# Patient requesting "shutdown" prior to arrival.



## imadriver (Sep 24, 2011)

So, completely Non-Medical Scenario that happens frequently in my parts. I'd like to see some of your responses to this.

SCENARIO:

You are responding to a 32/yo Male, complaining of Back Pain that's been chronic x7 years, and is requesting an ambulance. Patient also is complaining that it's hard to take a deep breath because of the pain. So you are going down the street emergency and dispatch comes back and tells you "The Patient is requesting shutdown prior to arrival." You then ask back dispatch, "So you want us to respond non-emergency?" Then Dispatch answers "Well, I can't decide that. That would be your choice."


So What Would You Do?

-Generally, I usually shut down anyway. I work nights and it's hard to see the house numbers with lights flashing. However, the exception is us getting dispatched to any call I believe we'll either need Fire / Law / Supervisor as to mark where I am on the street level and remain visible for safety reasons. There are also certain sections of town that you Want to shut your lights off as to not get a large crowd (very quickly!) Now, I'm a firm believer that I am a "Servant of the Public", but these, always, makes me want to bust in their neighborhood with Lights, Sirens, and laying on the Air-horn at 3am when they decided to call. Just to do it.


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## HotelCo (Sep 24, 2011)

imadriver said:


> Now, I'm a firm believer that I am a "Servant of the Public", but these, always, makes me want to bust in their neighborhood with Lights, Sirens, and laying on the Air-horn at 3am when they decided to call. Just to do it.



So waking everyone else up at 3am is being a public servant? Not everyone works nights....

They might not want attention drawn to themselves, maybe they don't want to wake everyone else up. Either way, who cares? If you feel like you're going to need PD, why wouldn't you request it beforehand? 

I shutdown when asked, and at night, usually shut down when I turn into the residential area where the call is. 


Sent from my iPhone using Tapatalk


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## Handsome Robb (Sep 24, 2011)

There's no reason to go screaming through a neighborhood in the middle of the night with RLS. Usually we shut down the siren and coast in with our lights, houses tend to be market pretty well around here.

That is a little on the ridiculous side saying that since the pt requested you to shut down that you are tempted to do the opposite...

We are pt advocates. You and your partner's safety come first then the patient's needs/safety. Shutting down is not only safer for your partner and yourself it also complies with the pt needs. Why would you want to challenge that? Either they are try not to attract attention or they are trying to be polite to their neighbors...


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## imadriver (Sep 24, 2011)

As said, I do shut down, and if they request it, I absolutely do. I've just always wanted to do it. There is one lady who does this about twice a month, and it's always because she stubbed her toe or something minor she makes up just to get up to the hospital across town so she can stay with her sister, who lives right next to the hospital, for the week. And she always waits until 2am cause she doesn't want her neighbors to know she is always calling for an ambulance. (And she tells you all this without hesitation.)

I've never done this. Just asking. And the shutting down in residential areas is just about what I always do. I shut off my flashers and turn on my flood/scene lights.



HotelCo said:


> So waking everyone else up at 3am is being a public servant? Not everyone works nights....
> 
> They might not want attention drawn to themselves, maybe they don't want to wake everyone else up. Either way, who cares? If you feel like you're going to need PD, why wouldn't you request it beforehand?
> 
> I shutdown when asked, and at night, usually shut down when I turn into the residential area where the call is.




Completely agree with the last part. And You've never been in the situation that you needed Law and nothing about the call hinted toward that? I couldn't tell you how many times that happens to me. And That Only time I do leave my lights on at the road, is usually on Arrests or at least an actual emergency that fire or Law hasn't made it to yet. Just so they can spot me better.



NVRob said:


> That is a little on the ridiculous side saying that since the pt requested you to shut down that you are tempted to do the opposite...
> 
> We are pt advocates. You and your partner's safety come first then the patient's needs/safety. Shutting down is not only safer for your partner and yourself it also complies with the pt needs. Why would you want to challenge that? Either they are try not to attract attention or they are trying to be polite to their neighbors...



I'm not talking about being unsafe, Just because your lights are on don't mean you have to drive 70+ mph. And as said, I never have and never will unless I have to do this. Just a hypothetical question.


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## JPINFV (Sep 24, 2011)

NVRob said:


> There's no reason to go screaming through a neighborhood in the middle of the night with RLS


I'll take this a step further. Generally inside neighborhoods there's no reason to use lights and sirens. In a lot of places there generally isn't enough room for cars to pull over properly anyways.


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## Shishkabob (Sep 24, 2011)

Honestly, it annoys me too.  If it's "emergent" enough to call 911 for an ambulance, at 3am, it's "emergent" enough to get the fastest response.  If you yourself don't believe your condition warrants LS, then you should possibly use that thought process for something else, such as calling a taxi.





I'm not one that wants LS on every response... but that needs to be up to the condition at hand, and not necessarily the patients requests.


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## usalsfyre (Sep 24, 2011)

You could take the lights and siren off the truck and it would make my day actually. 

That said, I'll do it if requested, but the "I'm worried what the neighbors will think" crowd irritates the crap out of me. I've actually been told I needed to mover around to the back so the neighbors wouldn't see an ambulance.


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## usafmedic45 (Sep 24, 2011)

> That said, I'll do it if requested, but the "I'm worried what the neighbors will think" crowd irritates the crap out of me. I've actually been told I needed to mover around to the back so the neighbors wouldn't see an ambulance.



If it's the middle of the day, I'll leave it on, especially for frequent flyers.  If it's at night, I would hope someone would have the concern for waking their neighbors up.  That's just the decent thing to do.


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## Sasha (Sep 24, 2011)

Whats the point of using lights and sirens in a residential neighborhood anyway? Bring the little kids running to see the cool truck and get around the non exsistant traffic?

Sent from LuLu using Tapatalk


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## usalsfyre (Sep 24, 2011)

usafmedic45 said:


> If it's the middle of the day, I'll leave it on, especially for frequent flyers.  If it's at night, I would hope someone would have the concern for waking their neighbors up.  That's just the decent thing to do.



The previous job I had I usually didn't turn them on after 7pm. Which irritated my last partner because she thought people moving to the shoulder was "fun".

The case I refer to above? Noonish in an "old money" neighborhood. Seems as though the wife was embarrassed of her husband's deteriorating condition from cancer (at least that was what the patient thought).


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## Shishkabob (Sep 24, 2011)

Sasha said:


> Whats the point of using lights and sirens in a residential neighborhood anyway? Bring the little kids running to see the cool truck and get around the non exsistant traffic?
> 
> Sent from LuLu using Tapatalk



Yes, but most kids, upon seeing and/or hearing an ambulance or other emergency vehicle, tend to have the forethought to NOT go out in the road... unlike your average civilian vehicle that doesn't scream "LOOK AT ME, HERE I COME!" and have an auto/ped on your hands.


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## EMSrush (Sep 24, 2011)

Interesting discussion. I work for a commercial 911 service and we don't decide how we respond to the call; dispatch does. Dispatch can upgrade or downgrade us as they receive more information en route.


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## usalsfyre (Sep 24, 2011)

EMSrush said:


> Interesting discussion. I work for a commercial 911 service and we don't decide how we respond to the call; dispatch does. Dispatch can upgrade or downgrade us as they receive more information en route.



Same, but is anyone really watching? Due to the size of the town I was never "late" responding to an emergent call responding non-emergent


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## imadriver (Sep 24, 2011)

Linuss said:


> If you yourself don't believe your condition warrants LS, then you should possibly use that thought process for something else, such as calling a taxi.



The lady I spoke of actually gave a decent reason: She would get arrested if she didn't pay a taxi. Doesn't matter for an Ambulance.




usafmedic45 said:


> If it's the middle of the day, I'll leave it on, especially for frequent flyers.  If it's at night, I would hope someone would have the concern for waking their neighbors up.  That's just the decent thing to do.



On the bad side of this, I've actually had a complaint on me about me pulling up to a scene without my lights on. Family didn't understand why I "wasn't" responding emergency. I actually turned off my lights when I pulled on their road about two blocks away. But Perception is Truth.




EMSrush said:


> Interesting discussion. I work for a commercial 911 service and we don't decide how we respond to the call; dispatch does. Dispatch can upgrade or downgrade us as they receive more information en route.



Generally, we don't either, EVERYTHING is Emergency Response unless it's a hold back, which we Can go emergency too a good staging area If there is a large distance to the call, but usually shut down a few miles out.


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## Shishkabob (Sep 24, 2011)

imadriver said:


> The lady I spoke of actually gave a decent reason: She would get arrested if she didn't pay a taxi. Doesn't matter for an Ambulance.



Get PD out there and let them know about her views on calling an ambulance because she doesn't want to pay a bill.  They'll have some words with her about 911 abuse.


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## imadriver (Sep 24, 2011)

Tried it... PD slapped her wrist and now they don't want anything to do with her. She wont tell anyone else but the EMS crews that. Once anyone else is around she starts with the "I told him I'm having chest pain! And He's not doing anything about it!" Even though she was saying something about her fever or whatever it was that time.

- I think she knows the limit. It's not abuse until you do it more than X amount of times here per month. So it's not an "arrestable offense"


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## Shishkabob (Sep 24, 2011)

Next time you're with her, key up the mic and have it admitted over the air.  

Once recorded, start emailing people such as your supervisor / med control / etc etc about what to do in the future about blatant abuse from this person.



MedStar in Fort Worth has an option where if it's a known system abuser, and the APP deems it a non-emergent call, they give a call to Med control, update the doc, and then refuse to do a transport.


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## imadriver (Sep 24, 2011)

oh my god Linuss you are a genius.

Of coarse, I couldn't do that on "purpose" though... hmm... I'll have to lean against my crew bench next time she's rambling, and think about it.


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## JPINFV (Sep 24, 2011)

Is Florida a 1 party or 2 party consent state?


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## imadriver (Sep 24, 2011)

JPINFV said:


> Is Florida a 1 party or 2 party consent state?




If we are speaking of Voice Recordings, Everybody must consent before any recording can be made. (purposely)


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## DrParasite (Sep 24, 2011)

As a matter of policy, we don't let the callers dictate our response.  So if the caller says "I need the paramedics" or "don't send the police" or "don't use your lights or sirens", it doesn't matter to us.  We screen the calls, send a response based on our dispatch protocols, and if policy says to do something, we do it.

as a general rule, I don't use the airhorns on night calls, or when transporting a patient, but lights and sirens are used (as directed by policy).  and on night calls, the lights go off once we arrive, and the flood lights go on once we have located the house.  for day calls, unless we are parked on a highway, the lights go off and I usually switch to my hazards.


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## Nerd13 (Sep 24, 2011)

I'll admit. This bothers me too. I just feel like if you're sick enough that I have to use my lights and sirens then your neighbors not knowing you're sick shouldn't be your first priority. An ambulance sitting in your driveway is going to be obvious with or without lights. 

I've also heard of people running lights with no sirens at night to not wake up the neighborhood and then getting complaints from the pts family because they couldn't hear them coming. My argument is that it's technically illegal here to run lights no sirens anyway but that's for another time...


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## JPINFV (Sep 24, 2011)

^
Just curious, but where is "here?"


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## DrParasite (Sep 24, 2011)

JPINFV said:


> ^
> Just curious, but where is "here?"


Quite a few states require an audible alert to accompany any visual emergency light, when a vehicle is in motion and responding to an emergency when using emergency warning devices.

translation: if your lights are on, your sirens needs to be on.

check your states Vehicle and traffic laws regarding emergency vehicles.

I know NJ and NY require this, and I am pretty sure PA, DE and MD are the same way.  can't speak for the west coast though


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## JPINFV (Sep 24, 2011)

I have no doubt that many states do, but I also have no doubt that many people -think- their state has such laws because an instructor, supervisor, or partner erroneously told them it.

Edit: Something else to think about. Does the law require sirens to be sounded with lights, or just that both lights and sirens be used in order to be exempt from certain traffic laws. Similarly, does it require a "siren" or just "audible warning device," which would include a siren, but also include a vehicle horn? If it's the latter, why would you need to run an audible warning device if you aren't actually taking advantage of the provisions of the law at that immediate point of time?

Edit number 2: Take NY's law. Under a strict reading, a siren is not required. Sounding the air horn, or electronic equivalent, satisfies the requirments to demand the right of way. 

http://public.leginfo.state.ny.us/LAWSSEAF.cgi?QUERYTYPE=LAWS+&QUERYDATA=$$VAT1144$$@TXVAT01144+&LIST=LAW+&BROWSER=BROWSER+&TOKEN=34468508+&TARGET=VIEW


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## usalsfyre (Sep 24, 2011)

So is there any reason to run emergency in areas and times where there's likely to be no traffic and/or traffic yielding to you won't make a difference in time?


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## Shishkabob (Sep 24, 2011)

Law?  No.  Policy?  Yes.


Though Texas law does require the operator of the vehicle to use what they deem necessary, as long as it follows agency policy and local law.



> Sec. 546.003.  AUDIBLE OR VISUAL SIGNALS REQUIRED.  Except as provided by Section 546.004, the operator of an authorized emergency vehicle engaging in conduct permitted by Section 546.001 shall use, at the discretion of the operator in accordance with policies of the department or the local government that employs the operator, audible or visual signals that meet the pertinent requirements of Sections 547.305 and 547.702.





Cool tid-bit?  I finally found the law that says I can park wherever the hell I want, whenever the hell I want.  In your face, gas-station attendant!


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## JPINFV (Sep 24, 2011)

Linuss said:


> Cool tid-bit?  I finally found the law that says I can park wherever the hell I want, whenever the hell I want.  In your face, gas-station attendant!



Including when not on an emergency call? 

Also, just because you could, doesn't mean you should. I've always found it tacky when fire fighters would park their fire engine in front of a grocery store in a manner that screws up the traffic pattern because they didn't feel like walking a few feet further.


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## Sasha (Sep 24, 2011)

JPINFV said:


> Including when not on an emergency call?
> 
> Also, just because you could, doesn't mean you should. I've always found it tacky when fire fighters would park their fire engine in front of a grocery store in a manner that screws up the traffic pattern because they didn't feel like walking a few feet further.



Right? Firefighters are supposed to be super fit a few feet wouldnt hurt them!

Sent from LuLu using Tapatalk


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## Shishkabob (Sep 24, 2011)

JPINFV said:


> Including when not on an emergency call?


  Even when.

Sec. 546.001.  PERMISSIBLE CONDUCT.  In operating an authorized emergency vehicle the operator may:
(1)  park or stand, irrespective of another provision of this subtitle




> Also, just because you could, doesn't mean you should. I've always found it tacky when fire fighters would park their fire engine in front of a grocery store in a manner that screws up the traffic pattern because they didn't feel like walking a few feet further.



If we COULD have parked somewhere else, we would have.  We had to park in the middle of the alley between the door and the gas pumps, not blocking any parking spot.  The attendant was angry because she couldn't see if "anyone was having trouble paying at the pump"


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## Tigger (Sep 24, 2011)

There's a large wooden sign in dispatch that says "The Answer is Yes." With that said, if the caller of a facility requests that we shut the lights off before getting on scene, we'll do it. It doesn't really effect me in the slightest, and I much prefer to start calls with a happy patient or facility staff.

Most of the SNFs we service request this, but for the 40 acre campus one, I leave them on so their security can find us when I get lost again.


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## NomadicMedic (Sep 24, 2011)

We actually have an SOG that states we turn lights and sirens off when entering a residential subdivision. Makes sense to me. I only use 'em on main roads anyway...


Sent from my iPhone.


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## usalsfyre (Sep 24, 2011)

n7lxi said:


> We actually have an SOG that states we turn lights and sirens off when entering a residential subdivision. Makes sense to me. I only use 'em on main roads anyway...
> 
> 
> Sent from my iPhone.



Yeah but it takes like what 20 minutes to get from one end of your state to the other? I mean geeze, I've had response districts that were bigger .


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## Shishkabob (Sep 24, 2011)

usalsfyre said:


> Yeah but it takes like what 20 minutes to get from one end of your state to the other? I mean geeze, I've had response districts that were bigger .



I've had county roads that took longer to get from entry to scene...


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## JPINFV (Sep 24, 2011)

Linuss said:


> Even when.
> 
> Sec. 546.001.  PERMISSIBLE CONDUCT.  In operating an authorized emergency vehicle the operator may:
> (1)  park or stand, irrespective of another provision of this subtitle



You might want to finish reading the section...

"Sec. 546.002.  WHEN CONDUCT PERMISSIBLE.(b)  Section 546.001 applies only when the operator is:(1)  responding to an emergency call;
(2)  pursuing an actual or suspected violator of the law;
(3)  responding to but not returning from a fire alarm;
(4)  directing or diverting traffic for public safety purposes;  or
(5)  conducting a police escort."​

What's interesting is that nothing applies to transporting, unless you want to finagle "responding" to include transport. 




> If we COULD have parked somewhere else, we would have. We had to park in the middle of the alley between the door and the gas pumps, not blocking any parking spot. The attendant was angry because she couldn't see if "anyone was having trouble paying at the pump"



...because people can't walk to the attendant?


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## NomadicMedic (Sep 24, 2011)

usalsfyre said:


> Yeah but it takes like what 20 minutes to get from one end of your state to the other? I mean geeze, I've had response districts that were bigger .



This is true. Our HEMS uses those balsa wood helicopters you power with a rubberband.  


Sent from my iPhone.


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## Shishkabob (Sep 24, 2011)

JPINFV said:


> You might want to finish reading the section...


  Technically, I DID finish reading Section 546.001 

Oh and, 
"directing or diverting traffic for public safety purposes"

Diverting traffic away from my ambulance so we can leave when we have to.  Ta-da.  ^_^ 

Maybe not within the "spirit of the law", but most defintly within it technically, which is really all that matters in courts anymore.  




> ...because people can't walk to the attendant?



I smiled and asked her to call the Police if she had an issue.  


I would have been less rude had she been less rude.


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## usalsfyre (Sep 24, 2011)

n7lxi said:


> This is true. Our HEMS uses those balsa wood helicopters you power with a rubberband.
> 
> 
> Sent from my iPhone.



When did AEL move into Delaware?!?


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## Nerd13 (Sep 24, 2011)

JPINFV said:


> ^
> Just curious, but where is "here?"



Michigan

If you want to get technical about it both sirens and lights have to be used in order to be exempt from some traffic laws. Why would I be running RLS unless it were to be exempt from those traffic laws though? 

I don't think our local police would ever do anything about it but it could come up in court were somebody to be running lights no sirens and have an accident.


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## JJR512 (Sep 24, 2011)

DrParasite said:


> Quite a few states require an audible alert to accompany any visual emergency light, when a vehicle is in motion and responding to an emergency when using emergency warning devices.
> ...
> I know NJ and NY require this, and I am pretty sure PA, DE and MD are the same way. can't speak for the west coast though


 
Maryland has this requirement. Well, sort of...



JPINFV said:


> I have no doubt that many states do, but I also have no doubt that many people -think- their state has such laws because an instructor, supervisor, or partner erroneously told them it.
> 
> Edit: Something else to think about. [1] Does the law require sirens to be sounded with lights, or just that both lights and sirens be used in order to be exempt from certain traffic laws. [2] Similarly, does it require a "siren" or just "audible warning device," which would include a siren, but also include a vehicle horn? If it's the latter, why would you need to run an audible warning device if you aren't actually taking advantage of the provisions of the law at that immediate point of time?


 
I added the numbers 1 and 2 in brackets to the above quote to address each of those questions as they relate to Maryland.

1. The special privileges afforded to a driver of an emergency vehicle in Maryland, while operating on an emergency call, are afforded only when the vehicle is operated with both audible and visual signals. *Md. TRANSPORTATION Code Ann. § 21-106*

2. An "audible signal" is specifically defined as a "siren, exhaust whistle, or bell capable of giving an audible signal". *Md. TRANSPORTATION Code Ann. § 22-218* Therefore, a horn, including an air horn, is not an audible signal as defined by Maryland law for the purpose of granting emergency driving privileges to the operator of an emergency vehicle.

In my experience, I cannot recall an EVO ever using a siren through a residential area when it wasn't necessary to do so, especially at night. In fact, I would even go so far as to say that in my experience, EVOs I'm familiar with use the siren as minimally as possible, period.


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## ArcticKat (Sep 25, 2011)

Linuss said:


> Next time you're with her, key up the mic and have it admitted over the air.



That wouldn't be a HIPPA violation at all?


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## JPINFV (Sep 25, 2011)

Since we're going down this path, California is an "as reasonable" requirement for auditory warning systems.


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## JPINFV (Sep 25, 2011)

ArcticKat said:


> That wouldn't be a HIPPA violation at all?




1. It's HIPAA (Yes, America's hat shouldn't know what Canada's Pants requires). 

2. Only if otherwise identifying information is also transmitted.


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## WoodyPN (Sep 25, 2011)

Also from Maryland, and when we respond at night when there is less traffic....we aren't going to blast halfway across the city lights and sirens unless we are dispatched as Echo. Other than that, we just use the lights. And they stay on @ the scene, especially when we have to stop in the middle of the street. Unless were dispatched Alpha, then we probably wouldnt but it depends to us where we park and what would make us more visible.


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## ArcticKat (Sep 25, 2011)

JPINFV said:


> 1. It's HIPAA (Yes, America's hat shouldn't know what Canada's Pants requires).



Sorry for my typo, at least we keep your bald spot warm. 



JPINFV said:


> 2. Only if otherwise identifying information is also transmitted.



Such as the original dispatch information for that particular ambulance identifying the age, gender, and location of the individual being recorded?  The same information broadcast over the air and scannable by anyone determined enough regardless how secure you think it is?


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## AlphaButch (Sep 25, 2011)

Linuss said:


> Technically, I DID finish reading Section 546.001
> 
> Oh and,
> "directing or diverting traffic for public safety purposes"
> ...



In Texas, it's been deemed reasonable that the law applies when parking an emergency vehicle to ensure easy egress in the event of an emergency. I'd have to look up the ruling (it involved wal-mart and a fire truck). 

I know alot of cities here in Texas have a "no L&S in a residential area after (time)". I've never seen it enforced or even brought up in regards to an emergency. 

At every service I've worked at - the decision to use L&S is made by dispatch or by the providers (on scene or enroute) and is determined by the call information. Once upgraded to echo status, it stays that way until someone assesses the scene and determines otherwise. We do find it poor form to use sirens in residential areas at night though, especially since it hasn't shown any difference in response time.


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## dixie_flatline (Sep 26, 2011)

JJR512 said:


> Maryland has this requirement. Well, sort of...
> 
> 
> 
> ...



This is true, to an extent.  Maryland does require Lights & Sirens to qualify under the statutes that protect us while driving "Emergency" (Priority 1 in Maryland terms, Code 3 elsewhere I guess).  If you don't have both L&S going, no proceeding through red lights or anything like that, and you're on much shakier ground in the event something goes wrong (but then again in that case you also have to be able to justify what made the situation a "true emergency" that required running P1 to begin with).

In practice, we run with lights and no sirens fairly regularly for a variety of non-critical patients (call it Priority 2), as well as while transporting patients whose conditions might be aggravated by the sound of the sirens.  

However, as a corollary, under no circumstances should sirens be run without lights.


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## DrParasite (Sep 26, 2011)

AlphaButch said:


> I know alot of cities here in Texas have a "no L&S in a residential area after (time)".


so which law should you follow, the state law requiring L&S in a residential area, or the city law saying not to?


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## AlphaButch (Sep 26, 2011)

The state law only requires L&S if you are requesting special privilege  (similiar to MD's requirements). We go lights only through residential areas unless we are requesting privilege (such as going against a red light), in which case we just hit the siren until we are clear of the intersection and no longer need that privilege.

State law supercedes the city ordinances. Again, I've never seen the city ordinances enforced other than a verbal warning to not spook someone's chickens or wake up the mayor's wife.


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## firecoins (Sep 26, 2011)

Patients don't dictate response or where we park.  :rofl:

If I don't need lights and sirens, I won't use them.  

If they request no lights, I wonder if they need an ambulance at all.  

Its been my experience that the worst patients walk to the ER or don't think they are having an emergency.  If they say no lights or sirens, they probably need them.


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## bstone (Sep 28, 2011)

When responding to a call that the PT requests no l/s I will decide if that is appropriate for the type of call. For a "don't feel well" I might agree. For chest pain and SOB then I will light it up. If it's 3am or a residential street with little traffic then I'll keep the lights on but turn the siren off. No sense in waking people up when it's not necessary to be making a very loud noise.


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## HotelCo (Sep 28, 2011)

imadriver said:


> Completely agree with the last part. And You've never been in the situation that you needed Law and nothing about the call hinted toward that? I couldn't tell you how many times that happens to me. And That Only time I do leave my lights on at the road, is usually on Arrests or at least an actual emergency that fire or Law hasn't made it to yet. Just so they can spot me better.



You said you leave them on if you believe you'll need PD. If you need PD, should you be going in? 

If you realize in the middle of the call that you need them, are you going to request them, run out and hit the lights, then go back on scene? If you can't wait the 1.7 seconds longer it'd take for them to find the big ambulance without the lights on, you probably shouldn't be staying on scene, yeah? 


Also for everyone else, we're not talking about responding with no lights and sirens. I hear a lot of "patients don't dictate our response." you're right, but I think this is more about shutting them down on their street. How much time are you going to save by having your lights on for a  couple hundred feet in a residential area? If I'm having a medical emergency, I wouldn't want all my neighbors coming out to stare at me while I'm being wheeled out to the rig.


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## Shishkabob (Sep 28, 2011)

I keep them on in the street on scene, day or night, for the simple fact that it's easier for others to find the ambulance if I need them to.


Be it police or another ambulance as backup, it's just easier to notice something bright and flashing.


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## Cup of Joe (Sep 28, 2011)

If its a call to a grammar school, where you could park in the parking lot, I could see the school requesting that just to keep from distracting all the kids with the flashing lights.  Though an ambulance in the parking would probably get everyone's attention anyway.


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## LucidResq (Sep 28, 2011)

Had a lady call 911 today for hematemesis. She requested early shutdown in part because she was trying very hard to keep her anxiety level down because she felt like she may have an asthma attack. I made this clear to them...  and ended up banging my head into the keyboard when I heard the whoo whoos in the background and her starting to freak. Guys, 2 seconds ain't gonna make or break this lady even if she has the Niagra Falls of GI bleeds. Working her up and stressing her out to the point she has an asthma attack will affect her.

I understand if you feel L&S are necessary for responder safety reasons, but beyond that... do right by your patient.


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## imadriver (Sep 29, 2011)

LucidResq said:


> I understand if you feel L&S are necessary for responder safety reasons, but beyond that... do right by your patient.



I agree, there are a lot of good reasons to shut down. And this would differently be one of them.

Although, a few days ago I actually had a request to shut down, and didn't (No Sirens, but Lights). The reason being is cause it was still early in the night, so there was traffic, and this person's driveway happen to be shared with a semi-major four lane road. I shut down as many lights as I could, but my front and back red flashers were still going because I had to park in the left lane of the road directly in traffic. The only time I do leave them on Whether they request it or not at night is when someone may need to spot me for whatever reason.


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## McGoo (Oct 1, 2011)

In West Australia, we only need lights going to claim the exemption from the road rules to go fast, sirens are optional. Our dispatch dictates priority to a call, but if it's not going to save any time getting there, or I'm so tired that I can't think fast enough to drive fast, I won't use them. 

As for shutting down early, I turn the lights off maybe a block or two away unless it's an MVA. Most nursing homes don't like the combined heart rate of their residents spiking unless it's absolutely necessary.


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## exodus (Oct 1, 2011)

McGoo said:


> In West Australia, we only need lights going to claim the exemption from the road rules to go fast, sirens are optional. Our dispatch dictates priority to a call, but if it's not going to save any time getting there, *or I'm so tired that I can't think fast enough to drive fast*, I won't use them.
> 
> As for shutting down early, I turn the lights off maybe a block or two away unless it's an MVA. Most nursing homes don't like the combined heart rate of their residents spiking unless it's absolutely necessary.



If you're that tired you shouldn't be driving at all...

Stay safe.


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## Missedcue (Oct 2, 2011)

It's my belief that we have lights and sirens for our safety as responders. I work in an urban environment and there are times that I have to run with lights and sirens at 3:00AM for BS calls because I don't want to get smashed into by a drunk in an intersection. However I also believe that your level of safety is at your discretion, I will not compromise my safety or the safety of my partner or patient  to save someone some embarrassment.  At night, I often go with just lights through neighborhoods and just tap my siren around blind curves and major intersections


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## Missedcue (Oct 2, 2011)

LucidResq said:


> Had a lady call 911 today for hematemesis. She requested early shutdown in part because she was trying very hard to keep her anxiety level down because she felt like she may have an asthma attack. I made this clear to them...  and ended up banging my head into the keyboard when I heard the whoo whoos in the background and her starting to freak. Guys, 2 seconds ain't gonna make or break this lady even if she has the Niagra Falls of GI bleeds. Working her up and stressing her out to the point she has an asthma attack will affect her.
> 
> I understand if you feel L&S are necessary for responder safety reasons, but beyond that... do right by your patient.



I totally agree. Going routine for the last block or 2 will not adversely effect your ability to make it to a patient in a timely manor.


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