medic417
The Truth Provider
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Nope L&S could actually worsen several of those.
Limited use of Lights and sirens
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Nope L&S could actually worsen several of those.
AJ Hidell
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Interesting. Every textbook I have ever read specifically mentioned those three conditions as requiring a smooth and quiet ride. Are you reading this in a text somewhere? Where you taught this by an instructor? Agency policy? Medical protocol? Is it just your opinion? If so, based upon what?
Medic:
Because it interferes with the prehospital care of eg. a CVA.....?
Which ones, and how would L&S hurt? Unless you can do thrombolysis or something for a MI or whole blood for the hypovolemic type emergencies, none of those can be treated in any way that is even close to definitive in the field. They are all time-sensitive, and outcomes worsen with more time until intervention (research supported for CVA and MI, probably for trauma, when bleeding out time = more blood out = bad)
Because it interferes with the prehospital care of eg. a CVA.....?
Which ones, and how would L&S hurt? Unless you can do thrombolysis or something for a MI or whole blood for the hypovolemic type emergencies, none of those can be treated in any way that is even close to definitive in the field. They are all time-sensitive, and outcomes worsen with more time until intervention (research supported for CVA and MI, probably for trauma, when bleeding out time = more blood out = bad)
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My opinion primarily (although it is also a medical and agency protocol). there is good research which indicates that CVA and MI outcomes are worse the longer the time between onset and treatment (at the hospital..unless you've got tpa). No, there are no studies looking specifically at L&S response...but logic says that if a. time = cells and b. L&S = less time, than logically L&S can improve outcomes.
Who said L&S driving is not smooth? lights just get you through traffic and traffic lights...i'm not talking about driving like a banshee.
quiet? how exactly does that impact outcomes? are the brain cells going to be disturbed by all the noise and die?
Edit: and even if you have a banshee driver..whats the evidence that lack of smoothness has a negative impact on CVA or MI outcome? I don't mean "the book said so"...I'm legitimately curious if there is any evidence that suggests this. First i've heard of it.
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medic417
The Truth Provider
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Please do some research grasshopper. Yes there are studys out there that show even in trauma rapid transport does not impact survivorability. As to CVA, AAA, MI sorry you are harming patients. The 1 or two minutes you might save if you arrive safely has no positive affect. Again time to get current research.
JPINFV
Gadfly
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How many drivers actually drive code 3 smoothly instead of doing the bat out of hell routine? I was talking to my normal partner on the phone (I've taken about a week and a half off from work for interviews) and he mentioned that he had a critical call and were transporting emergently and his partner that day, an EMT instructor and who has been in the field for years, ended up having to make a hard maneuver that resulted in my partner being slammed into the cabinets.
As far as the sound, it's all about classical conditioning. You hear a siren (a neutral sound. It is just a sound in the end.) and see it associated with emergency vehicles. After years of this conditioning you no longer need to see the emergency vehicle to know that siren=emergency. The siren can be heard in the back, so the patient hears it, thinks emergency, and you get a stress response.
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What about areas like mine, where running code can get you there 15-25 minutes earlier?
1 or 2 minutes..probably no notable difference in outcome except in extraordinary cases. Who said we only save 1 or 2 minutes? Yes i know research blah blah...that research wasn't the greatest quality. Your location may be different, but in our location the difference L&S and not is considerably more than that depending on the time of day and local traffic conditions.
I'd still love to be told at least generally what the reason that L&S "harms" CVA or MI (or AAA) patients. come on...give a "grasshopper" a hint at least
It's an interesting idea that I have not done research on this and am making things up out of thin air....although apparently there is some super evidence against rapid transport that I have missed....Look, I can't speak for anyone else, and I know there are people who drive like nuts, but honestly I am pretty good about driving smoothly L&S...and I know a couple of others who do the same. This is an issue of community standards within EMS in terms of what it means to go L&S. And I'm not an old grandma...I drive pretty fast...in my POV. I just realize I have people in the back of my box, and drive accordingly.
Sure, stuff happens with people on the road. A lot of that can be alleviated by not flying up behind people or riding them when they don't move over. A lot more by going very slowly through intersections. Sometimes stuff happens even when not going L/S
As for the stress response. I daresay being in an ambulance in the first place is enough to activate a pretty good stress response. The medic teling you you are having a heart attack/talking to the hospital and saying that/etc. will do the same thing. I"m thinking the additional stress added by the siren is not so bad...especially since the public assumes that everyone goes lights and sirens to the hospital. Unless they've had a lot of experience with EMS, they probably don't appreciate that only severe things go with sirens. Communication with the patient is probably just (if not more) of a factor in patient stress.
and even if I grant you that there is a stress response, there isn't any evidence that I've ever heard of (could exist...have to admit I haven't looked) that stress (at the magnitude we're talking about here) is enough to change pt. outcome. And even if that was a negative, it would need to be ballanced against the time savings of L/S and the positive effects on outcome of time saved.
medic417
The Truth Provider
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Can your partner safely and effectivly work? If no then no. How far are you traveling? My short transports are 90 miles. The difference between 80 and 85 is around 6 minutes, but the ride is much smoother at 80 and even smoother at 75. Honestly if your patient is goning on a minimum of a 1hour trip another 15 minutes is not going to have any major impact on survivability. Even the meds that everyone says we have to rush to the hospital to get, well first they should be on the ambulance, and second you are still in the window for administering it unless they delayed calling.
We actually have some areas that we go under the speed limit in order to allow the person in the back to work on the patient.
I'd still love to be told at least generally what the reason that L&S "harms" CVA or MI (or AAA) patients. come on...give a "grasshopper" a hint at least
Do you know what a stress response is?
Do you really want the patient to also needlessly experience
Increased HR
Increased BP
Increased RR
Glucose abnormalities
while also coping with any of the disease processes mentioned.
This has been researched carefully for years and articles can even be found in THE JOURNAL: JEMS.
While communication is important, this is a pretty naive statement. If this is the patient's first MI or CVA and the siren is blasting during his/her first ambulance ride, you can say pretty things to them all you want it will not change what they are feeling.
It is like preparing for a roller coaster ride. You know what is going to happen, but your body still responds to the ride regardless of how prepared you think you are.
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Our transport distances are 60-75 miles one way, to the nearest facility. Two lane highways where the speed limit is 55 or 60. For the most part, yes, we can effectively work at 85-90, although if we can't we ask the driver to slow down and take it easy until we complete whatever procedure we're doing at the time.
And yes, there are times we go under the speed limit if it is necessary to perform patient care. But the reason we turn on the lights is that if we are 1 mph over the speed limit, then technically we need to be running code or the driver could (not likely, I'll admit) be cited for speeding.
And yes, there are times we go under the speed limit if it is necessary to perform patient care. But the reason we turn on the lights is that if we are 1 mph over the speed limit, then technically we need to be running code or the driver could (not likely, I'll admit) be cited for speeding.
medic417
The Truth Provider
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And if it is such a simple thing to understand that it makes it into JEMS anyone that fails to understand must have problems. I would like to see you post other articles from real journals but the big words might overwhelm some.
Do tell, exactly what "work" are you doing with a CVA patient? Sorry, there is barely anything that can be done in-hospital, never-mind Granted with an MI patient there might be something to be done pre-hospitally that will be a benefit. Sometimes there isn't though.
NSR with ST elevation...what are you doing exactly? Around here ASA, Nitro, maybe MS...and that's about it. that takes what...the first 90 seconds of transport?
And yes...my partner can work in the back when I drive L/S. I don't go any faster than normal L/S...I just get to drive around traffic and through traffic lights.
Obviusly our location is different than yours. I wont tell you how to handle your territory, but around here the difference is between ~15 minute transport time and maybe 30-45 minutes if traffic is really bad. That may very well make a difference. Sounds like for you L/S means "faster than the speed limit" while for me L/S means "faster than traffic. I might be convinced that in your system L/S isn't called for really ever. That does not mean that L/S isn't needed anywhere.
What meds should be on the ambulance? Tpa? seroiusly? lytics for MI maybe... just not the case in most places though
As for the "window" idea (i'm thinking CVA here...that's the evidence i'm most familliar with). This is a huge pet peeve of mine. It is NOT(!) the case that any old time within the 3 hour window is OK . There is a good amount of research indicating that it is significantly better to arrive at the front end of the window than at the end. the "window" is the absolute limit...but CVA's are truly time-dependent emergencies, and early arrival, CT, and tpa IS better. I'll get on a soapbox here for a second...you owe it to your patient to get them to a stroke center as soon as safely possible if you suspect a stroke. You may never know the difference...heck they may not....but time is brain cells...and they do not grow back.
still waiting for even a hint towards evidence I didn't find in my non-research which suggests L/S transport is detrimental to patients (seriously...if it exists I want to see it)...
If this is directed at me you can go pound sand. I know plenty of big words, never read JEMS, and you have no idea what my educational background is. Just because we disagree doesn't mean I'm some moron who has never read a real academic journal or done a literature search.
You also owe it to your patient not to delay getting there by crashing.
Unlike TV, a stroke team does not magically appear out of thin air. They will be called while you are enroute and can be ready when you arrive. There is no need to try to shave off two minutes of time.
Seriously, you found nothing about L&S in your search?
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Middle of the desert, no cross streets, and visibility of 6-10 miles...yep.
medic417
The Truth Provider
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I have no problem with the lights if you are truly running safely considering the top heavy brick we are in and the Medic can work w/o hanging on for dear life. Honestly I am surprised your insurance does not stipulate no more than 10mph over posted limit. But running full speed again is unecessary risk and again only saves you 5-15 minutes compared to 70-75mph.
The lights also seem to get the deer and elk to get out of the road.
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I've never asked what our insurance stipulations are...hmm, I might have to go look that one up.
I do know that we are self insured to a point, but I don't know what the point is either.
And for further clarification, most of our transport speeds are in the 70-75mph range...although we have done 90 on a few occasions.
I do know that we are self insured to a point, but I don't know what the point is either.
And for further clarification, most of our transport speeds are in the 70-75mph range...although we have done 90 on a few occasions.
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