Light or No Lights?

[PaulEMT]

Lol thanks I needed that. Studies show you're gonna save very little time. I take it that you are probably in favor of transporting cardiac arrests too?

I'm an EMT. Are you? I am only here to help people.

 

[Scott33]

So would you transport a cardiac arrest?

 

[BasicBek]

With the way roads and traffic are here, we save a very significant amount of time by going emergent to every call. A lot of the time the issue is the response distance because this is one of the busiest systems in the world and trucks are always on calls and when 5 go out at a time, that 6th one might have a truck responding from 10 + miles.

There certainly are a great deal of calls that shouldn't have required an emergent response, but like I said before some of my most critical patients have come out as priority 2 (non-life threatening) calls. So it seems in patients best interest to run hot.

Transporting to the hospital is almost always going to be a code 3 transport (code 3 here is what code 1 is basically everywhere else), its non-emergent. But code 1 applies quite often too. We are 100% ALS here.

 

[BasicBek]

So would you transport a cardiac arrest?

In what case? Protocols everywhere are different. There are certain things that require we transport a pt in cardiac arrest. If we got a pulse back at any point during the code for example.

 

[Scott33]

In what case? Protocols everywhere are different. There are certain things that require we transport a pt in cardiac arrest. If we got a pulse back at any point during the code for example.

If you get a pulse back they are not in cardiac arrest.

 

[BasicBek]

If you get a pulse back they are not in cardiac arrest.

No duh. I said at any point, even if the pulse is lost again you still have to transport.

 

[NomadicMedic]

This is an interesting thread. Let's not let this degrade into name calling and hyperbole.

As several posters have mentioned, the rationale behind running red lights and sirens to every call is flawed. Studies have shown that there is very little time saved between a hot and cold response, and patient outcome has not been affected. MEDIC in Charlotte has done extensive research on response and transport times and the information is readily available.

I understand that public perception may play a part in determining your response mode, but it is dangerous and outdated to respond to every call with lights and sirens.

 

[BasicBek]

I can understand that over all it may not change patient outcome but there is still a great handful of calls that would've had a much worse outcome if we had gotten there by 24:59 vs 8:59. And if there is that fair of an amount of chance the patients fast response and care shouldn't have to suffer. I have had multiple instances, one where it was a priority 2 sick person, for high bp for example, no other symptoms, if we had responded cold priority 2 status (because chances are we would've been pulled from the call for a priority 1 elsewhere) then we would've been being called to a cardiac arrest instead because that very patient coded on us just minutes after she got in our truck and we got there in about 4 minutes. She got immediate CPR and full ALS and we got her back.

 

[ZombieEMT]

It's more dangerous to wait for red lights when the PT is bleeding out.

PaulEMT - I do not think anyone is suggesting that there is never a response with lights/sirens, but more based on the priority in dispatch. If we get a report that a patient is bleeding out, lights/sirens might be warranted.

 

[cprted]

I'm a little dumbfounded that there are services that run L&S to every call just because someone called 911. Maybe things are different south of the 49th, but here, people have no qualms calling 911 because they broke their finger, they've been feeling nauseous for five days, have a tummy ache, etc ...

 

[Medic Tim]

I'm a little dumbfounded that there are services that run L&S to every call just because someone called 911. Maybe things are different south of the 49th, but here, people have no qualms calling 911 because they broke their finger, they've been feeling nauseous for five days, have a tummy ache, etc ...

my first ems job was in the US. We responded lights and siren to everything then it was our choice to the hospital. Our dispatchers were the hospital switchboard operators who were put through a day of training by the hospital.(hospital run ambulance service) They are/were not EMDs. they would simply relay us the address and a chief complaint and keep track of our times.

there are several area in the states that use forms of priority dispatch like most places in Canada use. The pt's we see are also about the same. There is a lot of abuse and bs calls on both sides of the border.

 

[NomadicMedic]

Most services are now using some type of priority dispatch. This is eliminating red light and siren responses when they're not warranted. Clawson is quoted in an article saying that ambulance/rescue response related accidents decreased by 76% following the institution of priority dispatch codes. Now, I don't know how they managed to correlate that data, but I would think that an ambulance traveling with the flow of traffic, without excessive speed or their warning devices operating, would be less likely to be involved in a traffic collision than those with warning equipment operating and exceeding the speed limit. It just seems to make sense, doesn't it?

Studies have shown, the time savings and increase in positive patient outcome that everybody seems to talk about, simply isn't there.

 

[ZombieEMT]

I do believe that part of the issue with driving lights and sirens has do with the drivers. Lights and sirens are not a free pass to drive like a crazy person or violate any traffic laws. Light and sirens are simply warning devices, that help to move traffic when responding. Speed limits are posted for safety, that does not change because you are an ambulance. I see many of my partners that feel that they should go faster due to using lights and sirens.

Some people also forget the importance of actually stopping at a red light while using light/sirens. It is still very important to stop at the light and ensure that all traffic has STOPPED before preceeding through. I never assume someone is stopping, even if they appear to be slowing or have cars stopped in front of me.

I had a friend of mine in an ambulance accident who proceeded through an intersection going lights and sirens, assuming the car was going to stop because the one in front of him did. Unfortunately the car decided to go around the stopped car and smashed right into the ambulance. My friends partner will never walk again as a result.

 

[EMDispatch]

Clawson is quoted in an article saying that ambulance/rescue response related accidents decreased by 76% following the institution of priority dispatch codes.

http://www.emergencydispatch.org/articles/donoharm1.htm

It's pretty far down in the discussion on MPDS, but the statistic specifically comes from Salt Lake City.

 

[NomadicMedic]

http://www.emergencydispatch.org/articles/donoharm1.htm

It's pretty far down in the discussion on MPDS, but the statistic specifically comes from Salt Lake City.

Thanks. For some reason I thought it was Miami.

 

[TransportJockey]

Y'all forgot the biggest reasons for stupid policies like all calls receive a code three responses. This is fire and ems. Years of tradition unimpressed by progress

 

[Bullets]

It's more dangerous to wait for red lights when the PT is bleeding out.

I'm an EMT. Are you? I am only here to help people.

Dont feed the troll guys

I think it was Houston, it was definitely a major Texas metro area, that did another study that showed RLS (EWD in NJ) save no clinically significant time.

My agency just wrote a policy on RLS, we are only required to respond with RLS to the following:

a) All ALS calls
b) All working fires
c) All MVC with known or suspected entrapment
d) Emergency rescue and special operations (Technical Rescue, Water Rescue)

EMS provides all rescue services to the municipality.

And to an earlier poster, yes, NJDOH-OEMS released an updated vehicle operations guide that strongly discouraged RLS for transport and suggested it may not be needed for response.

Unfortunately, Division of Fire Safety refuses to address this, resulting in Fire going hot to EVERYTHING, even is persons on scene downgrade

 

[ZombieEMT]

Thanks Bullets - I actually did some research and was able to locate the guidlines.

 

[EMDispatch]

A few more links on the subject of L&S studies, as well as the ambulance accidents.
Is Ambulance Transport Time With Lights and Siren Faster Than That Without?
Patient Outcome Using Medical Protocol to Limit "Lights and Siren" Transport
Dispelling Myths on Ambulance Accidents

Also an opinion piece by Dr. Clawson
Unecessary Light-and-Siren Use: A Public Health Hazard

 

[the_negro_puppy]

Its absolutely absurd to call L&S to all 911 calls. Even here we used AMPDS and most calls are over-triaged.