Light or No Lights?

[DrParasite]

What's the thought process, if there is one, behind an outdated and dangerous practice like that?

As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....

Are you judged on your response times? I know our elected officials want a rapid response when 911 is called. even if it just saves a 30 seconds to a minute, that helps. if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace. Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?

The other thing is as I have said before, garbage in, garbage out. Just because the caller says the call is minor, doesn't mean the patient's isn't sick and dying. Until a medically trained person arrives and assesses the patient, they could be dying, just the idiot caller says the person's toe hurts.

Yes, most calls don't even need an ambulance, a taxi ride to their PMD would probably suit 80% of the calls just as easily, but until you get a trained medical professional to that scene, you won't know for sure.

 

[rmabrey]

Im on the fence. On one hand you get lights and sirens and the fire department for chronic back pain cause someone said the patient isnt alert.

Then you have days where a 26-A-2 (blood pressure abnormality) but the complaint is ALOC and vomitting that turns out to be having an MI.

 

[DrParasite]

Im on the fence. On one hand you get lights and sirens and the fire department for chronic back pain cause someone said the patient isnt alert.

Then you have days where a 26-A-2 (blood pressure abnormality) but the complaint is ALOC and vomitting that turns out to be having an MI.

not only that, but you get the FD arriviing quickly, the family is reassured (the like the FD and their quick response, even if they don't do much except apply oxygen), and often all the FD can do is hold the patient's hand as they request an ETA, and then request EMS to expidate as they are taking a nice easy ride with traffic.

Perception is a big thing, and who is then viewed as the heroes, and who failed the patient? remember, who will the family remember when budget time comes around, those who helped or those who arrived too late?

 

[Tigger]

As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....

Are you judged on your response times? I know our elected officials want a rapid response when 911 is called. even if it just saves a 30 seconds to a minute, that helps. if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace. Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?

The other thing is as I have said before, garbage in, garbage out. Just because the caller says the call is minor, doesn't mean the patient's isn't sick and dying. Until a medically trained person arrives and assesses the patient, they could be dying, just the idiot caller says the person's toe hurts.

Yes, most calls don't even need an ambulance, a taxi ride to their PMD would probably suit 80% of the calls just as easily, but until you get a trained medical professional to that scene, you won't know for sure.

If response times had any bearing on patient outcomes that would be one thing, but they don't. If the elected officials think that's all that matters, perhaps someone should try and educate them? Maybe add in the extra danger that 100% emergent responses put the general public in?

Not to mention that the first example is ludicrous, I doubt there is any agency in the country that would run non-emergent to an auto vs. ped regardless of the manner that they are dispatched.

 

[TransportJockey]

As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....

Are you judged on your response times? I know our elected officials want a rapid response when 911 is called. even if it just saves a 30 seconds to a minute, that helps. if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace. Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?

The other thing is as I have said before, garbage in, garbage out. Just because the caller says the call is minor, doesn't mean the patient's isn't sick and dying. Until a medically trained person arrives and assesses the patient, they could be dying, just the idiot caller says the person's toe hurts.

Yes, most calls don't even need an ambulance, a taxi ride to their PMD would probably suit 80% of the calls just as easily, but until you get a trained medical professional to that scene, you won't know for sure.

No we aren't judged on response times. Mainly because in my county we can have 2 minute responses, but we can also have 45+ minute responses because the vollies don't bother to respond to calls.

 

[Bullets]

As someone who is a proponent of L&S to all EMS calls where there is an illness or injury, unless there is a reliable on duty person on scene.....

Are you judged on your response times? I know our elected officials want a rapid response when 911 is called. even if it just saves a 30 seconds to a minute, that helps. if no one cares about your response times, than by all means, slow ride, just go with traffic at a normal pace. Also, when it takes yoru ambulance extra time to get to the kid who was struck by a car, and the mayor uses that incident as justification to get another company to take over the 911 contract, then what will you think?

The other thing is as I have said before, garbage in, garbage out. Just because the caller says the call is minor, doesn't mean the patient's isn't sick and dying. Until a medically trained person arrives and assesses the patient, they could be dying, just the idiot caller says the person's toe hurts.

If you want to get really technical, if your dispatchers are trained EMD, then your response time to having medically trained persons with the patient is effectively zero

My system is judged on patient outcomes

 

[DesertMedic66]

My system is judged on times. We (my company) signed a contract saying 90% of the 911 calls we will be on scene in under a certain amount of time (the county picks the time frame). If at any time we go below the 90% mark for 3 months in a row we loose our contract (possibly jobs) and another ambulance company will be brought in to take over our area.

Some of our responses to our outlying areas are +45 minutes. In order to keep the 90% we have to run code to all 911 calls (unless an on scene crew determines we can drive non emergent, which never really happens).

A lot of EMTs/Medics/Supervisors at my company know how dangerous driving code is, but we have to follow what's in the contract (what the public wants) or else we all risk loosing our jobs.

 

[DrParasite]

If response times had any bearing on patient outcomes that would be one thing, but they don't. If the elected officials think that's all that matters, perhaps someone should try and educate them? Maybe add in the extra danger that 100% emergent responses put the general public in?

I wish that would work, but that is above my pay grade. I'd make another comment, but it would sound incredibly racially insensitive.

Not only that, but when the uneducated public wants something done, and wants quicker response times because the ambulance is taking too long, then the mayor will do whatever he can to keep the voters on his side, regardless of if their complaint is based in reality or not

If you want to get really technical, if your dispatchers are trained EMD, then your response time to having medically trained persons with the patient is effectively zero

My system is judged on patient outcomes

They all are, but they mayor and most of the citizens disagree with your opinion on response times. And your first medical professional is the EMD, but they are still getting information from an uninformed citizen.

 

[unleashedfury]

we use the Priority Dispatch code. Alpha - Echo

Its honestly up to the crew chief on the call to justify the L&S enroute. I work mainly nightshift so when the streets are dead, were just a pretty light show. I would say that 70% of our responses are non emergent. and there is the few that are hot no matter what. Pediatrics, Allergic Reactions, Respiratory anything that could be justified as a load and go patient based on dispatch information.

Is the system flawed why yes, I had a patient the other night who was dispatched as Bravo sick person who we went to cold, to find out she was a unconscious stroke patient. However running hot would have saved us a minute at 3am?

98% of our transports however are cold.

Cardiac arrests transports are another I argue. Yes I am there to help people. However if after a significant amount of effort and resources have been utilized with no noted change. No defibrillation, asystole in all leads the prognosis is poor. Theres always gonna be that one who we did CPR for a half hour and we had ROSC. but those cases are far and few inbetween, yet the quality of life is poor afterwards.

 

[Rialaigh]

If response times had any bearing on patient outcomes that would be one thing, but they don't. If the elected officials think that's all that matters, perhaps someone should try and educate them? Maybe add in the extra danger that 100% emergent responses put the general public in?

Not to mention that the first example is ludicrous, I doubt there is any agency in the country that would run non-emergent to an auto vs. ped regardless of the manner that they are dispatched.

This begs the questio

Is the purpose of an EMS service to

1. Improve medical outcomes
or
2. To serve the public by having the highest patient satisfaction scores possible

Because those are two distinctly different goals.

If it is to improve medical outcomes then L+S is total crap 99% of the time.

However the current system is set up to serve the public. Do blankets have any effect on improved medical care, no they do not. However a blanket when it is cold is one of the biggest things an EMS crew can do to improve patient satisfaction. Do lights and sirens have any positive effect on any outcomes at all, no they do not.

However L&S serves a very important role in public satisfaction. And because of this I think they are absolutely necessary on many calls from a management/money/patient satisfaction standpoint.

 

[BasicBek]

This begs the questio

Is the purpose of an EMS service to

1. Improve medical outcomes
or
2. To serve the public by having the highest patient satisfaction scores possible

Because those are two distinctly different goals.

If it is to improve medical outcomes then L+S is total crap 99% of the time.

However the current system is set up to serve the public. Do blankets have any effect on improved medical care, no they do not. However a blanket when it is cold is one of the biggest things an EMS crew can do to improve patient satisfaction. Do lights and sirens have any positive effect on any outcomes at all, no they do not.

However L&S serves a very important role in public satisfaction. And because of this I think they are absolutely necessary on many calls from a management/money/patient satisfaction standpoint.

Very well put. I agree 100%.

 

[DesertMedic66]

Very well put. I agree 100%.

That nicely sums up my thoughts as well. When normal citizens hear the sirens they are thinking we are going to save a life. When a citizen hears the siren after calling 911 for their loved one it is a huge relief, at least that's how it was when I had to call 911 many years ago for my mom after she had a PE.

 

[chaz90]

This begs the questio

Is the purpose of an EMS service to

1. Improve medical outcomes
or
2. To serve the public by having the highest patient satisfaction scores possible

Because those are two distinctly different goals.

If it is to improve medical outcomes then L+S is total crap 99% of the time.

However the current system is set up to serve the public. Do blankets have any effect on improved medical care, no they do not. However a blanket when it is cold is one of the biggest things an EMS crew can do to improve patient satisfaction. Do lights and sirens have any positive effect on any outcomes at all, no they do not.

However L&S serves a very important role in public satisfaction. And because of this I think they are absolutely necessary on many calls from a management/money/patient satisfaction standpoint.

On some level I agree with your assessment that much of our role is to increase patient satisfaction. There's a huge difference in giving a patient a blanket vs. running hot though. The potential of harm is vastly increased by Code 3 responses and transports whereas passing out blankets has only positive consequences. We've done this to ourselves. Years of running hot to and from everything has caused a public perception of "if we're not running lights and sirens, we must not care." If we've caused this ourselves with years of practice, we can certainly reduce it too. Let's keep emergent responses and transports where they really belong. They should be the exception rather than the rule, and they should be used to help move through clogged traffic, but not to vastly exceed the speed limit and drive like maniacs.

 

[brian328]

Fire (ALS) runs code every time. The BLS ambo that does the actual transport does not (depending on the call). When fire/als is on scene they can upgrade the ambo or if the bls ambo has an extended response time they can be upgraded. Transport is code 2 or 3 depending on patients condition, traffic, etc. I think the system works well.

 

[BasicBek]

That nicely sums up my thoughts as well. When normal citizens hear the sirens they are thinking we are going to save a life. When a citizen hears the siren after calling 911 for their loved one it is a huge relief, at least that's how it was when I had to call 911 many years ago for my mom after she had a PE.

Exactly, I imagine it is a huge relief. We read it on their faces every day when they see us walk through the door, and usually thanking us for a quick response.

 

[Jim37F]

Exactly, I imagine it is a huge relief. We read it on their faces every day when they see us walk through the door, and usually thanking us for a quick response.

That, IMO, is a big factor, albeit an intangible one. We may not be able to measure it scientifically, but it's a factor that should not be discounted. Yes we are clinicians responsible for treating and caring for our patients, but in the end, whether you're an emt/medic for a private for profit company, govt agency, hospital or volunteer, we're all ultimately public service agents.

That's not to say we should run code to every call. The danger involved cannot be anymore discounted than the publics desire that when they have an emergency, emergency workers will respond emergent.

Of course the majority of those calls won't warrant the danger of an emergent transport, and a proper dispatching set up can reduce the number of code 3 dispatches for non emergent situations.

BUT a common theme I keep running into everywhere, is that dispatch information is notoriously unreliable.

Yes running code is dangerous. But I also think the public we serve views it as a danger inherent by the very nature of our jobs, just like the dangers of being shot when you're a LEO or having a burning structure collapse on you as a firefighter.

Of course that's not to say don't take measures to reduce the danger, such as not running code every call, or not driving like a madman when you do, don't be speeding and swerving like your playing GTA, and actually STOPPING and CLEARING Intersections. (I wonder how many accidents involving ambulances could be avoided just by doing that)

 

[unleashedfury]

On some level I agree with your assessment that much of our role is to increase patient satisfaction. There's a huge difference in giving a patient a blanket vs. running hot though. The potential of harm is vastly increased by Code 3 responses and transports whereas passing out blankets has only positive consequences. We've done this to ourselves. Years of running hot to and from everything has caused a public perception of "if we're not running lights and sirens, we must not care." If we've caused this ourselves with years of practice, we can certainly reduce it too. Let's keep emergent responses and transports where they really belong. They should be the exception rather than the rule, and they should be used to help move through clogged traffic, but not to vastly exceed the speed limit and drive like maniacs.

This is where we need to educate the public to change the perception of Emergency services. Like you said years and years of a specific practice has developed the perception of care vs don't care.

 

[Tigger]

That, IMO, is a big factor, albeit an intangible one. We may not be able to measure it scientifically, but it's a factor that should not be discounted. Yes we are clinicians responsible for treating and caring for our patients, but in the end, whether you're an emt/medic for a private for profit company, govt agency, hospital or volunteer, we're all ultimately public service agents.

That's not to say we should run code to every call. The danger involved cannot be anymore discounted than the publics desire that when they have an emergency, emergency workers will respond emergent.

Of course the majority of those calls won't warrant the danger of an emergent transport, and a proper dispatching set up can reduce the number of code 3 dispatches for non emergent situations.

BUT a common theme I keep running into everywhere, is that dispatch information is notoriously unreliable.

Yes running code is dangerous. But I also think the public we serve views it as a danger inherent by the very nature of our jobs, just like the dangers of being shot when you're a LEO or having a burning structure collapse on you as a firefighter.

Of course that's not to say don't take measures to reduce the danger, such as not running code every call, or not driving like a madman when you do, don't be speeding and swerving like your playing GTA, and actually STOPPING and CLEARING Intersections. (I wonder how many accidents involving ambulances could be avoided just by doing that)

So because the public expects us to put ourselves into danger, we should?

 

[Jim37F]

So because the public expects us to put ourselves into danger, we should?

No more so than our fellow first responders

 

[Jim37F]

Stop and clear intersections, don't be swerving, only oppose when absolutely necessary, lights and sirens do not mean you have to speed, and more. Assume every other driver is a complete idiot and there will be a car going through that red light at the same time you are if you don't stop and clear first.

I believe proper drivers training, reinforced regularly, and actually enforcing ECOC rules and punishing ambulance drivers that don't abide by them can and will have a significant impact on reducing the danger. On top of knowing when and when not to use this particular tool.

And if you still wish you didn't have to run L&S, maybe it's time to transfer to an IFT only company or health care facility