Light or No Lights?

[ZombieEMT]

I would like to get an idea how EMS runs in different areas and your opinions on Lights/Sirens. What does your department consider as an emergency run vs non-emergency or lights vs no lights?

A little background on this is I work with three different organizations that run three different ways.

A| Volunteer Department - We classify and emergency run as something with significant risk of lift, limb or eminent childbirth. Just because someone dials 9-1-1 does not mean that they will get a response with Lights/Sirens. Lights/Sirens is based on report and whether or not significant risk exists. In fact more than often, lights/sirens do not get used. If BLS, no lights/sirens ever in transport, if ALS up to ALS decision. Additionally some calls never get a light/siren response ie anything with stand-by/staging, mental health or lift assist.

B|Paid EMS Only - We classify an emergency run basically as anything that comes via 911 or direct line with chance of transport. All responses are lights/sirens and all transports are the same. This includes even the most minor of BLS calls and mental health calls.

C| Paid EMS and IFT - All 911 responses get Lights/Sirens. If the call is evaluated to be BLS only on arrival, transport is nonemergent with no lights/sirens. If ALS is on board, lights/sirens are used. No leway on either.


I personally like the volunteer way best. It is the safest option for me and my partner. Also, lights/sirens have shown to only shave off minimal time from response and transport. It distracts other drivers and makes the transport worse for everyone. Many calls we take do not really need and ER let alone an ambulance. I also want to add, that people seem to forget that when utilizing lights/sirens you should still drive with due regard. You should not be going anyway faster or braking any less because you have lights and sirens. They simply help to clear traffic and intersections.

 

[DesertMedic66]

Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.

Not the best system.

 

[Wheel]

Any 911 call gets a lights and siren response by an ALS ambulance and 1-2 fire vehicles. Patient is transported by ALS ambulance with the medic in back regardless if its an ALS or BLS patient. Light and siren transports are for critical patient.

Not the best system.

This is how ours is, except if we are responding to a facility with a nurse or a physician and a call that is not life threatening (very loose definition).

 

[Medic Tim]

We hav priority dispatch so we go code 1 ( lights and siren) or code 2 ( no lights no siren). I believe w go hot for Charlie calls and up.

 

[DesertMedic66]

This is how ours is, except if we are responding to a facility with a nurse or a physician and a call that is not life threatening (very loose definition).

If the facility calls 911 we respond lights and siren. If they call our dispatch line the facility staff can determine if they want us to respond to lights and sirens or no lights and sirens.

 

[RocketMedic]

We work the same way as Desert66, not the best system.

Running hot is usually retarded.

 

[Wheel]

We work the same way as Desert66, not the best system.

Running hot is usually retarded.

You can't say retarded.















But yeah, you're right.

 

[cprted]

Maybe people use 911 differently down south, but I can't imagine running Code 3 (lights and sirens) for someone complaining of a sore knee just because they called 911. My system uses AMPDS (Advanced Medical Priority Dispatch System), which we already think spits out way too many Code 3 responses. Through AMPDS calls get a response code which determines what resources are sent and in which manner. A call can either be:
-BLS rountine
-BLS Code 3
-BLS and First Responders Code 3
-BLS, ALS and First Responders Code 3

http://en.wikipedia.org/wiki/Medical_Priority_Dispatch_System

 

[the_negro_puppy]

AMPDS determines our response.

To go L&S to all 911 / 000 / 999 calls is ridiculous considering the nature of most of the calls.

 

[Mariemt]

We use them depending on the call. Whether we have a medic on board or not.

Unresponsive patient, patient not breathing, CPR in progress, um.... seizure in progress. Car accidents with injury. All get lights and sirens to the call. Not always will they get l and s transporting.

We do not transport imminent delivery of a baby unless we know for sure we have time. Delivering with a moving ambulance and woman strapped down isn't going to happen, we will deliver on scene or pull over.

Medics will work most codes on scene, if medic not on scene, we load and go and lights and sirens used. We are not performing CPR enroute as that is dangerous, we use and autopulse to transport

 

[Tigger]

In the fire district where I work fulltime, if you call 911 with a medical complaint you get an ambulance, engine, and shift captain all coming to emergent per the fire chief. We have EMD, but even Alpha level calls get all of this. If the patient requests no lights and sirens the captain has the option of downgrading the response. Crew discretion on transports, we very rarely transport emergent as a result. Exceptions include CVA, MI, and some unresponsives. Shift captain or chief can also make us transport emergently if we have pending calls so we can get back in service faster. I think the whole thing is silly, but oh well.

At my part time place we choose response priority. Most calls we respond to non-emergent unless it sounds obviously bad (difficulty breathing, unconscious, etc). Same thing with transports, we don't usually return hot since anything worth transporting emergent needs to go the city and there is a windy pass to descend to get there that you can't drive faster than 40-45 to get down smoothly. I like this a lot better.

 

[Superlite37]

Depends on the call. SOB, MVC, Chest pain, major trauma and of course the unresponsive/arrest, would get Lights and Sirens. Also if the truck is on its way back from a call, and have a long ETA, we generally light it up. Also depending on the call, dispatch will put a bird on standby, or auto lift one. But I work in a county where the nearest hospital is 25 to 35 miles away, depending on what base your working out of, we have two. Our average transport time is close to 40 mins, and that's just to the nearest facility, which is not a trauma center, but does have a great cath lab.

 

[NomadicMedic]

ALS responds to Charlie/Delta/Echo calls with lights and sirens.

Most (98%) of transports are cold.

 

[Anonymous]

Response to all calls with lights and sirens.

BLS transports no lights or sirens.

ALS transports lights and sirens.

However for the most part I drove my ambulance how I wanted. I didn't run "hot" for all ALS calls just because that is how everyone else did it and there were times I felt the need to upgrade BLS transports based on the condition of my patient.

 

[Christopher]

I would like to get an idea how EMS runs in different areas and your opinions on Lights/Sirens. What does your department consider as an emergency run vs non-emergency or lights vs no lights?

A little background on this is I work with three different organizations that run three different ways.

A| Volunteer Department - We classify and emergency run as something with significant risk of lift, limb or eminent childbirth. Just because someone dials 9-1-1 does not mean that they will get a response with Lights/Sirens. Lights/Sirens is based on report and whether or not significant risk exists. In fact more than often, lights/sirens do not get used. If BLS, no lights/sirens ever in transport, if ALS up to ALS decision. Additionally some calls never get a light/siren response ie anything with stand-by/staging, mental health or lift assist.

B|Paid EMS Only - We classify an emergency run basically as anything that comes via 911 or direct line with chance of transport. All responses are lights/sirens and all transports are the same. This includes even the most minor of BLS calls and mental health calls.

C| Paid EMS and IFT - All 911 responses get Lights/Sirens. If the call is evaluated to be BLS only on arrival, transport is nonemergent with no lights/sirens. If ALS is on board, lights/sirens are used. No leway on either.


I personally like the volunteer way best. It is the safest option for me and my partner. Also, lights/sirens have shown to only shave off minimal time from response and transport. It distracts other drivers and makes the transport worse for everyone. Many calls we take do not really need and ER let alone an ambulance. I also want to add, that people seem to forget that when utilizing lights/sirens you should still drive with due regard. You should not be going anyway faster or braking any less because you have lights and sirens. They simply help to clear traffic and intersections.

B's system is broken, plain and simple. I don't even know if you can call that a real EMS system. They're just playing around as far as I can tell. Very unprofessional.

A and C seem fairly reasonable, except C's "if ALS is on board L&S"...

Our service did 129 lights and sirens to the receiving facility in the last year (7/2012-7/2013; 2219 calls for service, 1385 transports). 71 were by protocol (STEMI, Stroke, unstable-ROSC, Trauma), the rest were provider discretion.

Basically only 5% were mandated L&S, and are fairly justifiably critical patients. Nota bene: this does not mean that any L&S usage is justifiable, but with a reasonable protocol in place you'll have a floor of less than 10%.

We routinely ask the question "why L&S?" during QA of calls where the provider chose to, because ambulance wrecks kills more people than you save by shaving off 1-2 minutes.

 

[Nightmare]

In my opinion

I am in a similar situation as you, with a few minor differences. The volunteer agency I run with will only use L&S at the discretion of highest ranking member present within the department going to the call, so basically based on the dispatch information most common L&S responses are MVA's with a long travel time (our district is very large) and then with transports L&S are only used on cardiac, stroke and patients deemed unstable (diff breathers etc.) But the paid agency I work with uses L&S on EVERYTHING, even the people with tummy aches. My thought is that the only time L&S should be used is to clear intersections so you arent stuck waiting at red lights for extended periods of time. But gotta follow the rules of your agency in the end.

 

[Bullets]

In all systems i work, use of L&S is at the crews discretion

Both are volunteer nights and paid days

We generally respond L&S for cardiac, seizure, unconscious/unresponsive, major trauma, and respiratory

 

[DrParasite]

All calls with reports of illnesses and injuries get a L&S response. People lie to dispatchers all the time, so I am not going to downgrade a response until a person with authority gets there. been burned a few times with the "man down" being a cardiac arrest, a "person vomitting" being a cardiac arrest, a "fall victim" being a skull fx, etc. Once personnel get there, they can downgrade or cancel responding units.

Of course, as someone told me on either this forum or firehouse.com, the toe pain complaint might be referred pain from a diabetic who is actually having an abnormally presenting MI....

Transporting w/ L&S is at the crews discretion. depends on where you are, how far the hospital is, city units w/ calls pending, time of day and traffic patterns, and most importantly, the patient's condition. With the 2-5 minutes saved in a 20 minute transport really affect the patient's outcome?

We also transport more cardiac arrests than we should.... always with L&S.... not my call on that one....

 

[Handsome Robb]

We use medical priority dispatching, the computer decides if we go code to the call or not by information given to the EMD. I know there are others around here that use the Clawson Cards as well.

Either EMT-I or P attends and RLS transport is on the medic's discretion.

It always makes me laugh when we transport someone from out of the area and they're floored that we aren't using the lights and sirens to transport them.

 

[chaz90]

It always makes me laugh when we transport someone from out of the area and they're floored that we aren't using the lights and sirens to transport them.

Patients seem to ask me all the time why we aren't transporting emergently. Most of the time they're fairly satisfied with my answer that we only use those for patients that are imminently circling the drain and they're not at that point.