Light or No Lights?

[Tigger]

I like the people that whine about not getting transported emergent. I tell them that they should be happy to not be hearing them, as many of the patients that do get transported like that are awful close to hearing nothing ever again.

 

[Chris07]

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.

Exactly how we are here. 911 calls get a BLS Ambulance, BLS Engine, ALS Squad. If ALS jumps on board it's a code 3 transport...automatically.

 

[NomadicMedic]

Exactly how we are here. 911 calls get a BLS Ambulance, BLS Engine, ALS Squad. If ALS jumps on board it's a code 3 transport...automatically.

Sorry, but that is ridiculous. A BLS engine and ambulance along with an ALS squad is a waste of resources and an "automatic" hot transport is dangerous for everyone. Must be California.

 

[Fox800]

My last system did this
Alpha: EMS non-emergent, dispatched first responders in outlying areas only (also non-emergent).
Bravo: EMS code 3. Dispatched first responders only in outlying areas (also code 3).
Charlie/Delta/Echo: EMS code 3, first responders code 3 (everywhere in the county).

 

[Chris07]

Must be California.

Nailed it. Total waste of resources...and I can't tell you how much BS I've taken L&S just because a medic jumped on board. Ex: headache x 45min with no other findings that should have been BLS but med control wanted it brought in ALS.
One of the many reasons why I want out.

 

[Trashtruck]

I'd end up being a pt if I worked in California, which would be some sick, sick irony.

Where I work: L/S to everything.

You make the decision to use them or not on the way to the hospital.

 

[DPM]

My system and the others near me that I have experience with all use EMD (Emergency Medical Dispatch.)

Calls are given an acuity level, either Alpha to Echo or 3-1, starting from BLS / BS up to the most emergent CPR in progress type calls.

When In doubt calls go out Priority 1(code 3) but can be downgraded Code 2 per EMD.

Unfortunately, only Alpha and Level 3 calls are BLS.

Code 3 returns are the Medic's discretion. Most returns are Code 2. Life, limb or serious injury get Code 3 (usually anything that would require an alert, like trauma, Stroke, STEMI)

 

[DarkStarr]

This thread makes me angry. Seriously, turn the lights OFF!

 

[chaz90]

I find myself having a conversation with a different BLS crew almost once a week about why I want to go non-emergent. To some, this seems to mean "lights no sirens" to placate me yet still get to the hospital faster through traffic. I understand that they want to be back covering their district and not wait in beach traffic forever, but you can only deal with one call at a time.

I was tossed up to the wheelwell of an ambulance last week when we had to brake really hard as we passed a vehicle on the right running lights after I had requested to transport cold. It's decidedly frustrating.

 

[Christopher]

I find myself having a conversation with a different BLS crew almost once a week about why I want to go non-emergent. To some, this seems to mean "lights no sirens" to placate me yet still get to the hospital faster through traffic. I understand that they want to be back covering their district and not wait in beach traffic forever, but you can only deal with one call at a time.

I was tossed up to the wheelwell of an ambulance last week when we had to brake really hard as we passed a vehicle on the right running lights after I had requested to transport cold. It's decidedly frustrating.

When I've had this problem in the past I've asked them to pull over to the side of the road and to get in the back and "help me for a second".

Once in the back, I explain to them that they can only help me if they slow down and drive with due regard, and if they do not slow down I will request another ambulance come and intercept us ("because I do not have the luxury of dying today"). If the other provider is interested in being helpful and driving with due regard I'll simply switch them out.

(I'll append this with the note that BLS crews request us to intercept rather than myself being on a fly car and riding along)

 

[EMTnurse]

We are a hybrid paid/volunteer agency. We run lights and sirens to the scene of all calls, unless it's just a public service call that doesn't require any actual medical care. We then make the call when we transport to the hospital whether L&S are needed. Priority 1 always gets them. Priority 2 is case by case. Sometimes smooth and easy is preferable to balls out. Priority 3 and 4 no L&S.

We also have a <15 min transport time from most of our run area, without using L&S, so that probably changes things. It's better, for us, to increase the chances of getting there safely vs. just a couple of minutes faster.

 

[DrParasite]

I understand that they want to be back covering their district and not wait in beach traffic forever, but you can only deal with one call at a time.

oddly enough, I find this attitude quite common, especially in two tiered systems. The BLS has a responsibility to cover their first due, so they want to transport, drop off, and get pack in their primary as soon as they can. The regional chase care ALS unit isn't in as much of a rush, because their response times are typically longer, and if they aren't available, oh well, the BLS should just transport rapidly to the closest appropriate ER. Plus BLS almost always beats ALS to the scene, so a few extra minutes won't matter to the public perception, whereas the BLS gets crap because it took them FOREVER to respond.

Not saying you are wrong in your thinking, just pointing that out.

I was tossed up to the wheelwell of an ambulance last week when we had to brake really hard as we passed a vehicle on the right running lights after I had requested to transport cold. It's decidedly frustrating.

probably wouldn't have happened if you were wearing your seatbelt, as is required by your agency's policy

 

[chaz90]

probably wouldn't have happened if you were wearing your seatbelt, as is required by your agency's policy

Ah, but our SOPs state that we need to be seatbelted as often as possible depending upon patient care needs. I had unbelted to reach over and change the IV drip rate. I'm belted probably 80% of the time on the way to the hospital and 100% of the time on the way back.

 

[CFal]

RI just passed a law excluding cops, FFs and EMTs from seatbelt laws

 

[Trashtruck]

Brilliant!

 

[TransportJockey]

RI just passed a law excluding cops, FFs and EMTs from seatbelt laws

Ugh that's exactly the opposite direction of where it should be going

 

[Handsome Robb]

RI just passed a law excluding cops, FFs and EMTs from seatbelt laws

That's the dumbest thing I've ever heard. I'm no saint about my seatbelt in the back but I try to be. The cab is a totally different story, wheels don't roll without belts on.

 

[Wheel]

That's the dumbest thing I've ever heard. I'm no saint about my seatbelt in the back but I try to be. The cab is a totally different story, wheels don't roll without belts on.

Yeah, not sure what the point of this law would be. I understand that you can't always be buckled in. I know I'm not, but that doesn't mean you shouldn't be.

 

[Handsome Robb]

Yeah, not sure what the point of this law would be. I understand that you can't always be buckled in. I know I'm not, but that doesn't mean you shouldn't be.

Unless a firefighter or a cop is in the back of an ambulance or some tactical vehicle (think SWAT APC) there is no reason they should be exempt from seatbelt laws. I'm not totally sure how it works for FFs being belted while they're getting their SCBA on and what not in the truck mounted ones so I could see n exemption there for the little bit of time it takes to get envy thing squared away without the seatbelt in the way but that's about it.

 

[wigwag]

We run L&S on nearly all responses, particularly since our dispatches are known to be wrong. I've been called to a "teen not feeling well" only to roll up on him in full cardiac arrest! Of course, I've also responded to "pregnant, full-term female hemorrhaging" only to determine, on-scene, epistaxis. The only time we wouldn't go L&S to the scene is if the dispatcher, PD or first responder says, over the air or a recorded line, "precautionary" or "mental hygiene."

From a legal perspective, they called 911 because (they believed) they were having an "emergency". If I were called to the witness stand, I would have to answer why I took it upon myself to determine it wasn't an emergency.

From the scene to the hospital, it just depends on the condition of the Pt. We don't employ hard rules. The notion you wouldn't go L&S with BLS is crazy. In NYC, as in many places, all trauma is BLS. If I have a guy who fell 15-ft off a ladder and is unstable or potentially unstable, you won't find me stopping at red lights under the false notion that BLS is never emergent.