# On driving lights and sirens



## medicdan (Dec 29, 2011)

Particularly in light of the recent EMSA crash, I have been re-thinking lights and sirens driving considerably. I would like to share some of my thoughts/rants, and get your responses. We've had pieces of this discussion before in different places, but i'm discussing a new approach. 

I will start by saying I am not a particular fan of driving with L&S… I work mainly PB (ALS) and my company has fairly few (or little) policies regarding driving. We do not have Road Safety, and it seems management does not care much what we do as long as nobody complains and there are no collisions. 

I am aware of the considerable risks that come with L&S, the high rates of collision and significant damage and the minimal cost savings. With that said, I generally drive to all emergencies with L&S, and modulate my speed/rush based on dispatch complaint (drivers make the priority decision here, not dispatch). Once we get the patient into the truck, I leave my partner (medic) to decide how they want to get to the hospital, but find myself disagreeing more often recently. More on that in a minute.

One of our managers (an experienced instructor in his own right) strongly believes, and shares broadly his belief that unless a team of RNs and MDs swarm around our patient when we arrive at the ED, or the patient receives some critical diagnostic or treatment within 3-5 minutes of arriving, we shouldn’t have been using L&S on the way in. Especially when working ALS, that makes a lot of sense. 

I recognize some EDs have particularly lazy staff, and this tenant stems from the quality (and accuracy) of our radio/triage report, but it resonates deeply with my thinking. We can do whatever we think is prudent on the way to scene, provide whatever assessment or treatment we need, then realistically look at how fast we need to get to the hospital. 

This is where I disagree with my medic partners—they like lights in, and I am reluctant. I absolutely trust them to make decisions that are in the best interest of the patient, realize that I do not always understand their motives, and always honor their requests (within reason), but just do not think it’s worth the risk for what I see as low priority patients. When I push their thinking after the call, I frequently get shallow excuses with no mention of patient acuity. When we are done with our paperwork 10 minutes later and say goodbye to the patient, they haven’t been seen yet by a tech or RN, let alone an MD. 

I don’t want to debate who’s in charge on a PB truck… that’s a different issue… but differing opinions on patient priorities, and whether we are really doing the right thing rushing patients, and developing more formal decision matrices for L&S use patient loaded. 

There are some services to my knowledge (Boston EMS comes to mind) that have policies that call for ALL patients to be transported L&S, even if they are going to the waiting room, ostensibly to maximize unit availability (boingo/TOTWTYTR can you confirm/deny?) Does anyone have data on whether the cost of adding trucks is more than increased crashes, or does that boil down to driver training? Do we have a panacea for emergency vehicle driver training? What do services with the lowest collision rates do? Is it a function of EVO or other drivers? Conditions? Type/size of vehicles?


----------



## Shishkabob (Dec 29, 2011)

My current agency has a robust driving system.  We have road safety, like you, and while they don't force a strict level each month, they want everyone atleast level 5 or above.  Calls are dispatched PMD, in an attempt to not run LS to non-emergent calls.  Obviously this has flaws in it, but in a busy system, I've run LS 2 times each shift for the past few shifts, while most of my calls are non-LS.  They also have a 5 week long driver training program, one week in class, and 4 weeks in the field, just driving.  They have policies, such as not forcing cars in to traffic (If we come up to a red light, and can't get in to oncoming lanes, we shut off lights, hang back a bit, and once it turns green, go again)


They still have a number of collisions during the year (all sent to incident review boards), but that's going to happen in a very busy system with a lot of trucks, and idiot civilian drivers on the road.



On the way back to the hospital, it's the crews decision, and I personally only do it in time sensitive things, such as MI/CVA or airway issues.  (Cardiac arrest are non-LS transports, if they even get transported)


I'm all for LS response to the scene for calls that call for it, because honestly, people who call 911 suck at giving info, and a stubbed toe can and has turned in to a cardiac arrest.  Back to the hospital?  With all that Paramedics can do today, it's not preferable the vast majority of the time, but as I stated, there's a few times where it is required.


----------



## R99 (Dec 29, 2011)

Depends entirely on how sick patient is and how much traffic.  

Lets be fair, theres nothing better than going the  down the main in the rush hour with lights and siren screaming, going as hard down on the air horn and two tone making as much noise as possible, it's great, its a good thing to do anybody mental who tell you different.


----------



## medicdan (Dec 29, 2011)

R99 said:


> Lets be fair, theres nothing better than going the  down the main in the rush hour with lights and siren screaming, going as hard down on the air horn and two tone making as much noise as possible, it's great, its a good thing to do anybody mental who tell you different.



Actually, I like many things more than this... it's not particularly exciting or enticing to me... but will do it if necessary. Just because we can do something doesn't mean we should...


----------



## abckidsmom (Dec 29, 2011)

R99 said:


> Depends entirely on how sick patient is and how much traffic.
> 
> Lets be fair, theres nothing better than going the  down the main in the rush hour with lights and siren screaming, going as hard down on the air horn and two tone making as much noise as possible, it's great, its a good thing to do anybody mental who tell you different.



Buckle your seatbelt, man.  And get ready to consider other people's viewpoints.  You are about to hear a lot.


----------



## abckidsmom (Dec 29, 2011)

I worked in an urban system that was a public utility model operated by AMR.  We had something called the 12 standards that I have been unable to find in a google search.  Anybody know what I'm talking about?

Anyway, OP, I agree with you 100%, and while I can't discount that it is FUN to drive with lights and sirens, I'll say it's also FUN to ski, it's FUN to blow stuff up, and it's FUN to throw rocks.

All of the above are activities that carry risk, and the risk should me managed in the best possible way.  Like with skiing, you follow the rules of the slopes, and the only one who gets hurt when you crash into a tree is you.  With fireworks, you don't do them during a drought, not inside the house, and not without sober adult supervision.  With rock-throwing, you aim away from people.

Sadly, with ambulance driving, you are aiming INTO people who are busy following the rules, going with the flow of traffic, and you and ONE other emergency are not worth risking all of those people.


----------



## R99 (Dec 29, 2011)

Even the most professional ambos I know are at heart a wee bit of a siren junkie

We take driving and driving safely very seriously and have strict laws about how long we can drive for as well as a comprehensive driver training program.  Lights and siren responses are used  when appropriate and safety is always paramount.  Doesn't mean it doesn't brighten the day a bit to play mobile christmas tree, come on lets be honest with ourselves

The fire boys go to every job with lights and siren, ambo dont.  Their fire truck weights in at thirteen metric ton, snorkels and the like even more, our hunk of crap van is about 2500kg.


----------



## Medic Tim (Dec 29, 2011)

Boston area services run L/S for everything in my experience. I did some ride time there as a student.

Where I work we are dispatched to code 1(l/s) or code 2( no l/s) calls. We have restriction of 20km/h over the posted limit to a max of 120km/h.(the highway speed limit is 110km/h). this is usually slower than the flow of traffic.

I find a run l/s to the hospital very rarely. even with cardiac pt's. we are 10-15 min from the hospital on most transports and you might save 1 min if you are lucky going l/s as most of it is highway driving. our driving is monitored by AVL so big brother is always watching.


----------



## Shishkabob (Dec 29, 2011)

abckidsmom said:


> I worked in an urban system that was a public utility model operated by AMR.  We had something called the 12 standards that I have been unable to find in a google search.  Anybody know what I'm talking about?




Yup.

Smooth braking
Constant rate acceleration
Rear tire concept
Rear space cushion
Side space cushion
Rear view mirror use
Eye movement pattern
Looking far ahead
4 second following distance
12 second lane change
Signalling turns and exits
Speed control




> who are busy following the rules, going with the flow of traffic,


You know that's just not true


----------



## exodus (Dec 29, 2011)

R99 said:


> Even the most professional ambos I know are at heart a wee bit of a siren junkie
> 
> We take driving and driving safely very seriously and have strict laws about how long we can drive for as well as a comprehensive driver training program.  Lights and siren responses are used  when appropriate and safety is always paramount.  Doesn't mean it doesn't brighten the day a bit to play mobile christmas tree, come on lets be honest with ourselves
> 
> The fire boys go to every job with lights and siren, ambo dont.  Their fire truck weights in at thirteen metric ton, snorkels and the like even more, our hunk of crap van is about 2500kg.



I would rather never run code, it's dangerous and most of the time benefits very little. L


---
I am here: http://maps.google.com/maps?ll=34.068410,-117.852668


----------



## Rettsani (Dec 29, 2011)

We can not decide how we reach the Patient, whether we drive with or without blue lights and sirens. This decides for us, the dispatcher. ^_^
Only when we have take the patient in our Rescue Vehicle, we had to do our own decision. If the patient's condition allows it, I prefer clear without blue lights and siren to drive. 

We have  for all rescue vehicles a regular driver training on the traffic training ground. In addition, we are taught about dealing with special and rights of way.


----------



## Meursault (Dec 29, 2011)

How much of the pressure to respond quickly to calls comes from the public or from municipalities? Do you think your managers feel it's medically important to have good response times, or that it's good customer service, or that it's necessary to keep the contract/get good funding?


----------



## Shishkabob (Dec 29, 2011)

MrConspiracy said:


> How much of the pressure to respond quickly to calls comes from the public or from municipalities? Do you think your managers feel it's medically important to have good response times, or that it's good customer service, or that it's necessary to keep the contract/get good funding?



My agency complies with the time standards as, no matter how incorrect and misguided, that's how civilians grade an agency on how good they are at their job.

However, they're pushing to get away from response times and making the civilians realize that there are much better ways to grade an agency, such as patient outcomes.




Any time a news agency runs an article about 'slow response times' and putting 'lives at risk', I want to punch the "journalist" for not digging deeper and seeing the delay in care is due to people calling 911 for inappropriate reasons and demanding transport.


----------



## Rettsani (Dec 29, 2011)

Good question next. From the pressure we got nothing on the ambulance with. We have 11 fire and rescue stations in the city, all vehicles at the Fire an Rescue Stations to be routed through a central control center.
If I get the message on my Pager then I know I must in 3 minutes be outside and 8-10 minutes be at the patient. :unsure:


----------



## EMSLaw (Dec 29, 2011)

MrConspiracy said:


> How much of the pressure to respond quickly to calls comes from the public or from municipalities? Do you think your managers feel it's medically important to have good response times, or that it's good customer service, or that it's necessary to keep the contract/get good funding?



I think it's the former, really.  At least for the large majority of ambulance calls - your sick person jobs, lift assists, random aches, pains, and sniffles.

For the first... forty-five or so years of its existance, my service operated under a system where rigs were stationed at various locations throughout town.  The crews were at home.  They would be toned out, and the driver would either have the ambulance at his home, or would go pick it up.  He would meet his crew, and they would go to the call.  Response times in our area averaged approximately 12-15 minutes.

Six or seven years ago, that response time suddenly became unacceptable.  For some reason, a sub-eight minute response is now the expected standard.  So, the crews stay at our station when on duty.  

While I haven't crunched the numbers, and it would require poring through a huge number of old run sheets, I suspect that evidence would show that the difference in response time was not medically significant.  But public and political perception required that we respond faster.  

I consider myself a mature, sober individual.  I drive as safely as I can, and I expect my crew to do the same.  There are times when I will put the hammer down - a serious call involving a child, for instance.  And yes, there is a thrill to driving with lights and sirens.  But as I've said (frequently) to some of our newer, younger drivers - we don't do anyone any good if we wreck our ambulance getting to the call.

The issue, like so many other things that plague EMS, comes down to public education.  The purpose of the ambulance is to deliver emergency medical care, and safe transportation to the hospital.  Expecting EMTs to magically appear at your door in five minutes because you have a sniffle is not realistic, and expecting that will put a lot of people, including the ambulance crew, everyone on the road, and - in my area - a large number of deer, in deadly peril.


----------



## rmabrey (Dec 29, 2011)

I normally don't mind driving LS to scene cause I understand dispatchers work with what they have. I mind driving lights and sirens in a rainstorm to an ED for a patient that has neck pain, that told dispatch they were seen, treated, and discharged, and want to go to another ED.................especially when its the dispatch manager taking the call. 

We rarely go lights and sirens to the ED. Only severe trauma, some CVA's, MI depending on how long they've been symptomatic. If we get ROSC we transport cold, if we lose them again, still cold. 

Sent from my Desire HD using Tapatalk


----------



## OrlandoRMAMedic (Dec 29, 2011)

I know we all have our examples of abuse of the system.  The one that I have had recently was a 23 y/o male c/o difficulty breathing.  We responded with L/S.  He walked down the 3 flights of stairs and met us at the truck as we were arriving on scene.  He explains that he cannot breathe through his nose (that was his difficulty breathing) and his girlfriend had just left (just before he called 911) to take their daughter to the walk-in clinic for the same thing.  He said his mother told him to call 911 and go to the hospital by ambulance instead of going with his girlfriend and daughter.

SMH


----------



## the_negro_puppy (Dec 29, 2011)

We are told whether or not to go L&S to the job depending on the AMPDS code.

It is up to us if we want to go L&S to hospital. We rarely do, i've been L&S to hospital less than 10 times in 2 years on an emergency ambulance.


----------



## Localmotion34 (Dec 29, 2011)

In my old county in NC we had to provide WRITTEN justification in our report for going LS with a patient in the back to the hospital.

Going to the scene, we used the "carding" system, where B-D levels we went LS to the scene.  Once we had the patient, it had to have been VERY serious to go LS.

When i worked in NJ, EVERY ambulance I ever saw was going LS TO the patient, and with the patient in the back.  Even ankle pain, they would run emergency traffic to the hospital.  Ri-dic-u-lous.  

I told my drivers that unless the patient was dying, we were NOT using LS going to the hospital with a patient in the back.  On the rare days I would get a Medic for a stable patient, they would hop in and I swear to you, we would be running NO LS, and their chase vehicle would still have the lights on.  We'd be stopped at a light, and again, they would leave their lights on.  After two rides like that I was overrode by our chief and had to use LS for everything. 

I am glad I got out of that system before someone got killed, and I would have been paying out a lawsuit for the rest of my life.


----------



## Tigger (Dec 29, 2011)

In the Boston area it seems like everyone gets transported L&S to the ED, which I think is ridiculous. It's convenient maybe, but not justifiable. The reasons I hear absurd...

"he has a trach in!"
"we don't have medics, what if she gets worse?"
"the traffic is going to be brutal and the Bruins are on!"


----------



## tssemt2010 (Dec 29, 2011)

the city fire department (wont say a name because everyone knows who they are) transports L&S to the ER about 90+% of the time because they "have a busy system" yes they have a VERY busy system but is it worth puttin your patients at risk of being involved in a wreck enroute to the ER with a STABLE patient?


----------



## mycrofft (Dec 29, 2011)

*LS doesn't mean fast.*

Necessarily.
The point about urban response speeding saving little time versus risk is lost on some laypersons and younger responders.

OK, if you take longer than the political minimum, have in mind the reason why. And remember you can discretely use LS for intersections and when you see traffic ahead congealing, then ooch through and continue.


----------



## rmabrey (Dec 29, 2011)

Tigger said:


> "we don't have medics, what if she gets worse?"



Lamest excuse ever. 

Sent from my Desire HD using Tapatalk


----------



## Medic2409 (Dec 29, 2011)

IMHO, L&S is a tool, just like any other, and needs to be used appropriately.

Completely taking it away is, again, my opinion, foolish.


----------



## enjoynz (Dec 29, 2011)

In NZ the dispatcher decides whether the ambulance goes out to a call under L & S.
Once the patient is on board the crew have to ask for clearence to travel to the hospital under L & S from dispatch.They don't normally ask for permission, unless the pt is one sick puppy!


----------



## adamjh3 (Dec 29, 2011)

enjoynz said:


> In NZ the dispatcher decides whether the ambulance goes out to a call under L & S.
> Once the patient is on board the crew have to ask for clearence to travel to the hospital under L & S from dispatch.They don't normally ask for permission, unless the pt is one sick puppy!



Just curious, have you had any issues with a dispatcher refusing clearance to transport l&s when indicated? What medical training does the dispatcher have? 

Not trying to pick a fight, I'm just curious as to how well this system works. 

Sent from my DROID X2 using Tapatalk


----------



## R99 (Dec 30, 2011)

enjoynz said:


> In NZ the dispatcher decides whether the ambulance goes out to a call under L & S.
> Once the patient is on board the crew have to ask for clearence to travel to the hospital under L & S from dispatch.They don't normally ask for permission, unless the pt is one sick puppy!



Hmmmm not sure where this came from but no "permission" is needed from EACC as long as I have been around (2007 onwards) who are they to decide how I transport a patient?


----------



## enjoynz (Dec 30, 2011)

adamjh3 said:


> Just curious, have you had any issues with a dispatcher refusing clearance to transport l&s when indicated? What medical training does the dispatcher have?
> 
> Not trying to pick a fight, I'm just curious as to how well this system works.
> 
> Sent from my DROID X2 using Tapatalk



The dispatchers have set protocols (A Standard manuel of how to deal with any situation) ...All situations are covered with codes. These codes are used for dispatching the trucks/chopper... depending on the 111(911) call - re the condition, amount of patients and their location.

I've never heard of a dispatcher not letting a truck transport to hospital with L & S...Although the patient needs to be a priority 1(life threating condition) or 2 (unstable condition)for them to allow you to do so.

Here is a link to the Dispatch Service for our region..if you care to have a nosey! 
http://www.wfa.org.nz/comms.htm


----------



## enjoynz (Dec 30, 2011)

R99 said:


> Hmmmm not sure where this came from but no "permission" is needed from EACC as long as I have been around (2007 onwards) who are they to decide how I transport a patient?



Are you in New Zealand?
If not...there is your answer.


----------



## R99 (Dec 30, 2011)

enjoynz said:


> Are you in New Zealand?
> If not...there is your answer.



Yes I am, "R99" should give it away lol

Maybe WFA are different but in Auckland at least its up to the crew on scene as to how the patient is transported.

I can find no reference in the Operations Manual either.

You are correct that the EACC determines if the job is p1/p2 based on the information received from the call taker.  

 To  transport somebody  to hospital with lights and siren they'd have to be pretty sick ie status one the risk is just not with it!


----------



## akflightmedic (Dec 30, 2011)

Lights and sirens...great topic and you are wise with your concerns and discretionary use.

I will state this anecdotal piece. As I grew more confident in my skills, knowledge and education...I got slower and slower with my driving or driving requests.

I noticed that at times, the more serious a patient was, the slower the drive I requested. Yes there were times where we proceeded with urgency but more oft than naught we drove NO lights or sirens. I think it keeps you the provider in a clearer state of mind and it also reduces patient anxiety.

There were times of peak usage when the BC would order all trucks to go LnS to free up units but even then we drove with extreme caution. LnS does not mean to go balls to the walls, hang on edge of your seat and cut everyone off while laughing nervously and then getting angry when people do not move.

Ask yourselves this...how many times have you found yourself or your partner becoming angry at a driver who does not react to your lights and sirens even though you know you have a total BS patient in back or are responding to a total BS call? I can freely state in my early years, I found this quite prevalent among coworkers and caught myself doing it many times.

Anyways, back on topic....I have found one of the better uses for LnS is simply to keep forward motion and I do not mean at 65mph on a city street. I mean creeping along at congested intersections or if traffic is backed up for whatever reason...then you crawl thru the maze at a very reasonable pace.


----------



## Meursault (Dec 30, 2011)

akflightmedic said:


> Ask yourselves this...how many times have you found yourself or your partner becoming angry at a driver who does not react to your lights and sirens even though you know you have a total BS patient in back or are responding to a total BS call?



I get angry when people don't move because occasionally screaming at cars that can't hear you is a prerequisite for a MA driver's license, because it's still a failure of driver education/awareness, and because I'm the one who has to justify long response times regardless of the nature of the call. 

With a BS patient in back, I've likely either talked my partner out of requesting lights and sirens, agreed with my partner on the same, or not even asked and started transporting without them.


----------



## Simusid (Dec 30, 2011)

We respond to all calls with lights and use sirens where appropriate.   The only exception would be if dispatch instructs us otherwise (rare).

We transport all calls in the same way.  Lights always on, sirens at intersections and overtaking cars.   Our "policy" is to drive the speed limit unless it's a priority 1 code, trauma, etc.   At red lights we clear each lane of traffic by stopping at each lane we cross and use eye contact to each vehicle, I don't know how standard that policy is in other services.

I was driving a particularly non-emergent patient last week in the normal fashion.   On the way home I asked my senior medic if I should have gone with no L&S.  He said using L&S lets us get back in service more quickly, and that had not occurred to me.  I do agree with that policy.  We have only 2 ALS trucks and due to staffing imbalances (years of experience) we may have the most senior medic at the hospital while the junior truck is heading to an "unknown medical" that turns into a code (happened last month).


----------



## medicdan (Dec 30, 2011)

Simusid said:


> We respond to all calls with lights and use sirens where appropriate.   The only exception would be if dispatch instructs us otherwise (rare).
> 
> We transport all calls in the same way.  Lights always on, sirens at intersections and overtaking cars.   Our "policy" is to drive the speed limit unless it's a priority 1 code, trauma, etc.   At red lights we clear each lane of traffic by stopping at each lane we cross and use eye contact to each vehicle, I don't know how standard that policy is in other services.
> 
> I was driving a particularly non-emergent patient last week in the normal fashion.   On the way home I asked my senior medic if I should have gone with no L&S.  He said using L&S lets us get back in service more quickly, and that had not occurred to me.  I do agree with that policy.  We have only 2 ALS trucks and due to staffing imbalances (years of experience) we may have the most senior medic at the hospital while the junior truck is heading to an "unknown medical" that turns into a code (happened last month).



Two questions: first, shouldn't both medic trucks be equally qualified to perform on any call, despite disparities in experience between staff? 
What I was originally trying to ask is whether the cost of accidents as a result of driving L&S for all calls is less than the cost to add a new truck, if you really need to maintain unit availability?


----------



## Simusid (Dec 30, 2011)

emt.dan said:


> Two questions: first, shouldn't both medic trucks be equally qualified to perform on any call, despite disparities in experience between staff?
> What I was originally trying to ask is whether the cost of accidents as a result of driving L&S for all calls is less than the cost to add a new truck, if you really need to maintain unit availability?



I would bet that truck staffing is worthy of it's own thread.  We're a mixed paid/volunteer service.  We have categories of Junior medics with less than 1 or 2 years experience, Senior medics with roughly 10+ years experience, and Staff medics make up the middle.  We can run an ALS truck with a P/B but we would probably only do that with a Senior medic.  A typical shift might be a senior, a staff, junior, and two basics.  And again, the basic experience may be anywhere from zero to 2+ years (basics with 2 years experience either go to medic school or quit).  We would typically staff the trucks with senior/Basic and Staff/Junior/Basic.

We provide medic scholarships and benefit from a lot of volunteer ride time and post license volunteer shifts as new medics gain experience.   That led to what we call our "mentor/shadow" program.  With the above staffing, we would dispatch the junior truck to the call with L&S while the senior truck would call "on the road in service - proceeding to call".   The senior truck will oversee and make sure the junior truck is all set and if so will return to the station.   This maximizes the training of our staff.   The 18 year senior medic has no real need to refresh his IV or intubation skills.

I will say that the cost of PROPERLY driving with L&S is low, that is my opinion.  Obviously that does not always happen.


----------



## Tigger (Dec 30, 2011)

rmabrey said:


> Lamest excuse ever.
> 
> Sent from my Desire HD using Tapatalk



You got that right. I love when my partner decides to overrule me and take someone in emergent right after I told them not too, citing the above excuse as justification.


----------



## Handsome Robb (Dec 30, 2011)

Remind me to stay far away from Massachusetts. Every patient gets transported RLS? That's absurd. 

The busy excuse sucks, I run in a high volume, urban system with no 911 backup agency, we are it as far as transport goes. It isn't common but every now and again we will end up with no transport units available and 911 calls pending. If you used "we had to get back in service faster" as your justification for transporting RLS you'd be out of a job pretty quickly.


----------



## Simusid (Dec 30, 2011)

NVRob said:


> Remind me to stay far away from Massachusetts. Every patient gets transported RLS? That's absurd.
> 
> The busy excuse sucks, I run in a high volume, urban system with no 911 backup agency, we are it as far as transport goes. It isn't common but every now and again we will end up with no transport units available and 911 calls pending. If you used "we had to get back in service faster" as your justification for transporting RLS you'd be out of a job pretty quickly.



Why exactly does the busy "excuse" suck?  If we're not in town and there is a dispatch, we have to call mutual aid.  This means a 6 minute response time turns into a 12+ minute response time.   It makes more sense to SAFELY drive L&S and end up with better call coverage.


----------



## exodus (Dec 30, 2011)

Simusid said:


> Why exactly does the busy "excuse" suck?  If we're not in town and there is a dispatch, we have to call mutual aid.  This means a 6 minute response time turns into a 12+ minute response time.   It makes more sense to SAFELY drive L&S and end up with better call coverage.



Because everytime there is 12+ minute response time the patient will die. What about first responders or FD?


----------



## Handsome Robb (Dec 30, 2011)

Simusid said:


> Why exactly does the busy "excuse" suck?  If we're not in town and there is a dispatch, we have to call mutual aid.  This means a 6 minute response time turns into a 12+ minute response time.   It makes more sense to SAFELY drive L&S and end up with better call coverage.



No it doesn't, sorry.

A miniscule amount of calls are actually truly time sensitive. 

You can say everyone drives super cautiously with or without a patient but the fact of the matter is you are still opposing traffic signals. All it takes is one person to miss something and now you have a unit OOS + a patient who is probably in a lot more trouble now than they were before, a crew out of service, another ambulance(s) responding to your scene to deal with the mess. Doesn't sound like a good situation to me. 

If your citizens are complaining about response times and you are as busy as you say, they can cough up some more money for better coverage. If you live in the sticks that's your choice but you need to recognize you will not get the same 911 service you would in a large urban area. 

We had a unit get into an accident responding code to a call. Took them, 3 other ambulances a supervisor and multiple PD units and an engine crew out of service to deal with.

So we went from being Level 3 (3 units available) to level 0 (none available) then eventually to status 6 (calls pending). Talk about a fuster cluck.


----------



## saskvolunteer (Dec 30, 2011)

Simusid said:


> Why exactly does the busy "excuse" suck?  If we're not in town and there is a dispatch, we have to call mutual aid.  This means a 6 minute response time turns into a 12+ minute response time.   It makes more sense to SAFELY drive L&S and end up with better call coverage.



That doesn't make sense, ever! I briefly chuckled, interrupting the sleeping people around the pool. Like, talk about stupidity.


----------



## Mavrande (Dec 30, 2011)

There's nothing wrong with turning your emergency lights on and then driving flow of traffic. Way I see it is, if I'm coming up to an intersection that I can't see around with no L+S, come to a complete stop at the stop sign, then the cross traffic is going to go, because that's how driving in urban areas works. Being in an ambulance doesn't stop you from being cut off. I'm now sitting at a stop sign. If I at least have my lights on and maybe twiddle the siren as I pull up, I have a much better chance of the cross traffic letting me go. Not to mention that the lights give me much better visibility around intersections, and maybe other drivers near me will be a little more cautious. Lights don't necessarily mean I'm driving like a maniac, and most of the times I get complimented on my driving I'm leaving the lights on and using the siren occasionally. I don't need to slow down as much at intersections where I don't have a stop sign because cross traffic sees me, stops, and I see them stopped. It's smoother and safer.


----------



## Handsome Robb (Dec 30, 2011)

Mavrande said:


> There's nothing wrong with turning your emergency lights on and then driving flow of traffic. Way I see it is, if I'm coming up to an intersection that I can't see around with no L+S, come to a complete stop at the stop sign, then the cross traffic is going to go, because that's how driving in urban areas works. Being in an ambulance doesn't stop you from being cut off. I'm now sitting at a stop sign. If I at least have my lights on and maybe twiddle the siren as I pull up, I have a much better chance of the cross traffic letting me go. Not to mention that the lights give me much better visibility around intersections, and maybe other drivers near me will be a little more cautious. Lights don't necessarily mean I'm driving like a maniac, and most of the times I get complimented on my driving I'm leaving the lights on and using the siren occasionally. I don't need to slow down as much at intersections where I don't have a stop sign because cross traffic sees me, stops, and I see them stopped. It's smoother and safer.



Are you talking about transporting a patient RLS? I still don't see the benefit except in severe circumstances and even then it's questionable.


----------



## JPINFV (Dec 30, 2011)

NVRob said:


> Remind me to stay far away from Massachusetts. Every patient gets transported RLS? That's absurd.



My two favorite sights when I was living in MA was seeing ambulances push lines of cars into an intersection against a red light and seeing ambulances coming up the 93 (I-93) with lights and sirens while being passed by other cars. 

Special recognition: Getting into a discussion with one of the owners of the company about the merits of a BLS unit going L/S (he asked why no L/S after I transported without them) while not going to the closest hospital (patient was in pain status post TURP with frank hematuria, but had been seen several times since the procedure was done. Outside of pain, the patient was stable), opting instead to make the 20 minute trek into Boston. 

I'm amazed I got out of MA without losing my sanity, as well as other issues.


----------



## EMSLaw (Dec 30, 2011)

Localmotion34 said:


> When i worked in NJ, EVERY ambulance I ever saw was going LS TO the patient, and with the patient in the back.  Even ankle pain, they would run emergency traffic to the hospital.  Ri-dic-u-lous.



That's a matter of local policy.  While I will admit that we respond /to/ most calls with RLS (we don't have EMD here, there is no priority of dispatch, and the dispatch information frequently proves incorrect), we very rarely go that way to the hospital.


----------



## NomadicMedic (Dec 30, 2011)

One of the ONLY reasons I can see transporting L&S is to make for a faster trip to the ED on days with heavy traffic. To make the Opticom work, we have to have lights and siren on. (or at least lights). Route 1, near the beach, in the summertime. That's one instance I'm ok with lights on for a transport... otherwise a 20 minute ride to the hospital could become an hour.


----------



## JPINFV (Dec 30, 2011)

Now opticom (and other signal preemption devices) is something that I'd like to see a study on in regards to time saved relative to lights and sirens and no traffic. I have no problem with ambulances transporting with opticom on, but no lights/sirens, especially if they have a non-visible light system (e.g. GPS or infrared). Heck, transport and respond all the time with a traffic pre-emption system for all I care.


----------



## ffemt8978 (Dec 30, 2011)

We transport the vast majority of our patients using L&S...and the reason is simple.  Given the distances we have to travel to get to the nearest hospital, driving L&S and speeding (75 mph on a 60 mph 2 lane highway with no cross streets or intersections and with all due care and regard) can save us 15 minutes of transport time before we even get to city limits.  

Unless it is a truly critical call, we will shut down our L&S as we approach the city, and proceed with a normal transport through town to the hospital.

If we transported non L&S, our average transport time is any where from 60-75 minutes.  Driving code like I described can cut that down to 45-50 minutes.


----------



## Handsome Robb (Dec 30, 2011)

ffemt8978 said:


> We transport the vast majority of our patients using L&S...and the reason is simple.  Given the distances we have to travel to get to the nearest hospital, driving L&S and speeding (75 mph on a 60 mph 2 lane highway with no cross streets or intersections and with all due care and regard) can save us 15 minutes of transport time before we even get to city limits.
> 
> Unless it is a truly critical call, we will shut down our L&S as we approach the city, and proceed with a normal transport through town to the hospital.
> 
> If we transported non L&S, our average transport time is any where from 60-75 minutes.  Driving code like I described can cut that down to 45-50 minutes.



See now this makes a little more sense to me. You're not having to clear intersections which is the most dangerous part of RLS driving.


----------



## ffemt8978 (Dec 30, 2011)

NVRob said:


> See now this makes a little more sense to me. You're not having to clear intersections which is the most dangerous part of RLS driving.


That's why we do it that way.


----------



## adamjh3 (Dec 30, 2011)

enjoynz said:


> The dispatchers have set protocols (A Standard manuel of how to deal with any situation) ...All situations are covered with codes. These codes are used for dispatching the trucks/chopper... depending on the 111(911) call - re the condition, amount of patients and their location.
> 
> I've never heard of a dispatcher not letting a truck transport to hospital with L & S...Although the patient needs to be a priority 1(life threating condition) or 2 (unstable condition)for them to allow you to do so.
> 
> ...



Much appreciated


----------



## the_negro_puppy (Dec 31, 2011)

ffemt8978 said:


> We transport the vast majority of our patients using L&S...and the reason is simple.  Given the distances we have to travel to get to the nearest hospital, driving L&S and speeding (75 mph on a 60 mph 2 lane highway with no cross streets or intersections and with all due care and regard) can save us 15 minutes of transport time before we even get to city limits.
> 
> Unless it is a truly critical call, we will shut down our L&S as we approach the city, and proceed with a normal transport through town to the hospital.
> 
> If we transported non L&S, our average transport time is any where from 60-75 minutes.  Driving code like I described can cut that down to 45-50 minutes.



So let me get this straight, even if you guys had something like a simple fractured radius you would spend 45-50 minutes driving L&S to hospital, putting your crew, the patient and other drivers on the road at unnecessary risk to save road time? Even if you are doing the speed limit people still drive crazily and are unpredictable around vehicles going L&S


----------



## Simusid (Dec 31, 2011)

NVRob said:


> No it doesn't, sorry.
> 
> A miniscule amount of calls are actually truly time sensitive.
> 
> If your citizens are complaining about response times and you are as busy as you say, they can cough up some more money for better coverage. If you live in the sticks that's your choice but you need to recognize you will not get the same 911 service you would in a large urban area.



You are absolutely right.  A minuscule number of calls are time sensitive.  I don't know which ones and neither do you.  So it's my job to be in service as soon as possible because (despite the fact that you clearly do not believe me) there are times when one minute either way will determine whether we are back in service to take a call in town or mutual aid must be called instead.  

The citizens are not complaining.   I have a service zone plan filed with the state.   I'm the one who monitors response times, mutual aid, and the money.   So does my general manager and my medical director.


----------



## Handsome Robb (Dec 31, 2011)

Simusid said:


> You are absolutely right.  A minuscule number of calls are time sensitive.  I don't know which ones and neither do you.  So it's my job to be in service as soon as possible because (despite the fact that you clearly do not believe me) there are times when one minute either way will determine whether we are back in service to take a call in town or mutual aid must be called instead.
> 
> The citizens are not complaining.   I have a service zone plan filed with the state.   I'm the one who monitors response times, mutual aid, and the money.   So does my general manager and my medical director.



I'll agree to disagree. As well as plan to never go near your state. While it is your job to provide EMS and compassionate and effective patient care to your district and mutual aid areas if called, it is not your job to endanger yourself, your partner, your patient, or the public by needlessly running RLS to the hospital.  Ever heard of "good of the many over good of the one"?


----------



## Simusid (Dec 31, 2011)

NVRob said:


> I'll agree to disagree. As well as plan to never go near your state. While it is your job to provide EMS and compassionate and effective patient care to your district and mutual aid areas if called, it is not your job to endanger yourself, your partner, your patient, or the public by needlessly running RLS to the hospital.  Ever heard of "good of the many over good of the one"?



I'm ok with some disagreement.   I will repeat that it is also our policy to drive the speed limit even with L&S (but I'll grant you that probably not all employees do that)


----------



## ffemt8978 (Dec 31, 2011)

the_negro_puppy said:


> So let me get this straight, even if you guys had something like a simple fractured radius you would spend 45-50 minutes driving L&S to hospital, putting your crew, the patient and other drivers on the road at unnecessary risk to save road time? Even if you are doing the speed limit people still drive crazily and are unpredictable around vehicles going L&S



Yes, we would, but you are making several erroneous assumptions in your post.

You're assuming that there are other drivers on the roads we use (most of the time, those highways only see 50-100 cars per DAY).  You're also assuming that we pass those vehicles we see without slowing down and doing it in a safe and controlled manner.  Finally, you're assuming that we have the ability to treat the patient's pain which we do not.  If we could treat a patient's pain, then we would be less inclined to drive the way we do.

I should clarify that since there is so little traffic on these highways, we do not run the siren the entire time.  This would unnecessarily increase patient anxiety, so we only use it when other vehicles are within sight.


----------



## lightsandsirens5 (Dec 31, 2011)

the_negro_puppy said:


> So let me get this straight, even if you guys had something like a simple fractured radius you would spend 45-50 minutes driving L&S to hospital, putting your crew, the patient and other drivers on the road at unnecessary risk to save road time? Even if you are doing the speed limit people still drive crazily and are unpredictable around vehicles going L&S



We do the same thing. Except I am often 120 minutes are more from the trauma center and cardiac/stroke center. That is why lots of things in my area get a ride on the bird. Normally a crushed hand would get run by ground to the er. Out here, with two plus hours to a trauma center, it gets to fly. 

Now I know this isn't a MedEvac discussion, but.....

That being said, there are many times I we run Pri-1 with something that is not "time sensitive" in a normal setting. But slap rural time frames on it, and it is a relative time sensitive condition.


----------



## JPINFV (Dec 31, 2011)

It sounds like FFEMT is using L/S more for the legal exemption from the speed limit than anything else, which would increase the safety factor. Of course my opinion is, in part, if you're going to speed, just speed.


----------



## Farmer2DO (Dec 31, 2011)

NVRob said:


> Remind me to stay far away from Massachusetts. Every patient gets transported RLS? That's absurd.
> 
> The busy excuse sucks, I run in a high volume, urban system with no 911 backup agency, we are it as far as transport goes. It isn't common but every now and again we will end up with no transport units available and 911 calls pending. If you used "we had to get back in service faster" as your justification for transporting RLS you'd be out of a job pretty quickly.



I run in a system that sounds similar to Rob's.  Difference is we go 32 (our term for emergency jobs holding) every day, usually multiple times a day.  32-5 is not uncommon.  You also would be job hunting if you used that excuse here.



Simusid said:


> Why exactly does the busy "excuse" suck?  If we're not in town and there is a dispatch, we have to call mutual aid.  This means a 6 minute response time turns into a 12+ minute response time.   It makes more sense to SAFELY drive L&S and end up with better call coverage.



12 minutes instead of 6 minutes?  Who cares?  Use the mutual aid, or put more ambulance crews on.  The increased risk to life and limb just doesn't justify it.  The first time one of your rigs is involved in an accident and someone is hurt or killed, and they were going red to "get back in service quicker", trust me, you and anyone else who approved of this decision will regret it.  



Mavrande said:


> There's nothing wrong with turning your emergency lights on and then driving flow of traffic. Way I see it is, if I'm coming up to an intersection that I can't see around with no L+S, come to a complete stop at the stop sign, then the cross traffic is going to go, because that's how driving in urban areas works. Being in an ambulance doesn't stop you from being cut off. I'm now sitting at a stop sign. If I at least have my lights on and maybe twiddle the siren as I pull up, I have a much better chance of the cross traffic letting me go. Not to mention that the lights give me much better visibility around intersections, and maybe other drivers near me will be a little more cautious. Lights don't necessarily mean I'm driving like a maniac, and most of the times I get complimented on my driving I'm leaving the lights on and using the siren occasionally. I don't need to slow down as much at intersections where I don't have a stop sign because cross traffic sees me, stops, and I see them stopped. It's smoother and safer.



You also have a much better chance of being involved in an accident, just for having your lights on, because people react poorly to them.  The only justification for transporting red is a critical patient in the back.  Ever.




n7lxi said:


> One of the ONLY reasons I can see transporting L&S is to make for a faster trip to the ED on days with heavy traffic. To make the Opticom work, we have to have lights and siren on. (or at least lights). Route 1, near the beach, in the summertime. That's one instance I'm ok with lights on for a transport... otherwise a 20 minute ride to the hospital could become an hour.



The only reason I can see transporting red is for a critical, time sensitive patient.



ffemt8978 said:


> We transport the vast majority of our patients using L&S...and the reason is simple.  Given the distances we have to travel to get to the nearest hospital, driving L&S and speeding (75 mph on a 60 mph 2 lane highway with no cross streets or intersections and with all due care and regard) can save us 15 minutes of transport time before we even get to city limits.
> 
> 
> Unless it is a truly critical call, we will shut down our L&S as we approach the city, and proceed with a normal transport through town to the hospital.
> ...



I just don't see the justification for transporting red unless your patient is critical.  15 minutes?  Who cares?  That's not going to make a difference in their care.  If you are short ambulances to cover jobs during that time, then you need to put more on.



Simusid said:


> You are absolutely right.  A minuscule number of calls are time sensitive.  I don't know which ones and neither do you.  So it's my job to be in service as soon as possible because (despite the fact that you clearly do not believe me) there are times when one minute either way will determine whether we are back in service to take a call in town or mutual aid must be called instead.



Your argument makes us nothing more than ambulance drivers.  "We don't know what's time sensitive, so we just go red with everything."  We absolutely know what's time sensitive, and if we don't, we shouldn't be doing this job.  That's why we have training and education.  



> The citizens are not complaining.   I have a service zone plan filed with the state.   I'm the one who monitors response times, mutual aid, and the money.   So does my general manager and my medical director.



Let me tell you, your citizens will be complaining if one of your rigs hits a family and injures or kills someone.  And your driver, and your service, will lose. Big time.



ffemt8978 said:


> Yes, we would, but you are making several erroneous assumptions in your post.
> 
> You're assuming that there are other drivers on the roads we use (most of the time, those highways only see 50-100 cars per DAY).  You're also assuming that we pass those vehicles we see without slowing down and doing it in a safe and controlled manner.  Finally, you're assuming that we have the ability to treat the patient's pain which we do not.  If we could treat a patient's pain, then we would be less inclined to drive the way we do.



Why pass them at all if it's not emergent?  And they have pain, so lets go faster.  Feel all the bumps.  That's got to feel good and make their pain better.

And if you don't have the ability to treat their pain, then get the ability.  Either intercept a paramedic that can, get your own paramedics with pain management capabilities, or fly them.  Turning your lights on increases the risks to your crews and patient, every time.


----------



## Shishkabob (Dec 31, 2011)

L&S doesn't mean speeding.  L&S doesn't mean unsafe.



What makes L&S unsafe are civilian drivers who are uneducated, and refuse to do the right and legal thing.


----------



## JPINFV (Dec 31, 2011)

Linuss said:


> L&S doesn't mean speeding.  L&S doesn't mean unsafe.
> 
> 
> 
> What makes L&S unsafe are civilian drivers who are uneducated, and refuse to do the right and legal thing.




http://newsok.com/emsa-ambulance-driver-pleads-not-guilty-in-fatal-accident/article/3634201

:sad:


----------



## Farmer2DO (Dec 31, 2011)

Linuss said:


> What makes L&S unsafe are civilian drivers who are uneducated, and refuse to do the right and legal thing.



That's the ONLY thing that makes them unsafe?  Sorry, I have to disagree with you.  So do the courts.  There are many, many unsafe emergency driving practices out there, and to put all of the blame on civilian drivers is way out of line.

According to a JEMS article (http://www.emergencydispatch.org/articles/lightssirenliability1.htm) in some states the civilians don't even have to give up the right of way.  In New Jersey, the emergency vehicle only has the right of way if the driver of the other vehicle voluntarily relinquishes it.


----------



## Simusid (Dec 31, 2011)

Farmer2DO said:


> 12 minutes instead of 6 minutes?  Who cares?  Use the mutual aid, or put more ambulance crews on.  The increased risk to life and limb just doesn't justify it.  The first time one of your rigs is involved in an accident and someone is hurt or killed, and they were going red to "get back in service quicker", trust me, you and anyone else who approved of this decision will regret it.



You don't see the benefit of a 6 minute response to a cardiac arrest?   REALLY? 

My neighboring town took 40 minutes to respond to a chest pain call.   I have a responsibility to provide the best care possible to residents of our town.   I do whatever I can to be in service and if that means that I drive the speed limit with my lights on and if that goes against your world view then obviously there is nothing else I can add.   If you feel so strongly about not being on the road I assume you never leave the station except for a call?   No trips for food or errands?

I don't know why I'm bothering to reply.   The two camps on this issue are clearly too far apart.


----------



## Remeber343 (Dec 31, 2011)

I'm here to work. Not run errands...


----------



## Shishkabob (Dec 31, 2011)

Farmer2DO said:


> That's the ONLY thing that makes them unsafe?  Sorry, I have to disagree with you.  So do the courts.  There are many, many unsafe emergency driving practices out there, and to put all of the blame on civilian drivers is way out of line.




Wait, where did I ever say the "only" thing or "all the blame"?  I didn't, ever.  I said civilians make it unsafe, and I stand by that.

If every single civilian car stopped in the right lane when there was an emergency vehicle present, every single time, and did everything correctly as it's supposed to be, how many accidents would there be?


You can be going below the limit in the left lane, and some idiot will STILL pull the the left and slam their brakes in front of you.





JPINFV said:


> http://newsok.com/emsa-ambulance-driver-pleads-not-guilty-in-fatal-accident/article/3634201
> 
> :sad:



Yes, his speed was excessive.


On the other hand... the civilian turned in front of the ambulance.


----------



## JPINFV (Dec 31, 2011)

Let me approach you at twice the speed limit and we'll see how much time you have to recognize and appropriately respond to an emergency vehicle.


----------



## Shishkabob (Dec 31, 2011)

JPINFV said:


> Let me approach you at twice the speed limit and we'll see how much time you have to recognize and appropriately respond to an emergency vehicle.




Unless we turn a blind corner, one should ever be surprised enough by our presence to make any sudden moves and thus causing an accident... that's kind of the reason for the lights and siren.  People aren't alert enough when they drive.  They don't check their mirrors as often as they should, if ever.  They blare their music with the windows up and look straight ahead, often tailgating the person in front.   They don't give themselves enough time to react, let alone react safely.  We try to mitigate that with better driving, but there's only so much you can do when people refuse to do their part.



I'm not excusing the speed, never have, never will.  But the person DID turn infront of the ambulance.  People seem to want to ignore that fact. 




One of the main killers of motorcyclist is people turning left infront of them.  They often claim the biker was speeding.  The biker may have some fault due to the speeding, but fact is, the person still did an illegal lane change infront of oncoming traffic, causing the accident.  If they pay attention, they can avoid the turn, avoid the accident, and it'd never be an issue.


----------



## ffemt8978 (Dec 31, 2011)

JPINFV said:


> It sounds like FFEMT is using L/S more for the legal exemption from the speed limit than anything else, which would increase the safety factor. Of course my opinion is, in part, if you're going to speed, just speed.



That is part of it.



Farmer2DO said:


> I just don't see the justification for transporting red unless your patient is critical.  15 minutes?  Who cares?  That's not going to make a difference in their care.  If you are short ambulances to cover jobs during that time, then you need to put more on.


Tell that to the patient who is in pain.  We're not short on ambulances...we're short on HOSPITALS within a close distance.  So at what point does time start to make a difference in a patient's care?  30 minutes, an hour?  I'm curious to know what you belive is an acceptable time limit for a patient to remain in pain without any treatment now that you brought it up.



Farmer2DO said:


> Why pass them at all if it's not emergent?  And they have pain, so lets go faster.  Feel all the bumps.  That's got to feel good and make their pain better.
> 
> And if you don't have the ability to treat their pain, then get the ability.  Either intercept a paramedic that can, get your own paramedics with pain management capabilities, or fly them.  Turning your lights on increases the risks to your crews and patient, every time.



Again, another member is assuming they know more about my area than they really do.  You're assuming that the roads are rough.  You're assuming we don't call for ALS for pain treatment (nearest ALS unit is 30 minutes away - with both of us driving code 3).  You're assuming that getting our own paramedics is a simple process and that we haven't tried.  (The voters have rejected the extra money it would cost.)  You're assuming we always have a helicopter available.


----------



## mycrofft (Dec 31, 2011)

This re-raises the urban versus rural or frontier watershed; but speed still kills in the country too. 

FFEMT raised an excellent point, and it has been raised in forums outside this one. Where are the rural hospitals or clinics? I can tell you that those in Nebraska started disappearing in the Seventies and were pretty much gone, at least in my experience, by the mid Eighties. Part of that was the cost of operation versus shrinking populations (due to farm and credit failures), but regional statistical analyses did not support keeping a fifteen bed hospital open when Omaha or Lincoln or Cheyenne Wyoming were "so close". 
Here in the Sierran foothills and such the smaller ones get bought, then "streamlined".
(Occupy THAT<_< ).


----------

