Calling 911 vs. Driving?

[RedAirplane]

We are always told to call 911 instead of driving to the hospital, and I teach this as well.

Does anyone know of any studies that compare survival rates on these things? Perhaps urban vs rural, etc? A quick search gave me a ton of websites but few research oriented ones.

Thanks.

 

[Aprz]

I don't have any research on this other than I have heard of fire departments and police departments transporting patients themselves instead of waiting for an ambulance and it having a better outcome, but I don't know exact details. Here is my opinion on the issue.

I am gonna say that the safest choice most of the time is going to be call 911 instead of driving to the hospital yourself.

If you drive a friend or family member to the hospital that is very sick, you might panic and speed, run red lights, etc. I see it on the news frequently. Expected fathers driving their pregnant wife who is in labor to the hospital, speeding, run red lights, and get pulled over by the police. Then they make a big deal about it because they get a ticket or get arrested. It's not a good idea.

The other deal is that not all hospitals are capable of providing the same care. The EMT/paramedic on the ambulance is going to know which facility is the most appropriate for you. It would be unwise to drive somebody to the hospital that doesn't have a cath lab when they are having an MI, a trauma patient to a non trauma facility, a stroke patient to non stroke facility, etc. You might get them to the hospital quicker, but they won't get the they need quicker. It may be even delayed now.

I would say one issue with saying always call 911 is a lot issues that 911 gets called to in the first place doesn't require ambulance transport anyhow.

I would also not be against driving somebody to the hospital if it is extremely close (like <5 minutes away) because the hospital will still be able to send them to the appropriate facility and at least start some care equal to or greater than the scope of the EMT/paramedic (eg give ASA, oxygen, NTG, etc on a patient having an MI) while waiting for an ambulance/flight to arrive to transport the patient to the appropriate facility.

Use sound judgement. If in doubt, call 911.

 

[Ewok Jerky]

"You might get them to the hospital quicker, but they won't get the they need quicker. It may be even delayed now."
-aprz

That. In addition, if the patient really is that sick, EMS can notify the hospital, start a line, get fluids running, general H&P, stuff that will make registration easier and give the ED a running start.

 

[Underoath87]

Depends on the complaint. About half of my patients end up dumped in triage without any interventions performed, because they called for a chronic problem, something that they were already recently seen for, etc. They could have saved time and money by just having a family member drive them in one of the 4 cars parked in their driveway...

But yes, if you're having an actual life-threatening emergency, I would think it best to call 911 unless you live within a few blocks of a capable hospital.

Edit: Err, I guess I just paraphrased Aprz. Sorry.

 

[Eddie263]

I would say depending on the chief complaint as well. For the stubbed toe drive it in. Many people have the idea that by going to the ER in ambulance means you'll get treated faster, which most of the time won't happen.

 

[Jim37F]

Some of our patients call 911 at the drop of a hat (oh, I stubbed my toe! Or I have a nosebleed or a headache, or I've been sick 3 days, better call right now at 3am) while others will pretty much flat out refuse to call until they're circling the drain (and even then it's usually family calling us). We had a patient yesterday who despite having pains in the chest for 3 days never called, but when it got bad, and had shortness of breath they decided to go to the hospital....via private auto....didn't even make it to the garage when he fell out. We get on scene, and in the "big sick/little sick" general impression was definitely big sick, 12 lead, medics work on starting a line, we start to load the patient into the gurney and the family requests we take him to the same hospital they were planning on going to.....30 miles away, at least an hour if not 2 in LA traffic. We say no, that's way to far, we wanna take him down the road to the hospital that's only 3 miles away (also happens to be our base hospital that's a STEMI and a Stroke center as well so not just a doc in a box band aid station)Family said ok, if you can't take him, we'll sign him out and take him ourselves. We had to convince them to let us take him to the local hospital for stabilization first (and who then call for an ambulance IFT later on), fortunately they agree to that. An hour later after dropping off another patient I poke my head into his room (well section of curtained off ER) to see how he's doing, turns out he had coded sometime after we dropped him off, they had gotten ROSC and doing post-arrest care, so a good thing he didn't go by private auto and code out while stuck in traffic on the freeway!

 

[Jim37F]

Double post

 

[RedAirplane]

Thanks all.

Unfortunately I'm awkwardly biased.

Too many people I know have driven themselves in for CP or post-syncope.

When I did my EMT ride alongs, I saw a man brought in to the ED in cardiac arrest. He was driving to the hospital with a CC of CP when he arrested. He was dead.

I'm so scared that will be someone I know one day.

Later that day we had a field save. Thabkfully our patient used 911 before arresting.

I'm really not sure how to get the message out that it's ok to call EMS. Honestly when I get a "BS" complaint I'm thankful that the patient knows how to use EMS and will not hesitate to do so.

I thought some evidence based study might be helpful.

 

[Carlos Danger]

If everyone only called the ambulance for legit emergencies, then I'd say of course - call 911 unless you are really close to the hospital and can get yourself there quicker safely.

But the way things are these days, with like 0.1% of EMS responses being true emergencies where EMS transport actually saves a life or limb, I think it's safe to tell people to take themselves unless they have a dire emergency.

 

[Tigger]

In the scheme of things, the majority of our patients could be transported to a hospital by wheelbarrow and still survive. But that isn't always the point. Sometimes you need to go to an ED for a non life threatening health issue that still requires an expeditious fix. Let the ambulance come and give you some symptom relief.

Again, we need to stop justifying our existence purely based on "saving lives" as that just isn't a big part of our role in the healthcare these days.

 

[EpiEMS]

The most relevant study I can think of is this one:
http://www.ncbi.nlm.nih.gov/m/pubmed/24387925/

In the study above, Philadelphia PD transports for certain kinds of traumatic injury experienced higher survival rates than EMS transport. Certainly bears consideration -- when you need a tourniquet until you get to a surgeon, why bother waiting for an ambulance, I suppose.

 

[evantheEMT]

What a lot of people don't understand is that ems doesn't just drive pts to the er. Ems providers treat pts and monitor the pt and like others have said we know what er to go to and which one might not be good for the pt.

 

[evantheEMT]

In the scheme of things, the majority of our patients could be transported to a hospital by wheelbarrow and still survive. But that isn't always the point. Sometimes you need to go to an ED for a non life threatening health issue that still requires an expeditious fix. Let the ambulance come and give you some symptom relief.

Again, we need to stop justifying our existence purely based on "saving lives" as that just isn't a big part of our role in the healthcare these days.

Hahahah, by a wheelbarrow that's awesome......but true.

 

[Underoath87]

What a lot of people don't understand is that ems doesn't just drive pts to the er. Ems providers treat pts and monitor the pt and like others have said we know what er to go to and which one might not be good for the pt.

Except that most people who call 911 don't actually need anything besides a next-day appointment with their GP. Your area may differ, but I doubt it.