Why don't we look at the logic?
Permanant injury/brain death from hypoxia, 6-8 minutes.
The NFPA 1710 standard is based upon a combination of accepted practices and more than 30 years of study, research, testing and validation. Members of the 1710 committee that developed the standard include representatives from various fire agencies and the International Association of City/County Managers (ICMA).
Yet the clinical outcome is not better.
On all EMS calls, the NFPA 1710 standard establishes a turnout time of one minute, and four minutes or less for the arrival of a unit with first responder or higher level capability at an emergency medical incident. This objective should be met 90% of the time.
So if you consider the delay in time of calling, lets say 30 seconds. The dispatcher taking information and dispatchig the responders, 1 minute. 1 minute turnout time, 4 minutes to arrival of the unit. (not to be confused with initiating patient care, which would be impossible unless you had a unit on every block and in every high rise already)
Time to pt contact: >6 minutes 90% of the time
Permanant injury/brain death from hypoxia, 6-8 minutes.
That is 6 minutes to relieve an airway obtruction. 6 minutes to start CPR. 6minutes to control a life threatening bleed.
For the benefit of the doubt, lets say it was an ALS response. By the time you start advanced procedures, like actual IV in and running add another 1 minute. Maybe interrupt CPR to look at the heart monitor?
Fail.
5 years ago I saw a study by the insurance institute of America that concluded there is an increase in the probability of being involved in an MVC by 300%. Last year the number 1 killer of both EMS and Police was traffic related.
If a fire department provides ALS services, the standard recommends arrival of an ALS company within an eight-minute response time to 90% of incidents. This does not preclude the four-minute initial response.
So under the best circumstance you arrive on scene in >6 minutes, but specify an ALS goal of under 8 minutes? Why is that? Because in anyplace other than a suburb, 4 minutes is totally unrealistic.
Permanant injury/brain death from hypoxia, 6-8 minutes.
Fail.
So you are going to risk the lives of crew, a increased response from a second unit in the event of a collision, countless "wake effect" accidents while driving with "due regard to public safety" to make no difference in the outcome of anything that can be helped from a basic CPR course?
How much is acceptable to spend on this "absolutely nothing?"
If you kill somebody on the way to a call in order to make a family "feel better" you got to a potentially permanantly vegatative patient at best when you arrive does it all balance out?
After the permanant disability or death of a responder, how is their family supposed to eek out a living? You see what people get on disability? Even less in most death benefits over the long term.
All that for "nothing?"
As long as you get paid OT for being in the honor guard at the funeral right?
Incorperate that with the findings of the OPALS study.
Logical conclusion: increased risk, no effective difference in outcome.
Let's relook at the things can can be helped.
Transport of CVA? Effective treatment for that measured in hours, not minutes.
Patient in DKA for days? they can wait a few more minutes. If not, nothing that was going to be done anywhere would change the outcome.
Hypoglycemic for hours, if not days? The same.
Anaphylaxis? No airway for 6 minutes best.
FBAO: the same.
Child in cardiac arrest? death.
Whether I trust the medical care or not, there is no responder I don't want to see go home after work. There is no injury or life worth trying to save at best a few minutes, when we have no evidence it helps in any case and the very logic looks flawed.
There are several effective steps to help a person not breathing that can be taught to everyone including children. There is one proven treatment to help in sudden cardiac arrest that can be done by J.Q. Public. It is a CPR class. Easy, cheap, and a pocket mask puts a responder on every block, in every occupied building, 24 hours a day. It is proven to better outcomes.
Much easier than an improvised cric.
It is also much easier to teach/learn CPR than to make up for the consequences of doing something like forcing a vehicle into an intersection that then gets t-boned so you can have enough room to run a red light.
Best of all, the most people have the best chance to go home at the end of the day. Patients, Crew, Bystanders.
It reduces the potential gravity of injuries in the accidents that remain when you reduce "speed" in the equation. (mass x speed)
We really have to get used to the idea that medicine cannot rescue in minutes what people have often done to themselves for years. About the only exception is trauma. While we strive to return people to as close to function as possible. Until we can start regenerating parts, all we can hope for is "close enough."
We cannot justify the loss of life of somebody we care about with the loss of another in the effort to look like we are "helping."
