putting him on a NRB, because no other service had CPAP at the time either. Halfway to his house, about 45 minutes - 1 hour into the trip, the wife riding with us told me that he had actually had a cardiac arrest and was going home to die, and that the hospital had told her they didn't expect him to survive the trip (found out later it was true). Got him home, on his home CPAP, and found out he died a few days later.



This guy seems to resemble that pile up on the southern motorway that happened on Friday or something; for real ... I am not sure where you is but here he'd get turfed to a nursing home, or the Patient Transfer Service would take him home with A-Zero who bought along their transport CPAP machine.  

I don't think its right for you get patients who you can't look after; i.e. the hospital shouldn't have let you take him if you didn't have CPAP and he needed.

In the acute patient there is always an argument for not waiting round for back up and just transporting however that is because you are moving them to the hospital and I don't think this applies here ... 



Rocketmedic40 said:


> That seems like poor medicine.



Welcome to the world of having a charity run the Ambulance Service; hmm, I think its donation appeal week in May or July or something .... its embarrassing, frustrating, rewarding and lots of other things all rolled into one!

We only carry one bulk and one portable sized oxygen and they are expensive to refill so if you drain your portable tank on one patient who gets CPAP then have to refill it well, that is going to cost a significant amount more and well, the deficit last year was $14 million so um ... yeah


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## Rialaigh (Mar 9, 2013)

Chase said:


> It is fairly common for our terminal CHF patients to be on CPAP for comfort measures, more so for the family then the patient. It is tough for them to watch their loved one fighting to breath even after *maxing out palliative doses of morphine and benzos.* It is usually the last treatment to go almost like a terminal wean from a vent.




No such thing...

Max dose is when pain is controlled or when they are no longer breathing...in the case of hospice nursing..whichever you reach first....IMO it should be true of comfort measures as well (When the family is ready...)



Would people agree that right now, in the systems we live in, it would reduce risk more if we worked on the dispatch side rather then the transport side (as we already have control of the transport side)...


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## Veneficus (Mar 9, 2013)

Rocketmedic40 said:


> That seems like poor medicine.



It is not really poor so much as it is limited resources.

As much as it pains me, truthfully reserving an ICU bed for somebody who is more critical is good medicine.

The other thing to consider is that these patients are pulmonary patients and they are not only more than capable of using CPAP, they are expert at treating the diseases that it is beneficial for.

It is just a different way of doing things.


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## Veneficus (Mar 9, 2013)

Chase said:


> It is fairly common for our terminal CHF patients to be on CPAP for comfort measures, more so for the family then the patient. It is tough for them to watch their loved one fighting to breath even after maxing out palliative doses of morphine and benzos. It is usually the last treatment to go almost like a terminal wean from a vent.



???



Rialaigh said:


> No such thing...
> 
> Max dose is when pain is controlled or when they are no longer breathing...in the case of hospice nursing..whichever you reach first....IMO it should be true of comfort measures as well (When the family is ready...)



What he said.

I would just ask if your facility is billing for all of these "family" comfort measures, because it just sunds to me like a way to pad the bill.


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## Mariemt (Mar 9, 2013)

Veneficus said:


> Just out of curiosity, how many of these patients have you had?



Well being dispatched too... about 10%. If you see my post about our dispatched calls. 

Transporting from scene..... is less. But I would say I have had 2 to 3 in the last month or so where we needed to get through 5 pm traffic


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## VFlutter (Mar 9, 2013)

Veneficus said:


> ???
> 
> 
> 
> ...



While in the hospital we still have maximum doses for our palliative/hospice patients. Once they are at a hospice facility they can do more.

I could have worded that better. They are usually already on CPAP we do not just put it on while they are dying. But we leave it on after discontinuing treatments until the very end where they will pass within minutes of taking them off. Even though it is technically still "life prolonging treatment" it is more so for comfort until they are ready to go.


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