How to drive lights and sirens...

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Handsome Robb

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Driving 'code' has been beaten to death. My question is what are your protocols/guidelines for transporting a patient with lights and sirens? Where I am doing my rides/ALS internship it is up to the medic in charge whether we return to the ED code 3. However, driving with a patient and attendant in the back is completely different than responding to a call.

When returning with a patient and running code, we are allowed to exceed the speed limit when it is deemed safe (which is subjective, I know) but when we get to urban surface streets we are instructed to drive smoothly up to the speed of traffic. The lights and sirens help us clear intersections and thats about it. There's no point to drive like a madman, it compromises patient care. Just wondering how it is done where you work/intern/volunteer? It seems to be an ongoing topic so I figured I'd start a topic on it.


Let the flaming begin.
 
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Here the ambulances are required to stop at all stop signs and red lights.
 
In our area, we respond to all calls hot (except for pshychiatrics and calls where we're going to need to stand-by). We are allowed to slightly exceed the speed limit, but as you said, no need to drive like a mad-man.

We need to stop at stop signs and red lights, and after looking to make sure everyone has stopped, we proceed through the intersection
 
With emergent returns it's always about the same speed as traffic, the blinkies and whoowhoos are just for intersections. So really with an emergent return it takes about the same amount of time as going routine, maybe we save a minute or two depending on traffic and distance.

I don't think many agencies keep hard and fast rules for emergent returns, often they are the same as the rules for emergent response, regardless of how different a driver must approach each setting. When I was an EMT and drove emergent to the hospital, I always drove in a manner that wouldn't get me yelled at. Now that I am in the back I have to say that I don't really ever request emergent transport. When I do I really could care less about the smoothness of the ride, my patient needs a doctor, and the less time they spend with me the better.
 
We're told to drive like we have a scalding hot cup of coffee with no lid between our legs. We routinely run code on the highways where we can be as much as 45 miles between intersections, but the vast majority of the time we shut down the code response upon reaching city limits.
 
Legal wise, there is NO law controlling what an emergency vehicle can do under lights and sirens in the state of Texas, so long as we show "due regard". We can do 150mph blowing through every stop light in the wrong way in traffic, and none of it is illegal, so long as it's done so safely. If an accident happens while we are running code, it's presumed our fault.

Company policy is a "10mph over speed limit" idea, and stop and clear every intersection.



It is up to Paramedic on the truck whether or not we transport L&S to the hospital.

Although the benefits of driving code are few, I tend to do it if it's a time sensitive thing, ie an MI activation, stroke activation, someone I have to take airway control of (Like if I RSI), or someone unstable to the point that I am playing catch-up... yes, even though it generally only saves a 10-15 minutes. I'm not a fan of doing it, but I will when I recognize a single Paramedic in the back is not enough for the patient.
 
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Anything not that is not a tender we are allowed to go 10 over the posted if L&S. We don't use an opticom system because our drivers were being stupid and just gunning it through the lights. We slow and/or stop at intersection and visually "clear" it before we proceed. We also only use the siren as we approach and go through intersections and when we are approaching other people. Our department does not do much in transport of Pts. We usually send via Pvt AMB.
 
I have not yet been on a priority transport with my squad yet. We will run most calls with lights and stop at intersections while using the sirens and make sure traffic is clear before proceeding. I imagine trauma calls might be different seeing as our closest trauma center is about 30 minutes away.
 
It is entirely at the discretion of the Ambulance Officer driving the vehicle as to how they operate (e.g. speed, lights or siren) taking into consideration the patients status (critical, serious, moderate or minor) and road traffic environment.

We use red lights but rarely use the siren other than at intersections
 
Lights & siren to the scene. Left to the discretion of the EMT in charge of patient care as to how we respond to the hospital. Most of the time, no lights & siren.........a little more urgent - no lights/siren until we hit traffic; urgent need (code, etc) - lights/siren all-the-way.
 
Driving code 3 doesn't change if we are responding to a call or transporting with a patient. We are only allowed to go 10mph above the posted speed limit not to exceed 75mph. Stop at all red lights and stop signs.

Now what does change is how we drive. When we are responding to a call it's pretty much hold on because it's a rough ride. Hit speed bumps at speed slow down slightly for dips. Hard on the brake. Floor the gas pedal. (now someone is going to chime in with how dangerous this is. But it's pretty much standard practice and is also done by the supervisors).

When we have a patient in the back everything is made as smooth as possible for the patient and the medic/EMT in the back.
 
The only things I tend to return emergent are system activations, meaning traumas, strokes and STEMIs, and then only because the chart will be QA'd and I'll get a ration of caca if I don't.

I hate running code. I hate running code to the call, I hate running code to the hospital...I just generally dislike it all around. I haven't seen that it makes any difference in my area.
 
The basic principle here is to drive with due regard. We have to stop at all stop lights and stop signs, yield to school buses, etc.

My approach when driving L&S is to drive exactly the same as if I was driving non-emergency. Stop where I need to stop and do not go any faster then when driving non-emergency.

It is near impossible to provide any care when being tossed around in a flying ambulance.
 
nwhitney said:
Here the ambulances are required to stop at all stop signs and red lights.
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I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign. Supposedly driving is the most dangerous aspect of the EMS field, and blowing through red lights is only contributing to that.

To the original question, the decision for an emergency transport is made only by the transporting crew. A lot of employees at my company will transport with lights and sirens in the absence of ALS. Often the patient is at little risk of further deterioration, yet we still transport at a "slow 2" to avoid having to wait at every single traffic light in the city. Right, wrong, or indifferent, that's how it is here. As I've mentioned in other threads, if a patient is in pain they don't need to spend anymore time in my BLS ambulance than absolutely necessary, so I am happy if my driver can safely shave five minutes off the transport.
 
Tigger said:
I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign.
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Not required in Texas. Infact, I can't think of a single state where it IS legally required.


The very nature of emergency vehicles laws is to exempt them from all traffic laws.
 
Tigger said:
I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign. Supposedly driving is the most dangerous aspect of the EMS field, and blowing through red lights is only contributing to that.
Click to expand...


The law in California states that we can go thru red lights at 15mph without stopping.

But company policy is to stop.
 
I have heard several different takes on Maryland's law, but according to my own research, as well as the prevailing view among the most credible people I know, there is no part of the law that specifies a maximum speed, or speed over speed limit, for emergency vehicles. At the state level. However, some jurisdictions or private companies may choose to create their own rule for how much to exceed the speed limit.

I believe that state law also does not require a full stop at all stop signs or red lights. Just as with speed, if a local jurisdiction or private company wishes to have more strict rules in place, they can do so.

I, personally, do not believe it is necessary to stop at every single stop sign or red light. Especially in non-urban areas, there are many intersections where you can see quite a distance down both sides of the cross road while approaching the intersection. If I can see a cross road is clear in either direction for at least a mile while I'm still a quarter-mile from the intersection, and it remains clear on my approach, why should I stop?

The laws that limit speeds and specify full stops exist as an attempt to provide legislation as a replacement for common sense. "Drive safely and prudently" should be all that is needed. It's sad that so many idiots out there have made it necessary for laws to be created to replace the common sense that is missing from so many people.
 
Tigger said:
I hope there is no place left in the country where the laws allow an emergency vehicle to not stop at red light or stop sign. Supposedly driving is the most dangerous aspect of the EMS field, and blowing through red lights is only contributing to that.
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Why do we need laws to govern what should be governed by professional judgement?
 
JPINFV said:
Why do we need laws to govern what should be governed by professional judgement?
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Exactly, and it's good to find another area on which we so closely agree when we traditionally have not agreed on much in the past (see the last paragraph of my previous reply).
 
firefite said:
The law in California states that we can go thru red lights at 15mph without stopping.

But company policy is to stop.
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I think that's just a very strong objection (as in, "There's absolutely zero hope that anything faster than this will, in any manner, approach "due regard") than a hard rule. CVC 21055 spells out the exemptions, which includes the chapter (chapter 2) on "signs, signals, and markings." CVC 21056 holds the requirement to drive with due regard.
 
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