When will we stop running code?

[Aidey]

We do the same.

What's to be annoyed about?

As a kid you enjoyed it and as a newbie you did as well. Burnouts or just getting too old for it seems to be a common trend. That said I don't disagree with anyone's points.

It is unsafe an unnecessary. It can cause hearing damage in responders. It poses a major safety risk to everyone on the road, and it has been shown to have no benefit except for in cardiac arrest situations. It has nothing to do with being burned out and everything to do with getting smart.

 

[waaaemt]

i don't see what there is to whine about running code. it's only a safety hazard on the road if you don't abide to your EVOC training like by blowing through intersections. and if you do use safe driving while going priority, the chances of someone else being stupid and hitting you is probably the same as when not code.

i can think of a few instances where a priority response is vital other than cardiac arrest. such as stroke? you only have so much time before you are permanently damaged by a stroke.

and like with all other unknowns, the chance that you get there in time for something that ends up being serious is totally worth it. if you guys say that it's not worth it cause only 50% of calls end up being serious, then why do CPR? cause the save rate nationally is what? 10-20%?

 

[Veneficus]

i don't see what there is to whine about running code. it's only a safety hazard on the road if you don't abide to your EVOC training like by blowing through intersections. and if you do use safe driving while going priority, the chances of someone else being stupid and hitting you is probably the same as when not code.

Not true at all. Call the insurance institute of America and ask them for the latest stas. more than 10 years ago they figured out there was a 300% increase in MVCs. That stat did not include wake effect.

i can think of a few instances where a priority response is vital other than cardiac arrest. such as stroke? you only have so much time before you are permanently damaged by a stroke. .

First I encourage you to look up the definition of a stroke.

Having now done that, time in stroke is measured in hours, not minutes.

and like with all other unknowns, the chance that you get there in time for something that ends up being serious is totally worth it. if you guys say that it's not worth it cause only 50% of calls end up being serious, then why do CPR? cause the save rate nationally is what? 10-20%?

50% would be great. Since only roughl 5% is a life threatening emergency, ake a subset of time critical ones, and it is probably less than 1%.

The CPR anaology is BS. If we estimate at 20% that is bringing 1/5 of people back from the dead.

Not exactly the same as saving 2-3 minutes driving for an increased accident risk.

I need to give up arguing with EMT-Bs. It is really like trying to reason with a 2 year old.

 

[NomadicMedic]

I need to give up arguing with EMT-Bs. It is really like trying to reason with a 2 year old.

This. A million times this.

 

[mycrofft]

On top of Code 3 responses my system also provides code 2 responses with non-emergent BLS calls or patients deemed stable by an on scene care provider with a response time frame twice that of our normal 10 minute 911 response. Once on scene we can upgrade(from code2) or Downgrade(from code3) as we see fit. Not all of our transports go code 3(lights and sirens) to the ER... Good System.

One of my personal black holes..."Code 2". If you do not use your lights and sirens, you cannot expect to get anywhere faster, unless your baseline response time includes personal stops. Unless you drive faster without warning deviceds? Or code 2 means drum faster with your fingers on the dashboard while enroute?

 

[NomadicMedic]

This is going nowhere, fast.

The original post was about ambulances responding HOT, that is, with lights and sirens, to a call where there are already EMTs on scene who have determined that the patient is stable and meets criteria for BLS transport. This is a daily occurrence in a certain city in the Pacific Northwest.

Lets all agree that lights and sirens adds a degree of danger to responses.

Lets also all agree that most seasoned EMS professionals do NOT like to respond hot due to the added risk of a motor vehicle collision.

Additional points can also be made that newer EMTs and medics enjoy driving hot and the idea that "the public expects us to drive hot" continues to be promulgated.

It is a fact that lights and sirens increase the risk of a traffic collision and it is time for us to take a long look at our response criteria and think about seriously limiting the use of lights and sirens when both responding and transporting.

 

[mycrofft]

This is going nowhere, fast.

The original post was about ambulances responding HOT, that is, with lights and sirens, to a call where there are already EMTs on scene who have determined that the patient is stable and meets criteria for BLS transport. This is a daily occurrence in a certain city in the Pacific Northwest.

Lets all agree that lights and sirens adds a degree of danger to responses.

Lets also all agree that most seasoned EMS professionals do NOT like to respond hot due to the added risk of a motor vehicle collision.

Additional points can also be made that newer EMTs and medics enjoy driving hot and the idea that "the public expects us to drive hot" continues to be promulgated.

It is a fact that lights and sirens increase the risk of a traffic collision and it is time for us to take a long look at our response criteria and think about seriously limiting the use of lights and sirens when both responding and transporting.

Hear hear.

 

[mycrofft]

You keep using that word. I do not think it means what you think it means.

 

[lightsandsirens5]

This is going nowhere, fast.

Agreed. I am closing this thread for now. When folks have cooled off, I'll consider re-opening it. I'll be running it be the other leaders here.

 

[waaaemt]

dang it the last thread was closed about codes

okay that last thread got a little out of hand..... c'mon guys we don't need this sarcasm and the immature comments.

anyway i wanted to reply to veneficus

Not true at all. Call the insurance institute of America and ask them for the latest stas. more than 10 years ago they figured out there was a 300% increase in MVCs. That stat did not include wake effect.

well i'd like to see the specifics of this. like i said, if the driver adheres to strict safety guidelines while running code it should greatly reduce the chances of accidents. of course they will still happen. but the 300% you're talking about i'm sure includes all the times EMS providers drive really recklessly while code and are at fault for accidents.

First I encourage you to look up the definition of a stroke.

Having now done that, time in stroke is measured in hours, not minutes.

i'm not talking about TIA's if that's what you're saying. of course i'm no PhD so maybe i don't know as much about strokes as you but i'm talking about what the rest of us know as CVAs from clots and aneurysms in the brain.

yes i know it's counted in hours, but how are we supposed to know when the onset was/how long the PT waited to call 911? then the transport time and waiting time at the hospital. plus the 3 hour window doesn't mean it gives us time to wait around for 3 hours from onset. the sooner the PT receives intervention the less damage is done.

50% would be great. Since only roughl 5% is a life threatening emergency, ake a subset of time critical ones, and it is probably less than 1%.

The CPR anaology is BS. If we estimate at 20% that is bringing 1/5 of people back from the dead.

Not exactly the same as saving 2-3 minutes driving for an increased accident risk.

I need to give up arguing with EMT-Bs. It is really like trying to reason with a 2 year old.

the 50% i said was based off a medic's comment somewhere earlier whose arguement was they shouldn't go code cause only 50% or something of *sick unknown only* calls ended up being serious. so no not all calls which would make that number roughly 5% just the unknown. and 2-3 minutes counts heck of a lot when you have cardiac arrest or serious trauma.

------------

to N7lxi

i get your point and know exactlyyyy what you're talking about since my comment was the one you talked about in your OP. yeah i know it increases risks and i don't think code should be a thing for headaches and stubbed toe type calls. i don't remember a recent MVC involving an AMR unit responding code in recent years either. i think it's good learning experience having priority calls though.


another point i'd like to make is to people on here who are saying absolutely no L/S no any BLS. like i said i agree that not all BLS need a code response but it really depends on the call. what if you have someone with a compound ankle fracture? that's not ALS unless they have a severed artery or another life threatening complication. but how long do you want to wait for an ambulance to show up if you're sitting there with your tib/fib poking out of your skin?

for BS or abuse of system calls, sure let them wait but not the people who have a legitimate injury even if it's not life threatening. i think if all code response is eliminated for BLS, people would rather forget 911 and have family take them to the hospital cause it'd be faster. then you'll have private ambulances AND fire departments loose the transport revenue which..is really the only source of revenue.

 

[waaaemt]

also i think it's really funny how in some threads we all love each other and in other ones everybody wants to give each other stomas

 

[JPINFV]

i'm not talking about TIA's if that's what you're saying. of course i'm no PhD so maybe i don't know as much about strokes as you but i'm talking about what the rest of us know as CVAs from clots and aneurysms in the brain.

A stroke and a TIA are both types of CVAs. A TIA is a CVA that resolves in less than 24 hours, an aborted stroke is a CVA that resolves in less than 24 hours with treatment, and a stroke is a CVA that lasts longer than 24 hours. Regardless, the treatment time frame for a CVA is measured in hours, normally at 3 hours, but many hospitals/physicians are pushing that to 4 hours or more.

yes i know it's counted in hours, but how are we supposed to know when the onset was/how long the PT waited to call 911? then the transport time and waiting time at the hospital. plus the 3 hour window doesn't mean it gives us time to wait around for 3 hours from onset. the sooner the PT receives intervention the less damage is done.

[emphasis added]

You can start with asking the patient or the family. Besides, if EMS is unable to get that little tidbit of history, how is the hospital going to get that tidbit of history. Do you think the time stops just because you reached the hospital? Do you think the hospital is going to go "Well, 3 hours and 1 minute. Damn, missed it by thiiisssss much!"?

the 50% i said was based off a medic's comment somewhere earlier whose arguement was they shouldn't go code cause only 50% or something of *sick unknown only* calls ended up being serious. so no not all calls which would make that number roughly 5% just the unknown. and 2-3 minutes counts heck of a lot when you have cardiac arrest or serious trauma.

Except most places aren't saving 2-3 minutes. Furthermore, if 2-3 minutes count, then EMS should be required to wait in the ambulance, engine on, map book out, ready to respond instantly. After all, you would be able to save that minute of chute time, and "minutes count."

another point i'd like to make is to people on here who are saying absolutely no L/S no any BLS. like i said i agree that not all BLS need a code response but it really depends on the call. what if you have someone with a compound ankle fracture? that's not ALS unless they have a severed artery or another life threatening complication. but how long do you want to wait for an ambulance to show up if you're sitting there with your tib/fib poking out of your skin?

So, what pain control is available to EMTs? Somehow an open tib/fib isn't going to respond to just splinting and ice. Some opioids would probably be really appreciated.... therefore making it a paramedic level call in an ideal world.

for BS or abuse of system calls, sure let them wait but not the people who have a legitimate injury even if it's not life threatening. i think if all code response is eliminated for BLS, people would rather forget 911 and have family take them to the hospital cause it'd be faster. then you'll have private ambulances AND fire departments loose the transport revenue which..is really the only source of revenue.

Even with code response and code transport, the vast majority of time it would be faster anyways for private transport. It's amazing how much time is saved without having to deal with the 911 operator, ambulance chute time, and ambulance response time, regardless of transport mode.

Besides, now we're justifying using lights and sirens because it keeps the call volume up? I think you're grasping at straws now.

 

[ffemt8978]

That thread was closed for a reason, and it wasn't so you could start another one to post your response.

EDIT: Okay, I've reopened this thread after it's cool down period. If it gets closed again, somebody is getting a forum vacation.

 

[Jon]

Interesting thread. VERY important point, and something that has been getting a lot of discussion out my way in the last year or so.

 

[NomadicMedic]

There's more than a few points made in this thread. None of which are good...

1) New providers like to run code. Lights and sirens are fun and are a break from the monotony of the Renal Rodeo.

2) private EMS companies run code to meet response time criteria and keep units in service.

3) 911 services use L&S to meet the public perception of "emergent response".

It's a fact that L&S increases the risk of a motor vehicle crash and does not save a significant amount of time.

So, rather than post with "my service runs code 2 or 3..." Or whatever, I'd love to see some constructive ideas as to how we can educate our fellow providers and employers that hot responses and transports are mostly unneeded and dangerous.

 

[Veneficus]

So, rather than post with "my service runs code 2 or 3..." Or whatever, I'd love to see some constructive ideas as to how we can educate our fellow providers and employers that hot responses and transports are mostly unneeded and dangerous.

Personally I would like to see the pay and benefits of providers at any given service reduced to cover the cost of all damages instead of insurance payouts.

But on the constructive side:

It is all about culture. Safety is a way of thinking.

The first thing that would help is making it illegal for all ambulances that are not part of a 911 system to use a lights and sren response or disobey any traffic law.

I am sure the IAFF and some other powerful backers would get behind sponsoring that legislation.

Another thing is to not let new people drive. This was also pioneered by the fire service where driving was a promotion to be earned over time and training. I have even worked one place where people with less than 6 months were not permitted to drive any vehicle in emergent conditions.

As for getting the word out, we need to consistently an relentlessly smack down any provider who has an answer other than this is a dangerous practice that needs to stop through peer pressure.

There needs to be grassroots campaigns by providers that challenge EMS leaders anytime they say response times matter or attempt to use them to justify a budget.

We need to create mandatory training not just the safe use of lights and sirens but points out the dangers and consequences of doing it also.

We need to stop teaching moments matter.

We need educated providers who understand why.

Most important, we need real preventative EMS that reduces the need for emergency response though community paramedicine and proactive involvement.

Edit: The use of lights and sirens by an interfacility transport should result in a 6 point penalty automatically to the driver. That will not only make it highly undesirable to get caught, but it will make it near impossible for agencies that push it to mantain employees or pay insurance costs.

 

[RocketMedic]

Emergent responses and L/S have a place (known critical call, heavy traffic, scene marking/warning), but that place is rare and dramatically overused. I have no problems throwing on the lights if I need my ambulance marked, stationary, on the side of a road. Going to that MVA with lights and sirens on, however, is reckless and unsafe. That patent's been sick/injured for some time, and barring extremely heavy traffic, my L/S aren't going to get me there safely any faster.

They will, however, place everyone at more risk.

 

[usalsfyre]

The first thing that would help is making it illegal for all ambulances that are not part of a 911 system to use a lights and sren response or disobey any traffic law.

I disagree, only because their are certain cases where emergent trips do make sense. Granted they are very rare. The last one I can recall was a 28wk pregnant patient in active labor who had presenting fetal parts, but who's membranes were not ruptured. She was being transferred from an ED in a hospital without a NICU to an academic center. She delivered 5 minutes after arrival. Another case is post-ROSC patients who are transported to non-interventional cath facilities because the protocols say "closest facility".

I am sure the IAFF and some other powerful backers would get behind sponsoring that legislation.

I would rather keep the IAFF as far away from any legislation involving EMS as possible. We've made enough deals with the devil.

Perhaps a mandatory utilization review on emergent IFT trips?

 

[RocketMedic]

I think that any change in emergent vs non-emergent responses would predicate a provider who did not believe that occlusive dressings control external hemorrhage, for starters.

I also think that dialysis and discharge trips could be easily handled by ambulettes at far less risk to us, our patients, and the public.

 

[Veneficus]

Perhaps a mandatory utilization review on emergent IFT trips?

Who is going to do the review?

The company management who overbooks their dialysis transfers?

The company that wants to keep a contract for IFT with a specific hospital?

What is the penalty?

Against who?

If you need to do an emergent delivery or c-section staff your CCT with a doc that can do it.

Otherwise, no need to whine.

In disasters, countries ask for medical teams. Not individual surgeons or nurses.

If your team cannot handle a case, it is no more critical care than a 911 ambulance.

As for the IAFF, if EMS cannot police itself and outside agency needs to.