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This isn't necessarily directed at any one person, but some of these posts really make me wonder if anyone is reading the rest of the thread before commenting.
Responding and Transporting Code 3
- Thread starter CPRinProgress
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I would do some research on this but if I had to venture a guess, 10 minutes isn't huge in 99.99% of transports. Certainly does not make a difference in most codes if you haven't gotten a pulse back yet.
kindofafireguy
Forum Crew Member
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. . . I hope this was sarcasm. Hard to tell online.
As I seem to have a different response area than most people responding to this thread, I feel I should reply.
In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be. Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.
The standard around here seems to be an excessive amount of emergent transports though. The mentality of care throughout the region is mostly scoop and go (even for ALS), and our protocols reflect that. I don't even have a complete (or partially complete, lacking a fast acting steroid) algorithm for anaphylaxis, as apparently medics have trouble getting an IV started with a full assessment and maybe one medication given.
On the other hand, chiefs here can post some truly amazing numbers for our responses. Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset. The objective data there makes people very happy, at least in reports. Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.
In our area we tend to have traffic that is so bad at least once a day that transport time can be cut by 20-30 minutes simply by turning on the lights, a slow siren, and driving slowly through places your vehicle shouldn't normally be. Granted this isn't always applicable, and my system tends to massively overuse the lights, but in urban/suburban areas an emergent response/transport can be a significant difference.
The standard around here seems to be an excessive amount of emergent transports though. The mentality of care throughout the region is mostly scoop and go (even for ALS), and our protocols reflect that. I don't even have a complete (or partially complete, lacking a fast acting steroid) algorithm for anaphylaxis, as apparently medics have trouble getting an IV started with a full assessment and maybe one medication given.
On the other hand, chiefs here can post some truly amazing numbers for our responses. Its not uncommon to see dispatch to balloon times on STEMI patients as low as 35 minutes, and I recently had a stroke patient in MRI within 40 minutes of onset. The objective data there makes people very happy, at least in reports. Also, our county is super lucky and no one gets killed doing anything here, so being proactive about cutting down emergency responses/transports isn't #1 on the list.
VFlutter
Flight Nurse
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But how much of that is EMS transport time? And how much time was actually saved running code 3?
Quoting those times does not really mean much without a breakdown. A dispatch to balloon time of 35 minutes is exceptional but that does not tell me much about the EMS system since transport is the least complicated step in the process. It would however make me assume that the hospital and cath lab are very good at what they do.
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In the downtown area of Sacramento, those times would not be uncommon at all. Why? That area has about a 5-6 minute response time, they tend to be on scene less than 10 minutes, and transport times to the hospital can be maybe 10 minutes. As long as the cath lab is ready to go and the ED staff is confident (relatively speaking) in what they're getting, it's not impossible to have dispatch to needle/balloon times of < 40 minutes.
In the more rural areas, in order to have such fast times, you'd have to have a helo.
medichopeful
Flight RN/Paramedic
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With the exception of certain situations, if 1-2 minutes is really that vital for the patient, they very well may not survive anyways.
Bullets
Forum Knucklehead
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Most of the people here work in urban/suburban areas
Overuse of L/S in the cities is more due to understaffing then need. Because there are not enough units to handle the calls, the units that are on are pressured to turn around quickly so they use the L/S to reduce their times. Seems to be common amongst the big city FD EMS agencies, philly, baltimore, NY and DC
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I'm not sure what you're getting at. I sit on scene a lot. I've got no problem sitting on scene and getting stuff done. If I've got a real short transport absolutely I'll make sure everything is done that I want done before we turn a wheel, but if I've got some time to do stuff there's no reason to not get moving towards the ER. If I get everything done on scene what am I going to do for those 20-30 minutes on the ride in from one of our outlying valleys? I This is just something we'll have to agree to disagree.
Meh, they work but you have to give them time to work, the light still has to cycle through being yellow, turning red then turning yours green. Plus when they change like that you still need to clear those intersections since it's usually an unexpected change and it can definitely mess with traffic. I've seen plenty of cars run through lights that have been changed by an opticom.
Another problem is there are a couple different models and brands and they don't play nice. Also the traffic signals have to be equipped to read opticoms.
FWIW they aren't including them on our new units from what I've heard.
Give me two examples where this is true. Not trying to be an *** but there really isn't all that many cases where minutes make the difference. It's really frustrating transporting a stroke in code 3, clean the unit do another run and come back 40 minutes later to find them still sitting in the ER
Heavy traffic situations are definitely one of those that you can save a substantial amount of time. There's a place for lights and sirens transport, it's just not as often as people like to think.
I think this is crucial. As much as we may want to admit it or not I think the use of lights and sirens does not have much to do with how much of an "emergency" it is. Traffic situations are ones where use can be warranted. Heck, in some big cities with horrible traffic problems I could see using lights and sirens to navigate the streets at 5 miles an hour to get that "back pain" to the ER, simply so I am not spending an hour with the back pain. In those situations I think we can agree lights and sirens would only minimally (if at all) increase the risk of an accident, and I am talking about dead stand still traffic...
It's simply about cost benefit. I am more likely to run lights and sirens on a back pain if it will save me an hour over a 10 mile transport than on a code that would save me 2 minutes on a 10 mile transport. One greatly increases risk, the other does not. One saves lots of time which places your unit back in service (for high volume areas) the other does nothing to improve outcome or save time for yourself.
I am not advocating the use of lights and sirens for back pain but my point is....maybe we should evaluate the use of lights and sirens not on the basis of how much of an emergency this situation is. But cost/benefit....
Chris07
Competent in Incompetence
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...unless you work in a system that's so *** backwards that all ALS runs, unless the medic specifically requests otherwise (which is extremely rare), is a L&S transport. I don't know how many people I've transported L&S for things that clearly don't need it, yet we have to because of the system's policy which dictates that if a medic is on board you have to transport L&S (Note: this is for 911). Also, all 911 calls get a L&S response.
The brilliant logic behind it all?
L&S Response: If the person called 911, they are having an emergency and who are we to determine what scale of emergency it really is? Run L&S in case it's serious. (I guess they've never heard of EMD).
L&S Transport with ALS: Get the medics back in service faster. (They are fire medics so they literally ride for the transport, transfer care to a nurse, and leave).
Hmmm....can't beat that logic! <_<
I can say that the only real benefit to going L&S is during heavy traffic and when transporting someone who is unstable. An unstable pt is more likely to get immediate physician attention upon walking in the doors.
We will use lights and sirens more often to get to a scene, than from scene to hospital. That being said, even that is rare..
We have a few patients in town that when we hear that address, we roll and we roll fast. Other than that. Unresponsive patients, choking children,choking anybody, drownings, cpr in progress etc will get me to flip my switch without hesitation.
We have a few patients in town that when we hear that address, we roll and we roll fast. Other than that. Unresponsive patients, choking children,choking anybody, drownings, cpr in progress etc will get me to flip my switch without hesitation.
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Action942Jackson
Forum Crew Member
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All our responses to the scene are L&S regardless of complaint. As a rural provider do I take distance and traffic into consideration when I have a P2 (ALS) patient? Yes. As we have 3 ambulances to cover 204 sq miles. It's a guaranteed 2 hours at the least for a 9-1-1 call from dispatch to available. Do I run L&S for the stubbed toe or back pain. No. Do I run it for that asthmatic that you can turn around with albuterol / methylpredisone? Yes.
To urban providers L&S may not make a difference. But in rural EMS where your next 9-1-1 call could be 50 miles outside of town and 70 miles to the ED. it truly does.
To urban providers L&S may not make a difference. But in rural EMS where your next 9-1-1 call could be 50 miles outside of town and 70 miles to the ED. it truly does.
BeachMedic
Forum Lieutenant
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How busy are the rural roads?
Action942Jackson
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Well considering that majority of rural roads are narrow two lane roads with ditches on either side. With traffic oncoming and going with your flow. Majority of our roads besides three 4 lane highways are back country roads where blind corners and large drop offs on the roads pose a decent threat to your response time. As we are the most rural suburb of a large city, there's only one road coming from our county to the city (2 countys over) A wreck happens on that road. Good luck your going no where. Unless you double back 15 miles north to the interstate and add 29 more miles to your transport time.
It's not like we have a 6 or 8 laner to open the throttle and hit cruise control.
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So how does driving emergent help with any of this?
If I need to get to a scene on a two lane road and a factory has let out 300 employees .. its going to be hard to get there and around with the turning traffic, people slowing etc. If I have a certain patient where time is critical, if I flip my lights, they will pull to the side, significantly reducing my response time.
We have 4 factories that all let out at the same time. Trying to get through that area and down that county road could be a problem during that half hour or so. A lot of people turning off and on ...
90% of my calls dispatched do not require them, but I do see the point of the poster above, yes you can and will use them in more rural settings. It can be a challenge on two lane roads, not always but it does happen.
I was a driver before even attending EMT classes, it is amazing how some people can react. You always have to watch yourself to make surd you don't get that tunnel vision, plus the people you share the roads with.
we have two police officers on our squad. I had to go through emergency driving with them, plus a training officer. Was an eye opener.
Just out of curiosity, how many of these patients have you had?